Telemedicine: Telemedicine Hype Cycle and the Future of Remote Care

The “as-usual” excellent Dr Bryan has posted this awesome post on Telemedicine. One of my favourite bloggers (and authors), he provides an ample fodder for thought and reflection. There has been a lot of noise about the telemedicine “technoutopia” and I remember a few colleagues congregating on Zoom calls to call it as the “new age of medicine delivery”. I haven’t seen their self congratulatory Twitter posts; I digress. Not everyone is wired to work-from-home. Medicine cannot be reliably practised from distance barring some “branches”.

Teleradiology had been an in-thing and I am surprised that it hasn’t found a mention in the pandemic. Most hospitals shipped it out to India with the “reduced” billing for the “off-peak hours”. However, I have had an extensive back and forth with one of my senior colleagues who dismissed the hype- it is predatory pricing or a poor reflection of standard of care. Radiologists reporting on the scans without clinical input cannot offer the depth of reporting required. My colleague went on to examine patients by himself to confirm the scan findings. He’s an exception to the rule while we deal with a lot of littered nonsense from “mom-and-pop” stores that dot with ultrasound and CT scan machines.

The US offers a different story in contrast wherein the sprawling campuses have been designed to facilitate “in-person” meetups; a kind of a glorified We-Work interface but scaled up. All of those investments count for nothing if there are no patients coming in because the insurers will argue that Telemedicine does offer a cost arbitrage (and value). As such, the friction will emanate from the real and notional value of medical consultations.

Loss of revenue. We learned quickly that revenue from teleconnection is not what it is for IRL care. For hospital systems the loss of facility fees created a gravitational pull back to in-person visits.

For an industry working on slim margins our archaic system of reimbursement prevented telemedicine from evolving as a sustainable, new way of caring or doing business.

The reality of caring for humans. The craziest angle of the telemedicine spike was the way the medical community almost universally abandoned the physical exam. For a brief moment in time physicians elected to deliver care without any physical data from the patients. But despite the honeymoon of believing that everything in medicine could be conducted virtually, we learned that teleconnection was good for a lot of things but not everything.

Telemedicine Hype Cycle and the Future of Remote Care – 33 Charts
The Hype Cycle

Dr Bryan also offers this graph of “enlightenment” wherein the hype cycles tend to peter out.

What is the future? That’s an open question and I will definitely see a lot of traction around this in the future. My thumb rule to analyse the value of any startup. If there are a lot of people discussing about it, then probably it is not worth it.

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