COVID-19 pandemic has been responsible for bringing several activities online. But, the one activity that has brought upon fear and comfort at the same time is virtual consultations. Even though people were able to get a consultation from the safety of their home, they were also worried about the quality of that consultation. After all, how will a doctor examine your throat or check your skin over Skype or Zoom? But, even with this, many people and doctors have changed their opinions about virtual consultation and are not thinking about continuing it in the long term.
According to research conducted by Deloitte, in 2021, the percentage of virtual visits to the doctor will increase to 5% globally. This percentage was only 1% in 2019. And even though 5% does not sound a lot, it will be translated into about 400 million video visits that, depending on what doctors are paid, will be about 25$ billion in USD.
The reason behind this growth is COVID-19. In April 2020, about 43.5% of US Medicare primary care visits were virtual. Before the pandemic, this number was just 0.1%. And even though virtual consultations can include nonvideo software solutions, emails and phone calls, the number of video visits have greatly increased. Compared to 10,000 people using the Video Connect system of the Department of Veterans Affairs in 2019, the number rose to about 120,000 per week. And, this is not just in the US, but all over the world. During the spring of 2020, in France, the video consultation services increased by 40 to 100%. A survey conducted in May 2020 shows that about 14% of Canadians would opt for a virtual visit going forward.
As video and other forms of virtual consultations increase, the companies that provide the technologies to support the consultations will have increased business. Deloitte predicts that the telehealth virtual visit solutions market will reach USD 8 billion in 2020. It is also expected that over USD 33 billion of home health care technology will be sold in 2021 which is about 20% over 2019. This includes monitoring and therapeutic solutions that can include medical-grade, medically-approved consumer products like smartwatches. This growth in home health care technology is partially driven by the increase in virtual visits.
Increase in virtual consultations
The technology for virtual consultations isnt new and has been around for several years. However, there are several factors, mainly COVID-19, that drove this increased usage. Lets go through these factors one by one:
The pandemic left people with no choice and with lowered regulatory barriers, people could access virtual consultations easily. The authorities in the United States loosened their regulatory barriers in March 2020. They also endorsed telemedicine and modified privacy rules. The country witnessed 10 years of change in a single week. Also, because of the coronavirus, people were forced to learn the software. Before the pandemic, there were millions of people who hadnt used video calling hardware and software before. Since they had to work from home, they had to use it for the very first time. Even before the pandemic hit the US, most people didnt use video calling, even though it was easy to use. Post-pandemic, almost everyone can set it up, get the right lighting levels, mute and unmute themselves, and do other things associated with video calls.
The generation of people who are newly skilled with this video calling is the millions of people who are over the age of 65. This was important as they visit doctors more times than the younger people. In the United States, the 65+ demographic accounts for only 17% of the population, but 30% of all doctors visits. In 2016, people over the age of 65 made 80% more visits to the hospital than the average number of visits by the general US population.
Research has shown that even when elderly users have the right connections and tools, they are likely to use any type of digital applications, mainly because of unfamiliarity. However, COVID-19 provided them with the much-needed impetus to change that. They had to undergo forced and rapid training on hardware and software needed to make video calls in order to stay in contact with their friends and family members. A fringe benefit of this was them being able to use these skills for virtual video consultations with their physicians that can drive significant growth in the market of virtual consultations.
Devices and connections
In the past few years, digital device ownerships generational divide has rapidly narrowed. More and more older people have started to increase their online presence which has increased their ability to engage in virtual consultations. This is an important step for people with constraints like limited mobility which makes it hard for them to visit the doctor in person.
Even though the devices required for video calls like laptops, tablets and smartphones have been broadly ubiquitous, for those over the age of 65, their ownership has been less widespread. But, this has changed in the past five years – for devices as well as connection. Between 2014 and 2019, in the United States, the overall internet usage increased by 6%, but for people over the age of 65, the internet usage increased by 16%. Even though not all senior citizens of America will be connected to the internet in 2019, the growing penetration rate and the pandemic suggests that in 2021, three out of four senior Americans will be connected. When it comes to enabling medical video consultations among the 65+ population, this is a critical mass.
Speed and reach
The extent to which the population is connected is what will drive the growth of virtual consultations. In 2017, about 12% of the United States rural residents didnt have access to the fixed internet service offering 1 megabit per second (Mbps) upload and 10 Mbps download. Furthermore, these are the maximum speeds which mean during heavy use periods, when the internet is shared by several users, the speed will get much slower. For most virtual consultation appointments, one needs an upload speed of at least 0.5 Mbps which means that when the connectivity is slower than the maximum possible speed for such users, their internet connection wont support a virtual doctors visit.
Another point worth noting is that connectivity access is lower among some populations apart from the ones living in rural areas. Also, people who are living in social housing, are from lower-income groups, are unemployed or homeless, have visual or other disabilities, whose first language is not English, and who have lower education levels have higher digital exclusion. Because of this, they wont be able to adapt to video visits or telemedicine in general as fast as other populations.
However, the connectivity situation is improving slowly. The United States government is working with network operators to not only get more and more people connected to the internet but also ensure that their connection is available at higher speeds, especially for the ones in rural areas. Telemedicine is becoming increasingly important for delivering healthcare. So, the initiatives to improve the connectivity access to the rural population will accelerate as well. It is possible that ubiquitous global coverage and high enough internet speeds can be achieved through low orbit satellite constellations. However, these networks are not in full service yet and there are a lot of issues around them, especially related to affordability.
Telemedicine will be further accelerated by the 5G technology as it enables faster transmission of high-quality video files and large images, reliable connections offering a guaranteed high quality of service, and better spatial computing and augmented reality/virtual reality. In some cases, it might even allow telemedicine to go beyond monitoring and diagnosis and enable doctors to perform surgeries and procedures using ultra-low latency virtual technology.
It is possible that in the future, virtual consultations will become the default. Historically, emails or phone calls were the most common electronic communications for businesses and consumers and video calls were used only in rare cases. Currently, we dont have any hard data showing these changes, but there are signs showing that video calling is the new norm and the reason for it is the coronavirus.
Some prefer video calling because of the mediums novelty. But, if people are starting to prefer video calls over other non-video methods, there are two critical implications for virtual medical consultations. If there is a permanent shift from voice calls and email to video, then Deloittes prediction of 5% visits to being virtual is very low. Second, the video might make virtual consultations more medically effective. Through the video call, a health professional will be able to assess a rash or laceration. It also has the benefit of showing the faces of the patient and the doctor. A seminal study conducted in 1979, long before video calling became widespread, concluded that in order to have a successful interaction between the patient and practitioner, effective nonverbal communication through voice tone and facial expression is essential.
When the global pandemic broke out in 2020, the healthcare industry was disrupted. But the pandemic has also increased the adoption of certain kinds of technology. Since coronavirus is still continuing to affect people all over the world, it is possible that the trend will continue this year as well. It is too early to know whether the changes made to the healthcare sector because of the pandemic will be permanent or not. But, the one thing that is clear is that the world needs to focus more on public health and preventative measures.
Clinicians, citizens, and policymakers all over the world are starting to realize the importance of better-connected information which include viewing the test results of COVID-19, its visibility, checking someones vaccine status from a different platform. However, these rapid changes have also brought upon challenges of ensuring that the new technology is seamlessly adopted into the existing healthcare system, especially in settings that dont have a mature infrastructure. The use of remote monitoring and telemedicine has continued in 2021 with better interfaces, improved reliability, and increased confidence amongst clinicians and patients. This transformation will help shift towards greater self-management and home care.
In 2021, AI might come into its own in the field of healthcare, along with automation. It is possible that by next year, there will be solutions supporting imaging, quality of reporting, and greater use of natural language processing. Combining these technologies will improve the health systems efficiency as they recover from the COVID-19 pandemic.
Telehealth can connect patients to important health care services using video conferencing, wireless communications, electronic consults, and remote monitoring. By increasing access to specialists and physicians, it can help patients get the right care, at the right time. According to AHA, about 76% of all US hospitals currently connect the consulting practitioners with patients at a distance using video calls or other technology. The Medicaid program of almost all the states offers some coverage for telehealth services. Private players are also embracing the coverage for several forms of telehealth services.
However, there are still some barriers to widespread telehealth adoption. Medicare still limits the payment and coverage for some telehealth services and is lagging behind other players. Recently, it expanded coverage for such services for substance use treatment and stroke patients as a response to the statutory changes. It has also expanded payments for virtual check-ins to clinicians. Even though these incremental steps are promising, they are not enough. There are several policy and operational issues, challenges of cross-state licensure, and limited access to broadband services that are hampering the ability to deploy telehealth services. To increase the use of services like virtual consultations, the federal government has to do more.
Research indicates that telehealth will be the future of the healthcare industry. So, now is the time to decide the type of solution that will fit the needs of the countrys health system and the technology the patients should expect to use in the future.