Endocrinologists’ Adoption of Telehealth Practices
In the wake of the COVID-19 pandemic, telehealth has become an increasingly utilized practice among health care providers. In a recent study1, researchers sought to examine the rate at which endocrinologists adopted telehealth measures into their practices and the characteristics of the endocrinologists who have adopted this measure.
Consultant360 reached out to study author Sujay Madduri, MD, who is an endocrinologist at MidMichigan Health, part of the University of Michigan Health System, about the study findings and their implications.
Consultant360: You note that a majority of the endocrinologists surveyed has implemented some aspect of telehealth into practice. Did you personally implement telehealth services during the quarantine orders? If so, how did your experience with telehealth compare with the endocrinologists in your study?
Sujay Madduri: As COVID-19 cases escalated in March 2020, cancellations and no-shows to the outpatient clinic were spiraling. I had to adapt to the changing landscape quickly, and telehealth was thus implemented. At MidMichigan Health, endocrinology was one of the first specialties to pilot virtual visits by the end of March 2020. Telehealth not only reconnected me with my patients, but also accommodated for stay-at-home orders, maintained social distancing, minimized the use of already scarce personal protective equipment, and curtailed transmission of the deadly virus. My personal experience using telemedicine was similar to our study group. I will rate it at 8/10.
C360: Your study notes that there was a significantly higher adoption rate in endocrinologists aged 40 years or younger, as well as those who practice in Northeastern, Midwestern, and Western parts of the United States. What is the importance of this finding?
SM: This is one of the limitations of my study. The results could have been skewed. The weblink to the survey was posted to a closed group on a social media platform. There is obvious selection bias in that younger endocrinologists are comfortable using information technology and social media platforms and are more likely to respond to the surveys. Remarkably, more than 50% of the study respondents were younger than 40 years, and the majority were employed.
Perhaps, health systems were swift to adopt telehealth compared with solo/group practices. During the pandemic's early days, uncertainty with telehealth services reimbursement may have delayed solo/group practices to switch. It was noted that most endocrinologists who had private practices were older than age 40 years. It is likely possible that those who did not adopt telehealth did not complete the survey.
In early April 2020, when the study was conducted, New York, New Jersey, California, and Michigan led the country in terms of the number of COVID-19 cases. Stay-at-home orders were instituted earlier in these regions compared with the South. All these factors could have played a role in the lesser adoption of telehealth in the southern states.
C360: What advice would you give to older health care providers who practice in regions with low telehealth adoption rates?
SM: Telehealth adoption is ultimately a provider’s personal choice. Lower adoption rates among older providers could be from inclination for in-person interaction. Other deterring factors include additional financial burden or dealing with a community that is not technologically savvy. Unlike the transition to electronic medical records, telehealth is not mandatory, and there is no incentive to adopt. The learning curve is not steep. In terms of a timeline, establishing telehealth infrastructure is a reasonably quick process. Several telehealth platforms have mushroomed during the pandemic that are ready to use. It’s like using a modified version of Skype or Facebook Messenger.
C360: What role do you believe telehealth will play in the future for endocrinologists? Do you believe that telehealth will be adopted into routine practice after the COVID-19 pandemic has ended? Why or why not?
SM: I firmly believe telehealth is here to stay after the COVID-19 era and will be incorporated into routine practice. Telehealth allows us to evaluate more patients and reduce overall wait times for the initial visit. From a patient’s perspective, telehealth essentially saves time by cutting down the travel time and wait time associated with seeing a physician in person. Travel time for some patients also translates to being off from work and financial loss. I am optimistic that telehealth will drastically improve in the future. With telehealth currently, we are at version 1.0, and there is lot of room for improvement.
C360: What knowledge gaps still exist concerning how endocrinologists utilize telehealth?
SM: Telehealth expands service lines and meets the goal of value-based care. Telehealth has the potential to reach a new patient population separated by time or distance, increases revenue, and lowers operating costs. I firmly believe it improves clinical outcomes by increasing physician-patient engagement. A few barriers need to be addressed, including the cost associated with investment for technology and other infrastructure, and its routine maintenance. State laws and regulations are known obstacles. Reimbursement with telehealth needs to be redefined and addressed. I am beginning to believe that physicians’ and patients' resistance to adopting telehealth will slowly improve in the future.
Having said that, we humans should not lose in-person contact and social interactions amid technological advancements. These social characteristics are the essential framework to deliver the art of medicine, which has its own unique therapeutic effect. Telehealth will never replace the charm of in-person visits but can be included as a dependable option to provide quality care when needed.
Reference:
- Madduri S, Chowdhary R, Reddy S. Telehealth adoption among endocrinologists during the COVID-19 pandemic. Endocrin Pract. 2020;26(8):846-856. https://doi.org/10.4158/EP-2020-0237