“Above all, telemedicine helps bridge the logistics gap for people, especially in rural communities, to gain access to healthcare expertise that is otherwise inaccessible."”

Rafay Ishfaq, the W. Allen Reed Associate Professor of supply chain management in Auburn University’s Harbert College of Business, has conducted research on the benefits and challenges of providing healthcare delivery via telemedicine—in which a patient uses a smart phone app or home computer to connect with a doctor via video. As the world faces the COVID-19 pandemic, he says telemedicine can help non-coronavirus patients as healthcare facilities concentrate on coronavirus patients.

Why is telemedicine so effective?

As we live through one of the greatest pandemics in the last hundred years, there are routine healthcare needs of people that cannot be overlooked. These are chronically ill patients who need health checkups or have other illnesses that require the attention of healthcare providers. This is where telemedicine steps in as a safety valve for the critically constrained healthcare system in the country.

In response to the COVID-19 pandemic, hospitals and community health centers have cut down on health services to help free up capacity for coronavirus patients. In these conditions, telemedicine is increasingly being used as a backup healthcare delivery mechanism to ensure that others patients who need care can receive medical attention without increasing their exposure to coronavirus.

It’s not just that telemedicine saves general public from visiting hospitals as a way to “flatten the curve” of new patients infected by the virus, telemedicine also saves critical hospital resources. The effectiveness of telemedicine in these circumstances comes from reducing the use of masks and PPE gear that many healthcare facilities across the country have reported to be in short supply.

What is telemedicine? How does telemedicine help in healthcare supply chain?

I have been working on research to study logistics challenges related to healthcare delivery. In this context, we can think of a healthcare system as a network of hospitals and doctors that resembles a retail supply chain. Typically, patients (customers) would travel to hospitals (retail stores) to fulfill their healthcare (shopping) needs. The hospitals keep stock of medical supplies (inventory) that can see a shortfall (stock outs) under an unforeseen demand spike (COVID-19 pandemic).

This research, Bridging the Healthcare Access Divide: A Strategic Planning Model for Rural Telemedicine Network, has identified how technology solutions, like telemedicine, help reduce the need for medical supplies and expand the utility of scarce healthcare resources. Above all, telemedicine helps bridge the logistics gap for people, especially in rural communities, to gain access to healthcare expertise that is otherwise inaccessible.

Telemedicine is a technology-enabled remote health consultation arrangement between patients and doctors/therapists. The patient uses an app on the smart phone or a home computer to connect with the doctor via a video link. In this session, the patient provides information about the symptoms and health conditions. The doctor conducts a visual (or a physical exam with the aid of a prearranged local trained staff). If a blood or urine sample is needed, the patient is referred to a local lab or clinic. Otherwise, doctor can prescribe medicine that can be picked up at the local pharmacy or ordered online.

As part of the COVID-19 response, this technology has now become a go-to option. As patients (both rural and urban) can no longer safely travel to the hospitals to see the doctor, telemedicine has brought healthcare to patients’ doorsteps. For healthcare providers, it is a great option to keep tabs on patients with chronic conditions, like diabetes, hypertension and mental health, as well as provide care to patients suffering from common ailments like flu and other infections.

What is being done to make telemedicine effective and useful during COVID-19 response?

The use of telemedicine during the COVID-19 pandemic has been enhanced under the CARES Act passed by Congress that allows all Medicare patients, both in rural and urban locations, to use telemedicine. The use of telemedicine is also boosted by the availability of a wide array of medical devices (covered by government and private health insurance plans) than can help you check your blood pressure, measure your blood oxygen and insulin levels. Some wearable devices, like the Apple Watch, can even produce electrocardiograms that can be digitally shared with the doctor through telemedicine.

“ Among people in the country making less than $30,000 a year, almost half of them don’t have access to broadband internet service, while three in ten people in the country do not have access to a smartphone. These statistics definitely point to a big part of the U.S. population that do not have the resources to use telemedicine."”

There are specifically designed HIPPA and HITECH compliant telemedicine platforms, like VSee, Doxy.me, and thera-LINK, which are being leveraged to expand the use of telemedicine. The Department of Health and Human Services has announced that video platforms, like FaceTime and Skype, are temporarily given approval for use by health care providers during COVID-19 response.

Is there anything more that needs to be done to improve access to telemedicine by more people?

Telemedicine requires broadband internet service that is capable of hosting video calls and requires digital equipment that can enable high rate of data transfer. Unfortunately, these technology resources are not widely available.

Among people in the country making less than $30,000 a year, almost half of them don’t have access to broadband internet service, while three in ten people in the country do not have access to a smartphone. These statistics definitely point to a big part of the U.S. population that do not have the resources to use telemedicine. Investments by federal and state/local governments to build broadband network in rural areas and open telemedicine centers in local malls and around city blocks would go a long way to bring telemedicine to the under-resourced segment of our society.

Are there any other issues that needs resolving to promote wide use of telemedicine?

We may think of telemedicine as simply calling the doctor and talking about our health concerns over a Skype or FaceTime video. In many states, telemedicine is considered regular medicine that has its own licensing requirements. Most states, for example, will not allow physicians to practice across state lines. For telemedicine to become a low-cost, highly-accessible healthcare delivery mechanism, states must allow doctors who want to consult with patients in multiple states to use the home state medical license.

Another relevant issue is reimbursements for healthcare consultations. As the use of telemedicine increases, health insurance companies can leverage the necessary scale to allow reimbursements of telemedicine services at a higher rate than what’s being offered now. This change will bring more healthcare providers to offer telemedicine services.

Rafay Ishfaq, the W. Allen Reed Associate Professor of Supply Chain Management in Auburn University’s Harbert College of Business, has conducted research on the benefits and challenges of providing healthcare delivery via telemedicine. He studies healthcare systems as a network of hospitals and doctors that resembles a retail supply chain. His primary research focus is on exploring the interplay between operational and service issues in the retail industry.