The Top 7 Things Every PA Should Know About Virtual Medicine and Telemedicine

PAs Have Tremendous Opportunity to Lead

July 3, 2019

By Desmond Watt, PA-C

Desmond Watt virtual medical director for One Medical
Desmond Watt, PA-C, is a virtual medical director for One Medical.

You’re probably hearing the terms more often – virtual medicine,  telehealth, telemedicine. But what do they mean? And how might they affect you and your daily practice? Desmond Watt, PA-C, president of AAPA’s Special Interest Group PAs in Virtual Medicine and Telemedicine (PAVMT), shares the top seven things that every PA – no matter your specialty – should know about this emerging and evolving healthcare space.

1. Virtual medicine and telemedicine, or telehealth, are essentially interchangeable terms.
While the industry has defined this area of practice as telemedicine, work in this field has evolved far beyond the telephone. We believe defining virtual care in broader terms is more inclusive of non-traditional practice settings, and acknowledges the nature in which care is being delivered – i.e. “virtually” or not necessarily with a patient sitting in front of you. As this area of practice grows dramatically, we should anticipate continued change and evolution of virtual care to include novel approaches to care, as well as more asynchronous care that is patient or program-driven – i.e. questionnaire based, patient self-serve, machine learning, care channel routing, and natural language processing to support more streamlined clinical care.

2. Virtual medicine is growing rapidly, and PAs have a part to play.
Last year, the VA performed more than 1 million video visits in 2018, for example. Teledoc, a large scale direct-to-consumer platform did almost 3 million video visits. Virtual medicine is not in the future – it is here now. I believe PAs have the opportunity to occupy a tremendous amount of space in virtual medicine, as our training is ideal for this area of clinical practice. We should seek to not only stay on trend, but to lead. We have a huge opportunity to do so, but a huge risk if we allow the momentum to pass us by. Staking a leadership position in this space is a critical component to continued growth and competitiveness of the PA profession.

3. Telemedicine is medicine, plain and simple.
I’ve spoken to enough PAs about this to know there seems to be a mystique around telemedicine as individuals have a hard time understanding exactly how it works, or how it could work for their patients. But this is simply care being provided in a non-traditional space. Telemedicine is not a lesser version of care where access or services are limited. This idea does a disservice to the potential impact of telemedicine on healthcare. Many studies indicate that telemedicine is cost-effective, and of equivalent quality to traditional in person care for a variety of clinical concerns. This is not to say telemedicine should replace in person care, but rather that we should seek to define the areas where it ought to. Telemedicine allows us to think of medical care as more of a matrix: the right care should be provided at the right time, in the right place, by the right clinician.

4. Telemedicine is for all clinicians and all patients, regardless of area of practice.
Many PAs seem convinced that telemedicine cannot be applied to their current practice setting or specialty. There is a use case, or many use cases, for all clinicians and patients regardless of the type of care being provided. It’s for us to define them, and then create the pathways and workflows that will support them effectively.

5. In the future of healthcare, telemedicine will play a significant part.
Telemedicine is already having an impact now as it relates to increasing access to care and eliminating geography as a barrier. As we look to the future, I anticipate high-level endorsement of comprehensive telemedicine services as an essential piece to resolving our national healthcare challenges. A congressional telehealth caucus already exists to help drive legislation. CMS is expanding coverage of services, as are private payers. State-based legislation is rapidly improving and expanding, supporting care delivery in this space. Patients are demanding more of this type of care, and clinicians – particularly early-career clinicians – are increasingly supportive. These are the right environmental pressures for transformation of our health care system. However, PAs must keep pace with these changes. Supporting and advancing legislation, such as Optimal Team Practice (OTP), will increase our ability to do so. Other legislative changes will be necessary as well, such as a PA interstate medical licensure compact. These are continued areas of focus for AAPA and PAVMT.

6. Virtual medicine doesn’t prevent collaboration – it enhances it.
Telemedicine is being used to redefine curbside consult through programs like the Project ECHO model. These programs use the “hub and spoke” model of care delivery: A knowledge base exists at the “hub,” often a large academic medical institution full of high-quality and knowledgeable specialists, and primary care providers in rural and underserved communities are the “spokes.” This telehealth model actually expands rural/limited access primary care providers’ knowledge in specialty care by connecting them directly with the experts through virtual care platforms.

7. For patients, telemedicine can be effective in a variety of situations.
Currently, we see telemedicine used in a lot of acute/transactional care, in particular in the primary care and direct-to-consumer spaces. Anything a clinician can imagine can be done competently without a robust in person physical exam can reasonably be done through telemedicine. There are also a number of organizations using telemedicine for chronic care follow ups and population health management. Mental health care is a tremendous example, as a secure video connection is often all that one needs to reliably communicate with their patients. This area of care has expanded rapidly in this space and will continue to do so. We also see a wide array of use across emergency medicine, hospital medicine, clinician-to-clinician, and more. Any area of care could effectively employ telemedicine if properly designed.

More Resources
CHLM’s Executive Leadership Conference,
PAs in Virtual Medicine and Telemedicine
PAVMT

Desmond Watt, PA-C, is a virtual medical director for One Medical, a membership-based primary care practice. Contact him at [email protected].