Survey results released yesterday by ACP showed that 51% of internal medicine physicians and subspecialists who are ACP members work in a practice that has implemented at least one of five different telehealth services: video visits, e-consults, remote patient monitoring, remote care management/coaching, and integration of data from patient wearables. Overall, ACP found that adoption and usage of telehealth among internists and subspecialists vary widely depending on application.
ACP surveyed a random sample of 1,449 members ages 65 years and younger in October 2018 and January 2019 to measure the availability and use of telehealth technology. Completed responses were received from 233 members (16.1% response rate) providing outpatient care (72% general internal medicine specialists and 28% subspecialists).
Telehealth is rapidly expanding, and other surveys have reported that many patients would like to use virtual communication channels to confer with their physicians. ACP conducted its survey to understand the current level of adoption among internists and subspecialists and to identify how ACP can help physicians respond to their patients' interest in using telehealth.
“ACP recognizes that telehealth technologies have the potential to improve access for patients, enhance patient-physician collaboration, improve health outcomes, increase patient satisfaction, and reduce medical costs,” said ACP President Ana María López, MD, MPH, MACP. “Our survey gave us valuable information about the state of telehealth adoption among internists, what we can do to improve it, and how we can lead internal medicine physicians in the appropriate use of telehealth.”
Additional key findings of ACP's survey include the following:
- E-consults were implemented most widely (33% have the technology), and they are used frequently among those with the technology (63% use every week).
- Technology for remote care management (24%) or video visits (18%) is less widely available.
- Having the technology available does not equate to adoption and usage. Among those with the technology, only 19% use video visits every week, while 50% use remote care management every week.
- Practicing internists are often not the decision makers within their practice about whether a technology is implemented.
- When asked about implementation plans, 24% to 34% said they don't know or it is not their decision (varies by technology).
- Many physicians are interested in learning more about available technology solutions (55% of those with no technologies implemented, and 51% of those with some implementations).
The barriers to telehealth adoption among physicians go beyond the issues of reimbursement, licensing, and regulatory barriers. ACP found that physicians find it challenging to integrate telehealth into their practices' workflow. They also expressed concerns about patients having access to the needed technology, and the potential for medical errors.
“The good news is that more than half of internists are interested in ACP providing guidance and education to help them safely and effectively integrate telehealth into their practices,” Dr. López said.
To support internists in implementing telehealth technologies, ACP plans to develop and release practical resources specific to an internal medicine practice. The initial focus will be on virtual visits, expanding to other telehealth applications in the future as the technology matures. ACP will offer guidance on appropriate use cases, practice workflow changes, the current state of reimbursement and regulatory issues, and equipment and vendor selection.
“We hope these resources can help close the gap between physician use of telehealth and patients' desire for flexibility and access to their physicians,” said Tabassum Salam, MD, FACP, ACP's Vice President for Medical Education.
ACP supports the expanded role of telemedicine in the primary care setting when used as a component of a patient's longitudinal care but recommends that physicians should use their professional judgment about whether the use of telemedicine is appropriate for a patient and the situation. ACP also supports reimbursement for appropriately structured telemedicine communications. These recommendations were set forth in a 2015 ACP policy paper on the use of telemedicine in primary care.