Why Telehealth Won’t Make Healthcare Sustainable

Why Telehealth Won’t Make Healthcare Sustainable

Telehealth (i.e. video conferencing) does nothing to change the fundamentally flawed current architecture of healthcare.  In fact, it serves to reinforce the view that healthcare is about face-to-face appointments, albeit via video conferencing.  Telehealth does nothing to improve sustainability by allowing patients to interact with health information, but merely digitises an existing construct.


Underlying our largely broken health system lie a number of faulty assumptions.  Chief amongst these is the idea that healthcare only occurs when a patient meets face-to-face with a health provider.  The appointment is currently the fundamental unit of healthcare delivery across the globe.  Behind this assumption lies the view that healthcare is so complex and knowledge-intensive, and health providers so deeply skilled, that anything outside of the face-to-face appointment is not legitimate healthcare.

In my view, this flawed assumption contributes to an incorrect understanding of what healthcare actually is.  I’ve started to refer to this as “the flawed architecture of healthcare“.  In response I’d like to propose a new architecture for healthcare, drawing heavily upon many of the concepts contained within the transcript of Don Berwick’s Escape Fire address.

Rather than healthcare only occurring through the transactional unit of the appointment, I’d like to propose that “healthcare occurs every time a patient interacts with information that relates to their own health.”  In some (perhaps many) situations this interaction between patient and information can and should be mediated by a health provider, but not always.

There are many legitimate cases where a patient can and should interact with health information that will support their decision making and modify their behaviour.  In a previous blog post I gave the example of how my wife and I used Digital Health Communities to support us through a very difficult time when my wife suffered from Hyperemesis Gravidarum during two pregnancies.  In that post I explained that we used helpher.org, not for diagnosis, but for emotional and psychological support, and for the sharing of stories.  I argued that this was every bit as much “healthcare” as the many appointments that we attended.  This distinction is critically important, because it continues to hold back the sustainability of our health systems, even in the face of much so-called innovation.

Let me take the example of telehealth…  Firstly, let me be clear that when I say telehealth I mean health appointments via video conferencing.

Now don’t mishear me, I believe that telehealth does great things for the accessibility of healthcare.  It lessens the tyranny of distance, giving greater access to primary and specialist healthcare for patients living in rural and remote areas.

But here’s the thing.  Telehealth (i.e. video conferencing) does nothing to change the fundamentally flawed current architecture of healthcare.  In fact, it serves to reinforce the view that healthcare is about face-to-face appointments, albeit via video conferencing.  Telehealth does nothing to improve sustainability by allowing patients to interact with health information, but merely digitises the existing construct of the face-to-face appointment.

If we’re looking for a major step forward in health system sustainability, telehealth is not it.  Rather, we need to look towards the ways in which digital health will allow us to connect patients to providers through mobile devices, creating genuinely new models of care in which clinicians can engage with their patient cohorts in ways that don’t always involve face-to-face appointments.


4 thoughts on “Why Telehealth Won’t Make Healthcare Sustainable

  1. When I have the conversation with individuals and companies about telemedicine benefits I explain that it does not replace your physician or your physician specialists. The membership benefits I propose is complementary to your health care plan, it does not replace it.

    There are various types of telemedicine. There is recovery or clinical telemedicine where your primary care physician, specialists, and hospital know your health condition, i.e. you have had a stroke, cancer, and health issues.

    Whether it is post surgical or periodic exams, the consultation maybe by phone or video at home or at a local care center which has a nurse, doctor, and video and communication equipment to have consultations with specialists and doctors.

    There is a second type of personalized healthcare which is concierge medicine. People have agreements with their primary or specialist care doctor to pay a monthly or annual fee. The doctor will limit the number of patients, in their practice, to have time to speak with patients on the phone or to see them on short notice for health issues.

    Membership or pay per service telemedicine is a third type of concierge medicine for routine health issues, cold, flu, stomach, allergies, skin rash, and other health issues where a consultation with a doctor can be resolved on the phone or video which avoids a visit to urgent care or emergency center.

    People who have health issues, which are more serious may want to consult with a doctor before making an appointment with their primary care physician or before going to urgent or emergency care will find a doctor advise helpful.

    Telemedicine is not designed to replace regular medicine. Its purpose is to return people to the habit of talking to a doctor or nurse about your health issues.

    With a quality telemedicine membership benefit, the interaction you have with a telemedicine physician is recorded and a written record is sent to the doctor you choose in your web portal health web portal.

    Telemedicine returns to what it used to be, having a conversation with a doctor about your health questions.


  2. If your idea of Telehealth as ‘video conferencing’, is shared by others, your sound bite of “Why Telehealth Won’t Make Healthcare Sustainable” is correct. Using only 2 dimensions i.e. visual and verbal was never going to be a substitute for face to face consultations.
    If we add another dimension, i.e. the provision of a complete set of vital signs being taken by the patient themselves for the Doctor to see live and on screen during the remote consultation, we are now in the real world of Telehealth, not video conferencing.
    Owing to advances in technology and the development of medically approved devices for use at home. this solution is now being assessed by NICE, and will drastically change the NHS approach to the requirement for endless face to face visits. It will enable new methods of service delivery to fix “the flawed architecture of healthcare“

  3. In these times of consumerism, I think that having alternatives are the best in healthcare. When driving to New Jersey to see my in-laws, I always see a huge billboard on the Emergency Room wait times at a local New Jersey hospital. As a consumer, I have the right to drive to that ER and wait XX amount of time or pull out my iPad or iPhone and see a physician immediately for $49.00 and get immediate care. Will this work for everyone? No, but again, it is an option for me and I have the right to choose that option or attempt to book an appointment with my physician who might be on a 3 month waiting list. Options and alternatives to healthcare in the US is being driven by consumerism. Telemedicine is 1 option.

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