Telemedicine: Unclogging the appointment traffic jam

As I call to book an appointment with my family physician in early November, I am brought back to the days of driving my tiny Honda as a teenager on the 405 freeway in Southern California rush hour traffic. I called on November 9th and was given an appointment for January 19th for my annual checkup. Yes, the wait time of 45 days (excluding holidays and weekends) does seem extreme, but I love my doctor. I would always wait for her, but I don’t know if all patients would be that understanding.
 

Although a survey found that the average cumulative wait time to see a physician for five specialties surveyed in 2014 in 15 markets was 18.5 days, my experience in metropolitan Los Angeles is similar to the statistics for Boston which has a cumulative average wait time of 45.4 days for a physician appointment.
 

I bet that there is also a seasonal shift to the physician wait time for an appointment. In my practice, I scheduled my winter months very carefully, taking less physicals and planning for more sick visits as the cold and flu season neared. I know first-hand that the summer months are lighter and the winter months sometime seem to have an endless queue of patients and scheduling havoc.

From a patient perspective, the vision of the tiny Honda in the endless line of cars in freeway traffic isn’t far-fetched when it comes to scheduling a checkup in the winter, it’s a reality.

Telemedicine to Relieve the Congestion

Traffic engineers use the concepts of traffic volume, congestion, and fluid dynamics to look at patterns of traffic flow and how they might ease freeway traffic. In a physician office, we have traditionally looked at offering extended hours or adding mid-level providers as a means of easing this appointment scheduling congestion. In 2016, some of these more traditional approaches are no longer attractive as disruptive technology is changing how we practice medicine.

Telemedicine is one of the new tools in the physician arsenal which can unclog the congestion – improving both the physician’s and patient’s outlook. Telemedicine makes up nearly one-fourth of the health IT market, which was valued at $15.6 billion in 2014 and is expected to increase to nearly $20 billion by 2019 with a compound annual growth rate of 4.8%.

Patients Are Ready for Telemedicine

Patients are ready for alternatives. They are craving to try another avenue for access to healthcare. When the average US patient spends about 20 minutes sitting in the doctor’s waiting room, they are open to finding solutions that save time.   Three quarters of patients indicate they are comfortable with the idea of communicating with doctors using technology instead of seeing them in person and nearly one in four patients already receive health-related reminders on their device. With the telehealth market expansion, it is predicted that the number of patients using telehealth services will rise to 7 million in 2018, up from less than 350,000 in 2013. For those patients who have tried it, 67% of patients find that telemedicine improves their satisfaction with their medical care.

Taking the Telemedicine Exit

As with any new technology, physicians are generally cautious. We want to test the option by letting just a few cars off the exit, making sure we are successful before diverting more traffic off the telemedicine exit.  Physicians often like to start off slowly and convert just a few in-person visits to telemedicine visits a week. Perhaps they start with follow-up visits for well controlled patients like the patient with high blood pressure who religiously checks her own blood pressure at home.  This example is an easy opportunity to move patients out of the waiting room and open space on the appointment calendar.

Physicians also spend a lot of time on unpaid tasks of returning phone calls and reviewing laboratory tests. Physicians, on average, reviewed 19.5 laboratory reports per day and fielded 23.7 telephone calls per day that were determined to be of sufficient clinical import to engage a physician. Each of these phone calls takes staff time. Additionally, some of these turn into more lengthy conversations requiring physicians to alter treatment plans and give treatment advice. Turning the more complex phone follow-ups into telemedicine visits ensures that physician time is accounted for.

Telemedicine visits are also faster. Imagine using an asynchronous telemedicine platform. How long would it take to review patient data and type up a treatment plan? A 10-15 minute visit can conservatively be turned into a 5-7 min visit.

In a short time, physicians might find that the waiting room queue has improved. They might even be able to leave to pull off the freeway earlier on a Friday afternoon, pull into their home office, and take a more leisurely path of seeing patients just before the weekend.