The 5 C’s that will shape the future of telemedicine: Care, Convenience, Comfort, Confidentiality, and Contagion

The 5 C’s that will shape the future of telemedicine: Care, Convenience, Comfort, Confidentiality, and Contagion

We had the pleasure of sitting down with Ray Dorsey MD to discuss the future of telemedicine in Parkinson’s disease.  Ray and his colleagues have performed extensive research on this topic and also have a paper (the 5 C’s) just out in the Journal of Parkinson’s Disease. Ray is also the lead author of a new Amazon.com bestseller called Ending Parkinson’s Disease: A Prescription for Action. Our interview is below.

Ray Dorsey MD

Who is Ray Dorsey?

Ray Dorsey MD is the David M. Levy Professor of Neurology and Director of the Center for Health + Technology at the University of Rochester Medical Center in New York. He completed his undergraduate studies at Stanford University, medical school at the University of Pennsylvania, and business school at the Wharton School. Dr. Dorsey is helping investigate new treatments for movement disorders and is improving the way care is delivered for individuals with Parkinson disease and other neurological disorders. Using simple web-based video conferencing, he and his colleagues are seeking to provide care to individuals with Parkinson and neurological diseases anywhere that they live. He is also the principle investigator of a large Parkinson’s disease grant called a Udall grant which focuses on new technologies and their use in Parkinson’s disease. His research has been published in the leading medical, neurology, and economic journals and has been featured on National Public Radio, The New York Times, and The Wall Street Journal.

What are the 5 C’s that will shape the future of telemedicine?

The distribution of clinicians, long travel distances, and disability all limit access to care, especially for persons with Parkinson’s disease.  Telemedicine is not a panacea for all of these challenges but does offer advantages.  These advantages can be summarized as the 5 C’s:  accessible care, increased convenience, enhanced comfort, greater confidentiality to patients and families, and now reduced risk of contagion. 

Telemedicine has long offered 4 C’s:  care, convenience, comfort, and confidentiality. Technology can make care more accessible to individuals with Parkinson’s.  Many, if not most, individuals with Parkinson’s disease lack access to care either due to distance, disability, or simply due to the absence of doctors.  While traditional clinics are accessible to individuals with early or mild Parkinson’s, they are often inaccessible to those with a later stage of the disease.  The fifth C is contagion- the need for telemedicine during infectious pandemics.

You and the Parkinson’s community have been trying to get telemedicine adopted for over 10 years.  What changed recently and what are the limitations of telemedicine?

The COVID-19 pandemic has driven rapid, widespread adoption of telemedicine.  Telemedicine also has its limitations, including the inability to perform parts of the physical examination and inequitable access to the Internet and related technologies.  From this pandemic will be a wealth of new telemedicine approaches which will fundamentally change and improve care as well as research for individuals with Parkinson’s disease.

 Why do patients and families frequently prefer telemedicine?     

Telemedicine makes care more convenient.  Studies have demonstrated that a typical 30-minute office visit for Parkinson’s disease door to door consumes over four hours for patients and caregivers.  The vast majority of that time is spent traveling and waiting.  Telemedicine visits save money, avoid many miles of difficult travel for those with impaired driving ability, and reduce the risk of falls and accidents.

 Do you think patients prefer being seen in their home setting?

Telemedicine allows patients to be evaluated from the comfort of their own home.  In many ways, telemedicine represents the second generation of the classical house call.  In the 1930’s, 40% of physician-patient encounters occurred in the home.  Telemedicine enables physicians to re-enter the home and to examine the patient in their own natural setting.  This setting may provide better insights into how individuals function in their daily lives.  Telemedicine offers the enhanced understanding of social circumstances, and the possibility of a more patient-centered experience. 

What are the limitations to telemedicine?

In addition to its advantages, telemedicine has well established limitations.  Many elements of the physical examination (e.g., detailed assessments of eye movements, evaluating rigidity, testing of reflexes) are challenging to assess remotely. Despite these limitations, numerous parts of the exam can be conducted remotely with some creativity and guidance. While the examination is important, 80% of medical diagnoses remain based on history, which can readily be obtained remotely. 

What will the future models of telemedicine care look like?

Future models will deliver care to patients from a diverse set of specialties.  These will include mental health specialists, physiotherapists, neurosurgeons, speech-language therapists, dieticians, social workers, and exercise coaches.  Along with these new care models, digital therapeutics, defined as treatments delivered through software programs, are emerging.  Telemedicine is now being introduced as a bridge to restart clinical trials and will increasingly become a normal part of future research studies. 

 While telemedicine may be enjoying its finest hour, its future is not entirely certain.  Many of the changes in the U.S. (e.g., insurance coverage by Medicare, reduction of licensing restrictions) that have enabled telemedicine use during this time of crisis are only temporary.  In many cases, telemedicine is less financially attractive to medical centers than in-person care.  Ensuring that the policy changes that have supported telemedicine’s rise become permanent will likely require political action and overcoming objections from those vested in a pre-COVID model of care.  Until then, thousands of patients and hundreds of clinicians will be gaining increasing experience with telemedicine. 

To read more books and articles by Michael S. Okun MD check Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #EndingPD #ParkinsonPACT #Parkinsonsecrets and https://www.tourettetreatment.com/