Amaan Syed
The Dawn of a New Age: Transformative Telemedicine
Introduction
Telemedicine and digital health have emerged as transformative forces in the healthcare
landscape, offering innovative solutions to improve access to care, enhance patient outcomes,
and reduce healthcare costs. These technologies encompass a range of services, including virtual
consultations, remote monitoring, mobile health apps, and wearable devices. However, while
telemedicine and digital health hold immense potential, they are hindered by present challenges.
Not all, but some obstacles include regulation, licensure privacy, and equity.
Before discussing telemedicine in its breadth and understanding why a shift in healthcare
is necessary for the rapidly changing landscape, some context must be provided as to why
telemedicine was heavily relied on, especially during the recent pandemic in the United States.
One of the biggest issues that still plague communities around the globe is healthcare access.
Across the world, millions of individuals struggle to access timely, affordable, and quality
healthcare services, often due to geographical remoteness, socioeconomic disparities, or
limitations in healthcare infrastructure.
Difficulties in Healthcare
A big contributor to these difficulties in access is stigma and biases. Unintentional bias
from clinicians and staff makes patients feel unwelcome and reluctant to return.1 Implicit biases
like racial biases have been proven to be one of the biggest contributors to disparities in
healthcare for example. An interesting view is made in Dayna Bowen Matthew's book, Just
Medicine: A Cure for Racial Inequality in American Healthcare. There is little reason to believe
that physicians have not been exposed to the negative narratives about racial minorities that
circulate in society—discourses that become the stuff of unconscious negative attitudes about
1
Butkus, Renee, Katherine Rapp, Thomas G. Cooney, and Lee S. Engel. “Envisioning a Better U.S. Health Care
System for All: Reducing Barriers to Care and Addressing Social Determinants of Health.” Annals of Internal
Medicine 172, no. 2_Supplement (January 21, 2020): S50. https://doi.org/10.7326/m19-2410.
racial groups. This creates views about racial minorities that they are not consciously aware of,
leading them to make unintentional, and ultimately harmful judgments about people of color. 2
This can lead to detriments in ease of access and quality healthcare and presses the need for a
more inclusive network of healthcare that can ensure that those of all races can get quality access
to healthcare. One of the solutions is telemedicine, as it allows for more patients to be able to
connect with more professionals, as patients can connect with providers with a click of a button,
regardless of geographic location, and have more of a selection when it comes to the provider.
The implementation of telemedicine has proven capability, as during the COVID-19 pandemic
the traditional modes of healthcare were disrupted as social distancing measures necessitated
alternative means of accessing care, and the concept of telemedicine took off.
(Image Credit)3
Rising costs of healthcare will always be a concern for the foreseeable future, both for
providers and beneficiaries. Telemedicine effectively reduces unnecessary emergency
2
Matthew, Dayna Bowen, PhD. Just Medicine: A Cure for Racial Inequality in American Healthcare. Google
Books. NYU Press, 2015.
3
Justin Lo et al., “Telehealth Has Played an Outsized Role Meeting Mental Health Needs During the COVID-19
Pandemic | KFF,” KFF, March 22, 2022,
https://www.kff.org/mental-health/issue-brief/telehealth-has-played-an-outsized-role-meeting-mental-health-needs-d
uring-the-covid-19-pandemic/
department visits, hospitalizations, and transportation costs. Especially the last factor, many
living in rural areas find it difficult to access healthcare. In fact, according to the Health
Resources and Services Administration, over 23 million people reside in primary care health
professional shortage areas or HPSAs.4 Length of travel to health care centers, need for housing
and food while traveling for care, and cost of child care and missed work are other factors that
affect the experience of those from rural communities when seeking care, aside from even just
the costs. Telemedicine optimizes healthcare delivery processes by enabling virtual
consultations, remote monitoring, and digital interventions, leading to increased efficiency and
cost-effectiveness.5 The potential for telemedicine as a main alternative to traditional in-person
healthcare is very promising, but issues arise because of the framework of healthcare that is very
resistant to change.
Breaking the Barriers to Change
Restrictive Regulation
Addressing the roots of the system is the only way to create usurpation and a beneficial
change to the scene of healthcare. The frameworks in charge of telemedicine practice, licensure,
and reimbursement vary significantly across regions in the United States. However, outdated
regulations that do not take into consideration the rapidly changing digital world and licensure
requirements for those looking to become involved with the field are hindering the seamless
integration of telemedicine into healthcare delivery systems. Each state dictates separate
Medicaid policies, creating a patchwork of telehealth laws and regulations across the nation.
Additionally, the laws are written in such a way that there is a parity between the coverage
services and payment which is often an incentive for providers to use telemedicine. Telehealth
payment parity requires insurers to reimburse the same payment rate for telehealth services as
in-person care, but in reality, enforcing this equal pay undermines telemedicine’s
4
Butkus et al., “Envisioning a Better U.S. Health Care System for All: Reducing Barriers to Care and Addressing
Social Determinants of Health.”
5
Josh, “How Does Telemedicine Help Reduce Costs? | SmartClinix,” Smart Clinix, November 23, 2023,
https://smartclinix.net/how-does-telemedicine-reduce-costs/#:~:text=By%20embracing%20technology%2C%20tele
medicine%20eliminates,both%20patients%20and%20healthcare%20providers.
cost-effectiveness. This is because it eliminates the potential cost savings associated with virtual
care. If healthcare payers are required to reimburse telemedicine services at the same rate as
in-person visits, they may be less inclined to adopt telemedicine as a cost-saving measure.6 This
directly impacts the implementation of telemedicine, as it decreases the opportunities and outlets
for individuals to pursue telemedicine as their own cost-saving measure, and continues to
strengthen the foundation of disparity in healthcare. Instead, it would be wise to adopt a payment
model that rewards value in the remote delivery of services regardless of the service, rather than
paying providers at capped rates. This may encourage providers to utilize telehealth as a service,
particularly in a redefined approach that makes it more mainstream and a quality alternative to
expensive traditional healthcare.
Certifications and Licensures
Another challenge is licensure. Federal and state licensure, as a matter of fact, have
inhibited the adoption of telehealth since its inception. In short, providers need to obtain some
form of licensure in each state they wish to practice in. Because telehealth’s entire premise is to
connect patients and doctors at a distance, these licensure laws limit the reach of physicians.
Patients have access only to those who have a current license in the state in which they reside.
However, there is an expedited method to licensure in multiple states, which should be pushed
for as well as other policies created revolving around this concept. Donned the Interstate Medical
Licensure, qualified physicians can obtain the license to practice in multiple states. This compact
allows for states to easily communicate with each other and share information about other
physicians who have previously submitted in their State of Principal License (SPL) -- the state in
which a physician holds a full and unrestricted medical license. This allows all participating
states in the compact to speed up licensure for the individual, allowing for physicians to possess
further, reach to benefit those in rural and underrepresented communities.7 It is also refreshing to
see states like Florida take the initiative and pass a new law to authorize out-of-state healthcare
6
Jack Karsten, Jordan Roberts, and Nicol Turner Lee, “Removing Regulatory Barriers to Telehealth Before and
After COVID-19,” Brookings, May 6, 2020,
https://www.brookings.edu/articles/removing-regulatory-barriers-to-telehealth-before-and-after-covid-19/
7
“Physician Licensure | Interstate Medical Licensure Compact,” Interstate Medical Licensure Compact, February
28, 2024, https://www.imlcc.org/a-faster-pathway-to-physician-licensure/
professionals to deliver telehealth services to local patients. 8
(Image Credit)9
It is clear to see the progression of interstate compacts among professions that offer
multistate practices. Because of these enactments, there is more facilitation of licenses and
therefore directly impacts the opportunities for telemedicine to take precedence if need be.
Streamlining requirements through methods like this creates pathways for patients in
underserved areas and provides more outreach to those who may be afflicted with hardships but
do not have the resources to get through them.
Concerns around Privacy
8
“House Bill 267 (2023) - the Florida Senate,” n.d., https://www.flsenate.gov/Session/Bill/2023/267.
9
“The Growth of Health Care Licensure Compacts | NCSBN,” NCSBN, n.d.,
https://www.ncsbn.org/compacts/growth-of-licensure-compacts.page.
Privacy can impact the scene of telemedicine as well. There are valid concerns because of
the sensitive nature of healthcare data and the remote delivery of medical services. As such,
transmitting sensitive patient data over digital networks requires the security of the data.
However, this always comes with risk and can discourage many from keeping digital records and
not investing in telemedicine. To help with assurance in telemedicine, encryption, secure
networks, and robust authentication mechanisms are essential. New encryptions like the
Lionized remora optimization-based serpent (LRO-S) encryption method that uses assistance
from artificial intelligence can help encrypt sensitive data and reduce privacy breaches and
cyber-attacks from unauthorized users and hackers. The LRO-S technique encrypts sensitive
patient data before storing it in the cloud and generates secret keys that are one-of-a-kind, which
also provides a cost-effective and efficient way to store this personal data.10 Any concerns with
telemedicine’s liability to exposure of data can be diminished because of new encryption
methods like this. Because the world of cybersecurity is always evolving as well, the need for
new protection against novel threats can be quickly combated by developing encryptions and
software that are built to create a more secure experience for the individual.
Equal Access
The final barrier that is posed by the mass implementation of telemedicine is equity.
While telemedicine aims to provide just this, there is a possibility, although slim in comparison,
to exacerbate existing disparities in healthcare access and outcomes. Access to telemedicine
depends on access to the necessary devices or internet infrastructure, and marginalized
populations or areas may not have access or affordability to such, widening the gap that
telemedicine tries to close. There is also a technology literacy aspect to this as well, so
individuals who are not familiar with technology or who have limited digital literacy skills may
face barriers to accessing telemedicine services. But, providing training and support to help
individuals navigate telemedicine platforms can help address this barrier. Language and cultural
barriers also pose problems, so telemedicine platforms should be equipped to support
10
Almalawi, Abdulmohsen, Asif Irshad Khan, Fawaz Alsolami, Yoosef B. Abushark, and Ahmed S. Alfakeeh.
“Managing Security of Healthcare Data for a Modern Healthcare System.” Sensors 23, no. 7 (March 30, 2023):
3612. https://doi.org/10.3390/s23073612.
multilingual services and cultural competence to ensure that all patients can effectively
communicate with healthcare providers and receive culturally sensitive care. There have already
been initiatives to counter some of these disparities, one of which emphasizes the increase in
broadband infrastructure. Created by the name of Federal Communications Commission
Programs, the FCC administers several programs aimed at expanding broadband access in
underserved communities, including rural areas and tribal lands. Initiatives such as the Rural
Health Care Program and the Connect America Fund provide funding to support the deployment
of broadband infrastructure and increase access to telemedicine services in these areas.
Summary
With the ever-shifting landscape of healthcare and the increased siphoning of quality
healthcare so that it is only reserved for those with a paycheck big enough to afford it, an
upheaval of a traditional system must be put into effect to cater to all corners of society.
Therefore, a push towards telemedicine that keeps the patients at the forefront of priority as well
as keeps other stakeholders such as the insurers and government regulating agencies in the loop
to create a more beneficial healthcare system would be of the essence in such a digital world.
With aid from policies already in place as well as the utilization of advent technologies such as
AI and encryption, the case for implementation of telemedicine as a mainstream alternative to
traditional healthcare is very strong. The barriers of regulation, licensure privacy, and equity can
be bypassed with informed decision-making and critical thinking. This all culminates in a more
easier and personable form of healthcare that has no bounds, encompassing the depths of society
that are often overlooked for a brighter future.
Works Cited
Butkus, Renee, Katherine Rapp, Thomas G. Cooney, and Lee S. Engel. “Envisioning a Better
U.S. Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants
of Health.” Annals of Internal Medicine 172, no. 2_Supplement (January 21, 2020): S50.
https://doi.org/10.7326/m19-2410.
Matthew, Dayna Bowen, PhD. Just Medicine: A Cure for Racial Inequality in American
Healthcare. Google Books. NYU Press, 2015.
Justin Lo et al., “Telehealth Has Played an Outsized Role Meeting Mental Health Needs
During the COVID-19 Pandemic | KFF,” KFF, March 22, 2022,
https://www.kff.org/mental-health/issue-brief/telehealth-has-played-an-outsized-role-meeting-me
ntal-health-needs-during-the-covid-19-pandemic/
Josh, “How Does Telemedicine Help Reduce Costs? | SmartClinix,” Smart Clinix, November
23,2023,https://smartclinix.net/how-does-telemedicine-reduce-costs/#:~:text=By%20embracing
%20technology%2C%20telemedicine%20eliminates,both%20patients%20and%20healthcare%2
0providers.
Jack Karsten, Jordan Roberts, and Nicol Turner Lee, “Removing Regulatory Barriers to
Telehealth Before and After COVID-19,” Brookings, May 6, 2020,
https://www.brookings.edu/articles/removing-regulatory-barriers-to-telehealth-before-and-after-c
ovid-19/
“Physician Licensure | Interstate Medical Licensure Compact,” Interstate Medical Licensure
Compact, February 28, 2024, https://www.imlcc.org/a-faster-pathway-to-physician-licensure/
“House Bill 267 (2023) - the Florida Senate,” n.d.,
https://www.flsenate.gov/Session/Bill/2023/267.
“The Growth of Health Care Licensure Compacts | NCSBN,” NCSBN, n.d.,
https://www.ncsbn.org/compacts/growth-of-licensure-compacts.page.
Almalawi, Abdulmohsen, Asif Irshad Khan, Fawaz Alsolami, Yoosef B. Abushark, and Ahmed
S. Alfakeeh. “Managing Security of Healthcare Data for a Modern Healthcare System.” Sensors
23, no. 7 (March 30, 2023): 3612. https://doi.org/10.3390/s23073612.
