The logo of virtual assistant Amazon Alexa is displayed on a smartphone. Amazon is teaming up with a startup to deliver patient data through the device. In 2018, nearly $10 billion was invested in virtual health care but telehealth forsakes essential aspects of medicine.
Thomas Trutsche—Photothek via Getty Images
By Elisabeth Rosenthal
May 28, 2019

Last month, Amazon opened a new health care frontier: Alexa could now be used to transmit patient data. Using this new feature—which Amazon labeled as a “skill”—a company named Livongo will allow diabetes patients—which it calls “members”—to use the device to “query their last blood sugar reading, blood sugar measurement trends, and receive insights and Health Nudges that are personalized to them.”

Private equity and venture capital firms are in love with a legion of companies and startups touting the benefits of virtual doctors’ visits and telemedicine to revolutionize health care, investing almost $10 billion in 2018, a new record for the sector. Without stepping into a gym or a clinic, a startup called Kinetxx will provide patients with virtual physical therapy, along with messaging and exercise logging. And MavenClinic (which is not actually a physical place), offers online medical guidance and personal advice focusing on women’s health needs.

Last month, at Fortune’s Brainstorm Health Conference in San Diego, Bruce Broussard, CEO of health insurer Humana, said that he believes technology will help patients receive help during medical crises, citing the benefits of home monitoring and the ability of doctors’ visits to be conducted by video conference.

But when I returned from Brainstorm Health, I was confronted by an alternate reality of virtual medicine: a $235 medical bill for a telehealth visit that resulted from one of my kids calling a longtime doctor’s office. It was for a five minute phone call answering a question about a possible infection.

Virtual communications have streamlined life and transformed many of our relationships for the better. There is little need any more to sit across the desk from a tax accountant or a travel agent or to stand in a queue for a bank teller. And there is certainly room for disruptive digital innovation in our confusing and overpriced health care system.

But it remains an open question whether virtual medicine will prove a valuable, convenient adjunct to health care. Or, instead, will it be a way for the U.S. profit-driven health care system to make big bucks by outsourcing core duties—while providing a paler version of actual medical treatment?

After all, my doctors have long answered my questions and dispensed phone and email advice for free—as part of our doctor-patient relationship—though it didn’t have a cool branding moniker like telehealth. And my obstetrician’s office offered great support and advice through two difficult pregnancies—maybe they should have been paid for that valuable service. But $235 for a phone call (which works out to over $2000 per hour)? Not even a corporate lawyer bills that.

Logic holds that some digital health tools have tremendous potential: A neurologist can view a patient by video to see if lopsided facial movements suggests a stroke. A patient with an irregular heart rhythm could send in digital tracings to see if a new prescription drug is working. But the tangible benefit of many other offered virtual services is less certain. Some people may like receiving feedback about their sleep from an Apple Watch but I’m not sure that’s medicine.

And if virtual medicine is pursued in the name of business efficiency or just profit it has enormous potential to make health care worse.

My doctor’s nurse is far better equipped to answer a question about my ongoing health problem than someone at a call center reading from a script. And, however thorough a virtual visit may be, it forsakes some of the diagnostic information that comes when you see and touch the patient.

A recent study published in Pediatrics found that children who have a telemedicine visit for an upper respiratory infection were far more likely to get an antibiotic than those who physically saw and doctor, suggesting overprescribing. It makes sense: A doctor can’t use a stethoscope to listen to lungs or wiggle an otoscope into a kid’s eardrum by video. Similarly, a virtual physical therapist can’t feel the knots in muscle or notice a fleeting wince on a patient’s face via camera.

More importantly, perhaps, virtual medicine means losing the support that has long been a crucial part of the profession. There are programs to provide iPads to people in home hospice for resources about grief and chatbots that purport to treat depression. Maybe people at such challenging moments need—and deserve—human contact?

Of course, companies like those mentioned are expecting to be reimbursed for the remote monitoring and virtual advice they provide. Investors, in turn, get generous payback without having to employ so many actual doctors or other health professionals. Livongo, for instance, has raised a total of $235 million in funding over six rounds. And, as of 2018, Medicare announced it would allow such digital monitoring to “qualify for reimbursement,” if they are “clinically endorsed.” But ultimately will the wellbeing of patients or investors decide which tools are clinically endorsed?

So far, with its new so-called skill, Alexa will be able to perform a half dozen health-related services. In addition to diabetes coaching, it can find the earliest urgent care appointment in a given area and check the status of a prescription drug delivery.

But it will not do many things that patients desperately want, which technology should be able to readily deliver, such as a reliable price estimate for an upcoming surgery, the infection rates at the local hospital, the location of the cheapest cholesterol test nearby. And if we’re trying to bring health care into the tech-enabled 21st century, how about starting with really low hanging fruit: Does any other sector still use paper bills and faxes?

Elisabeth Rosenthal is editor-in-chief of Kaiser Health News and author of An American Sickness: How Healthcare Became Big Business and How You Can Take it Back.

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