Telemedicine and Its Impact on Patient Care Quality

Introduction

The modern healthcare system is considerably more advanced and complex than it was even a decade ago. According to various researchers, the modern healthcare system is a managed one that widely uses technology, in contrast to previous systems (Conklin, 2002). The many uses of technology in modern healthcare include diagnosis, minimally invasive treatments, and improved monitoring of vital signs. Moreover, technology is now being used to consult with medical experts from around the world remotely, leading to improved healthcare and enhanced patient experiences.

Many mobile applications have also been developed to help both patients and doctors. These tools are not only helping patients recover but also improving their overall quality of life (Tiago et al., 2016). This paper investigates how telemedicine — a special category of health technology — affects patient care. The investigation is conducted primarily through a review of the journal article Telemedicine Follow-up After Bariatric Surgery by Meyer et al. (2018), supplemented by broader literature on the field.

Background and History of Telemedicine

For over thirty years, health services researchers, clinicians, and other medical experts have been studying how computers and advanced telecommunication technologies can enhance healthcare. One of the most significant technologies in healthcare since the early 20th century has been telemedicine. Telemedicine is a combination of technologies that enables the delivery of healthcare in unique situations. More precisely, telemedicine is defined as the utilization of communication technologies and electronic information to deliver or support healthcare in situations where there is a physical separation between participants (Conklin, 2002; Tiago et al., 2016). In other words, telemedicine connects healthcare providers with patients across distances. Beyond care delivery, it also enables medical experts to share knowledge and experience without meeting in person. While telemedicine may seem like a very modern concept, it has been in existence since the early 20th century, though it has grown exponentially and become more integrated into healthcare delivery over the past two decades.

In 1906, the inventor of the electrocardiogram published an article describing a telecardiogram. More practically, since the late 1920s, medical experts and specialists have used radio to give medical advice. The state of Alaska was perhaps the first to actively use telemedicine in its healthcare system, owing to its vast geography and the large number of residents living in villages far from cities. Most villages were served by community health workers who would travel to remote communities, conduct audiometry and otoscopy examinations, and then transmit information to medical specialists in Fairbanks or Anchorage. Those specialists would then determine whether a patient with negative test results needed to travel for in-person care. This early form of telemedicine has since evolved dramatically. Today, high-definition video systems allow medical experts and specialists to engage with one another and with patients in real time, and peripheral devices facilitate both sound communication and remote patient examination (Board on Health Care Services, 2012).

Store-and-forward technologies have also greatly improved over recent years, increasing their role in healthcare delivery. In optometry and ophthalmology, for instance, practitioners are using non-mydriatic cameras to perform retinal screenings on patients with diabetes without requiring pupil dilation, increasing screening rates. Teledentistry has similarly been used by dental hygienists and dentists to deliver improved oral healthcare. Perhaps the largest areas of telemedicine application are psychology and teledermatology. Since the early 1990s, multiple reports have shown that diagnoses made through teledermatology have a high rate of agreement with those made by in-person specialists, and patients treated via teledermatology report high levels of satisfaction with their care. Nevertheless, some dermatologists have expressed concern about the increasing role of technology in their field (Board on Health Care Services, 2012).

Reports and studies similarly show that mental health diagnoses made using telehealth technologies align closely with in-person diagnoses, and patients report satisfaction with telehealth-based mental health treatment. It is expected that telemedicine equipment will continue to improve, making telemedicine even more prominent in healthcare delivery.

As telemedicine grows in prominence, in-person care faces both new opportunities and new challenges. There is a need to examine how both modalities can be used concurrently to deliver quality care everywhere, how telehealth models can be streamlined for broader adoption, and how evidence-based standards of care can be established and maintained — particularly for practitioners serving remote and rural communities.

Relevant Laws and Regulations

Healthcare is heavily regulated in most countries, and telemedicine is no exception. Equipment must meet several regulatory standards before being approved for use, including those governing patient privacy and the sharing of patient data.

One of the primary laws governing healthcare technology in the United States is the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The law regulates patient data privacy, and its Privacy Rule is especially relevant to telemedicine. This rule protects patients' personal health information by requiring vendors, providers, health plans, and any other party handling patient data to inform patients about intended data sharing and to obtain their consent before doing so.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its associated Quality Payment Program (QPP) include two provisions relevant to telehealth. The first, the Advanced Alternative Payment Models section — which includes coalitions such as Accountable Care Organizations — indirectly rewards efficient and high-quality care; experts expect telehealth payment structures to fall under this section. The second is the Merit-Based Incentive Payment System (MIPS), which tracks quality of care, cost, advancing care information, and improvement activities, and is expected to affect telehealth reimbursement as well.

Many state-level laws also govern telemedicine. For example, Connecticut has enacted telemedicine legislation that permits the prescription of controlled substances for the treatment of substance abuse and mental health conditions via telehealth. In summary, telemedicine is subject to a broad and complex framework of federal and state regulations.

Review of Telemedicine Follow-Up After Bariatric Surgery

In Telemedicine Follow-up After Bariatric Surgery, Meyer et al. (2018) investigated the use of telemedicine for standard post-operative follow-up among patients who had undergone bariatric surgery. The research team gathered satisfaction surveys to compare patient satisfaction between telemedicine video visits and in-person visits. The study was a retrospective review drawing on medical data from a single surgery center.

Data were collected from the Kaiser Permanente Health Connect Electronic Medical Record System. The researchers specifically examined hospital readmission and emergency room visit rates within 30 days following bariatric surgery, gathering data from twenty-one months both before and after the implementation of a telemedicine video visit mobile application. Because the research relied on primary data from medical records, the methodology is regarded as scientifically rigorous. The findings showed that telemedicine visits produced significantly higher patient satisfaction scores than in-person visits.

The study concluded that telemedicine video visits are both efficient and safe for post-surgery follow-up, as they are associated with high patient satisfaction and do not increase hospital readmissions or emergency room visits. This finding aligns with Sada et al. (2019), who found that surgical complications are identified not primarily through scheduled clinic visits but through patients independently recognizing a need for medical care. Together, these findings support the safety of telemedicine as a follow-up modality for bariatric surgery patients.

Conclusion

Research reveals that telemedicine can be highly effective. It is not a substitute for in-person care, but rather a substitute for the traditional face-to-face patient encounter. It is in many ways a superior alternative for routine and follow-up interactions because it eliminates unnecessary logistical burdens, is convenient and cost-effective, and makes it easier for patients to access specialists. In short, it makes the patient–provider interaction more manageable and more pleasant for patients.

Telemedicine also enables people in rural or remote areas to access specialized care that would otherwise be unavailable to them. For post-operative patients, telemedicine allows convenient, location-independent follow-up and supports better outcomes. It helps registered nurses and physicians follow up with patients more closely and deliver more holistic care by making patients easier to reach and monitor on a regular basis.

Finally, in light of the COVID-19 pandemic, telemedicine has taken on even greater importance by reducing the risk of infection associated with traveling to and attending clinical appointments. As technology continues to improve and regulatory frameworks continue to evolve, telemedicine is likely to become an even more central component of modern healthcare delivery worldwide.

References

Meyers, A. J., Pontarelli, E., Dutta, S. K., Grinberg, G., & Yenumula, P. R. (2018). Telemedicine follow-up after bariatric surgery. Surgery for Obesity and Related Diseases, 14(11), S168.

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Conklin, T. P. (2002). Health care in the United States: An evolving system. Michigan Family Review, 7(1).

Board on Health Care Services; Institute of Medicine. (2012). The evolution of telehealth: Where have we been and where are we going? In The role of telehealth in an evolving health care environment: Workshop summary. National Academies Press.

Sada, A., Asaad, M., Reidt, W. S., Kellogg, T. A., Kendrick, M. L., McKenzie, T. J., & Habermann, E. B. (2019). Are in-person post-operative clinic visits necessary to detect complications among bariatric surgery patients? Obesity Surgery, 1–4.

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