Researchers Explore How the Surge in Telemedicine Might Impact Diagnosis

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The TeleDx project, a literature review and series of interviews, found that health systems surveyed patient satisfaction with telemedicine but did not measure the accuracy of diagnosis presented via telemedicine.

“We found that many patients like the convenience of telemedicine, but we also need more research into who is being left behind in the process, such as small practices or people without access to high-speed internet.”

Not enough has been done to understand the accuracy or efficacy of diagnoses delivered by telemedicine according to a new issue brief from the Society to Improve Diagnosis in Medicine (SIDM). The TeleDx project, a literature review and series of interviews, found that health systems surveyed patient satisfaction with telemedicine but did not measure the accuracy of diagnosis presented via telemedicine.

The TeleDx project identifies a critical gap in the health system’s understanding of telemedicine as an estimated one in ten diagnoses are incorrect. These inaccurate or delayed diagnoses affect more than 12 million Americans each year with most people experiencing an inaccurate or delayed diagnosis at some point in their life. Given the growth of telemedicine during the pandemic, understanding how telediagnosis impacts diagnostic quality and safety is critical.

“We found that telediagnosis has potential, although there is still much to learn about how virtual diagnosis can be done most effectively,” said Suz Schrandt, JD, senior patient engagement advisor at SIDM, who served as the principal investigator on the project. “We found that many patients like the convenience of telemedicine, but we also need more research into who is being left behind in the process, such as small practices or people without access to high-speed internet.”

SIDM launched the TeleDx project to understand the current landscape of telemedicine and diagnosis research and practice, and the on-the-ground experience of patients, clinicians, and others. Lingering research questions about telediagnosis fell into four categories:

  • Technology—what technology obstacles do certain patients face and how can telemedicine create greater access for patients without primary care clinicians and specialists nearby?
  • Clinical experience—how can telemedicine replicate the benefits of in-person visits through the screen and how can telehealth simplify and make routine testing and evaluation more efficient?
  • Measuring effectiveness—could patient surveys ask about diagnostic accuracy and could virtual care provide a mechanism for better tracking/reporting missed diagnoses?
  • Forecasting—how will the effectiveness of telediagnosis be assessed for reimbursement purposes and how will legal and regulatory changes such as medical malpractice and scope of practice laws impact the future of telemedicine?

Across all of the project interviews and listening sessions, there was universal support for keeping telehealth in some capacity, particularly for facilitating easier access to care among the patients. However, clinicians and health system representatives expressed uncertainty around how to measure effectiveness and were grateful for relaxations in payment regulations during the pandemic.

“Overall, research priorities regarding the effectiveness of telediagnosis must focus on what symptoms require in-person assessments; what the right mix of in-person and virtual care looks like; who is being left behind in the expansion of virtual care; and what determines success or failure in telediagnosis,” said Mark Graber, MD, FACP, founder and president emeritus of SIDM, and co-author of the issue brief.

Researchers reviewed 2,597 abstracts and 210 full texts from the last three years, along with blogs, Twitter chats and other secondary literature texts. Researchers conducted a 10-year lookback at an additional 203 abstracts and 35 full texts. SIDM obtained diverse perspectives by interviewing patients and caregivers, clinicians, clinical practices, telemedicine industry reps, and hospital/health system leaders.

This project was funded through a Patient-Centered Outcomes Research Institute (PCORI) Engagement Award Initiative (EAIN-00177). The content does not necessarily represent the views of PCORI, its Board of Governors, or Methodology Committee.

About the Society to Improve Diagnosis in Medicine
The Society to Improve Diagnosis in Medicine catalyzes and leads change to improve diagnosis and eliminate harm from diagnostic error. We work in partnership with patients, their families, the healthcare community and every interested stakeholder. SIDM is the only organization focused solely on the problem of diagnostic error and improving the accuracy and timeliness of diagnosis. In 2015, SIDM established the Coalition to Improve Diagnosis, to increase awareness and actions that improve diagnosis. Members of the Coalition represent hundreds of thousands of healthcare providers and patients—and the leading health organizations and government agencies involved in patient care. Together, we work to find solutions that enhance diagnostic safety and quality, reduce harm, and ultimately, ensure better health outcomes for patients. Visit http://www.improvediagnosis.org to learn more.

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