Dear Editor,
We greatly appreciated the insightful review, “Telemedicine and Its Impact on Academic Medical Centers: A Narrative Review,” published in your recent issue.[1] The article highlights the many benefits of telemedicine, particularly its role during the COVID-19 pandemic, when its adoption became widespread. The review emphasizes key advantages, including cost-effectiveness, rapid service delivery, improved access to specialists in remote areas, reduced patient travel expenses, and better utilization of healthcare resources. It rightly advocates for the thoughtful and universal adoption of telehealth.
The introduction effectively outlines telemedicine’s role in primary care, particularly in addressing geographic challenges faced by rural areas in the United States. Telemedicine is presented as a convenient pre-screening tool before in-person visits via smart devices, enhancing accessibility. However, rural areas often experience poor network coverage, which can impede the effective delivery of telehealth services. Moreover, telemedicine cannot replicate essential components of in-person consultations, such as symptom-based physical examinations, palpation, percussion, and auscultation—critical elements for comprehensive care.[2] This limitation poses risks of missed diagnoses or incomplete care.
While the authors suggest telemedicine as an initial step before in-person consultations, this approach may conflict with evidence-based medicine principles. Patients often seek medical care based on symptoms or routine appointments, during which physical examinations frequently reveal underlying conditions. Additionally, telehealth services may incur extra costs for patients who subsequently require an in-person visit, creating financial burdens. Privacy concerns also remain significant, as sensitive health data could be vulnerable to security breaches.[3]
Telehealth risks widening existing healthcare disparities, especially among minority populations and those with limited access to technology or reliable internet.[4] Rather than addressing fundamental deficiencies in rural healthcare infrastructure, telemedicine might be perceived as a long-term substitute rather than a temporary solution, potentially delaying the development of robust healthcare systems in underserved areas.
The methodology presented in the review overlooks the potential role of telehealth in urban settings. While access to healthcare is generally more available in cities, long waiting times can deter timely care. Patients might turn to telehealth to save time and money, but this approach risks missing critical examination findings, compromising care quality.[5]
The review references a study by Kavitha et al.,[5] suggesting that 94% of podiatry cases can be managed via telemedicine. However, the cited study notes that 94% of cases fall into the “stable” category, implying they could potentially be treated using telemedicine, with some uncertainty. Moreover, the study involved only three cases—an insufficient sample size to justify extrapolation to a national scale.
In its discussion on ICU telemedicine, the review highlights its effectiveness in reducing cross-contamination risks and maintaining high sepsis care standards. We agree that tele-ICU models can enhance care in such controlled environments.
In conclusion, telemedicine is an emerging and valuable healthcare tool that gained significant traction during the COVID-19 pandemic. It has proven effective in specific scenarios, such as addressing minor conditions, facilitating follow-ups, and providing patient reassurance. However, telehealth should complement, rather than replace, traditional in-person care.
To maximize its potential, we recommend establishing a regulatory body to oversee telehealth audits and develop guidelines for its use. Insurance coverage for telehealth services should also be standardized, with reduced costs reflecting the lower resource demands compared to traditional in-office visits. Such measures will ensure telemedicine evolves as a reliable and equitable adjunct to modern healthcare systems.
Author contributions
RH: Conceptualized the idea, designed the article, manuscript writing and revisions. RH: designed the article, manuscript writing and revisions. JC: Conceptualized the idea and critical review.
Conflicts of interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding Statement
The author(s) received no financial support for the research, authorship, and/or publication of this article.
References
- 1.Weng B, Morrissey R, Zafar M, Siddiqui S, DeVrieze B, Jabbar ABA, et al. Tele-medicine and its impact on academic medical centers: A narrative review. J Family Med Prim Care. 2024;13:5472–5. doi: 10.4103/jfmpc.jfmpc_886_24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Almathami HKY, Win KT, Vlahu-Gjorgievska E. Barriers and facilitators that influence telemedicine-based, real-time, online consultation at patients'homes: Systematic literature review. J Med Internet Res. 2020;22:e16407. doi: 10.2196/16407. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Hall JL, McGraw D. For telehealth to succeed, privacy and security risks must be identified and addressed. Health Aff (Millwood) 2017;33:216–21. doi: 10.1377/hlthaff.2013.0997. [DOI] [PubMed] [Google Scholar]
- 4.Truong M, Yeganeh L, Cook O, Crawford K, Wong P, Allen J. Using telehealth consultations for healthcare provision to patients from non-Indigenous racial/ethnic minorities: A systematic review. J Am Med Inform Assoc. 2022;29:970–82. doi: 10.1093/jamia/ocac015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Kavitha KV, Deshpande SR, Pandit AP, Unnikrishnan AG. Application of tele-podiatry in diabetic foot management: A series of illustrative cases. Diabetes Metab Syndr: Clin Res Rev. 2020;14:1991–5. doi: 10.1016/j.dsx.2020.10.009. [DOI] [PMC free article] [PubMed] [Google Scholar]