The American Telemedicine Association describes telemedicine as “the remote delivery of health care services and clinical information using telecommunications technology.” Telemedicine is also referred to as telehealth or virtual health and includes all channels using the Internet, wireless, satellite and telephone — and as an industry, it is growing exponentially.
In late December 2013, Forbes reported an HIS analyst predicted that the U.S. telemedicine market will grow from $240 million today to $1.9 billion in 2018 — an annual growth rate of 56 percent. Earlier this year, in May of 2015, FierceHealthIT quoted a market intelligence firm, Tractica, report that said “the number of consumers using home health technologies globally will grow from 14.3 million in 2014 to 78.5 million by 2020.”
Obviously the telemedicine industry is growing, but is there a consumer demand for it?
Do consumers want to have the ability to securely email or text their providers? Do they want to be seen via video rather than in person? Do they think these services would benefit their health? Are they already engaged with providers using these channels? To answer those questions, iTriage launched an in-app survey to gather information from its tech-savvy users. The 27-question survey was made available to all current mobile iTriage users on iOS and Android phones and tablets between July 17, 2015, and Aug. 31, 2015. The random sample consisted of 1,617 total responses. Demographically, survey respondents ranged in age from 18 to 75+ — with the largest percentage (43%) falling between 45 and 64, slightly more than half were female (55%), and most had health insurance (87%) and a primary care provider (80%). Additionally, the findings indicate respondents tend to visit their providers fairly infrequently, with a majority (52%) going to see a health care provider three times/year or less.
What Consumers Said
Overall consumers don’t seem to be in any hurry to communicate with providers using nontraditional channels. Given that 51 percent find it easy or very easy to get in contact with their providers, maybe they don’t see a reason to use methods other than what they have always used. However, 19 percent of them did report that it was difficult to get in contact with their health care providers, so that subset may be open to trying new methods of health care communication.
When they do get in for an office visit, 54 percent of respondents cited short appointments with limited face-to-face time as a barrier to communication and 20 percent thought a lack of technology was a problem.
In terms of communicating with their provider, respondents continue to have an affinity for the face-to-face visit at 63 percent, followed closely by a preference to communicate via phone at 59 percent. Face-to-face communication may still be valued because most people don’t see their provider more than once or twice a year and value the in-person interaction. As popular as video visits are in industry media, they came in dead last at only 8 percent.
Although respondents are avid text and email users in general — 70 percent use email daily and 78 percent use texting daily, they are not necessarily accustomed to using those channels to reach their health care providers. Yet even in the information age, only 47 percent of respondents report having the ability to email and/or text their providers. Of those, only 52 percent have ever used these channels to contact their provider. Pretty evenly across all age groups, approximately half (47%) the people who have the capability to email or text their providers never use it. Yet, 14 percent switched providers specifically to be able to communicate with their providers this way.
Of those that do not have access to email or text as a method to communicate with their provider, 75 percent would like to be able to email/text provider. Almost 60 percent (59%) think the ability to do so would benefit their health, but 25 percent are unsure, and 16 percent don’t think it would be beneficial. Almost half (45%) of these people would consider switching to a provider that offered text/email as a communication channel.
Regardless of having the ability to email or text their providers, 60 percent of respondents believe having the capability to communicate with providers via text or email would benefit their health.
When it comes to using video as a general form of communication, 42 percent of respondents said they never use Skype, FaceTime or other video services — however 20 percent use it more than once a week. Again, usage in normal life doesn’t appear to translate to usage in communicating with their providers. Most people (52%) don’t even know whether their provider offers video visits. Of the 4 percent who can access to video visits, only slightly over half (53%) have actually used the service. Sixty-five percent of them labeled their experience with video visits as good or great, but nearly a third (30%) didn’t see any benefit in having the ability to communicate with providers in that way.
When looking at all survey respondents, only 20 percent think they would benefit from video visits — 47 percent are not sure, and 33 percent do not think they would benefit from this service. This means 80 percent of people are not convinced having access to video visits would benefit their health. Perhaps this indicates the need for a public education effort highlighting the value of virtual health.
Key groups have distinct preferences
Three distinct groups surfaced with responses that differed significantly from the full set of survey respondents. These groups included frequent flyers or people who see a provider at least once a month, the very young (<24) and the elderly (>65).
Twenty percent of respondents visit a health care provider at least one time every month. We looked specifically at their data because they use the health system more than most people. When comparing these “frequent flyers” to the full set of respondents, more of them are female (60% compared to 55%) and about 7 percent more of them have a primary care physician (87%). This group also appears to be very loyal to their own doctor — 43 percent have been seeing the same provider for 5 to 10 years.
Over a third would consider switching providers if they could email/text and 4 percent already have made the switch for that reason.
This group prefers to communicate with their doctor via the phone (61 percent), while 58 percent also said they favor face-to-favor. Texting and email tied at 41 percent. An online patient portal scored 19 percent and again, video visits came in last with 9 percent. Despite incentives and surprisingly for a population of frequent flyers, 50 percent say they do not have access to a patient portal.
Frequent flyers are also split 50/50 on having the ability to email/text a provider. Of those that can send messages to their providers, 64 percent think this ability is beneficial to their health, yet 35 percent never use it.
Seeing providers so often, one might think this group was ripe for video visits. However, only 5 percent said their provider offered the service, while 47 percent didn’t know if video visits were an option. In fact, 93 percent of them had never communicated with their provider using video, and weren’t confident they would benefit from that service — 22 percent said “yes,” it would be beneficial; 35 percent said “no;” and the largest percentage, 43 percent, said “possibly.”
The Young and The Old
Only 61 percent of the <24 segment reported having a primary care physician, compared to 92 percent of the 65+ segment. When asked if they would be willing to switch providers to gain access to the ability to email or text their provider, 56 percent of the younger group was willing to switch — the highest percentage of all the age groups — while the elder group had the lowest number willing to switch at 33 percent.
In contrast, face-to-face and phone were almost equally preferred by the 65+ group at 59 percent and 60 percent respectively. Text messaging dropped from 36 percent with overall respondents to just 25 percent with the elder group. As expected, video was even less popular (5%) in this segment.
One additional surprise was that the elder group was overwhelmingly male at 67 percent — the only age group other than 55–64 where the men were the majority. In contrast, the younger group was dominated by females at 76 percent — the largest majority of all the age groups.
What’s ahead for telemedicine?
Consumers are taking a wait-and-see approach and not adopting new channels as rapidly as the potential for telemedicine might suggest. Largely, it appears consumers are fairly satisfied with the status-quo of contacting their providers via phone and face-to-face visits. Because face-to-face and phone are preferred nearly equally when looking at the full sample of iTriage in-app survey data, does that indicate an apprehension with newer communication technologies like video and text? Or is the lack of usage just a sign that we are still early in the adoption process?
Will consumers eventually recognize the value and begin to demand the ability to communicate with their providers using new technology?
Maybe consumers aren’t sold on the technology just yet, after all they don’t use video communication that often in their daily lives either. Maybe they want the intimacy and relationship that’s created when seeing a provider face-to-face or being able to talk with them on the phone. Perhaps consumers don’t understand how a video visit would work — what conditions it would treat, how the provider can diagnose them without an in-person examination, etc. — or they may anticipate an extra cost associated with such a service.
Whatever the reason, consumers seem slow to adopt these new telemedicine technologies to communicate with providers. It will be interesting to see who ends up forcing the use of these communication channels. Will the burden of proving the value of these technologies fall on the health care provider? The insurance payer? Or will consumers eventually recognize the value and begin to demand the ability to communicate with their providers using new technology?
Today, for the most part, consumers appear to underestimate the value in these new communication methods. Repeatedly the findings lead to the need to educate the consumer on the benefits of telemedicine — especially video visits. Right now, consumers just aren’t making the connection between better access to their provider and better health.