The Modern-Day Housecall: Pros and Cons of Digital Health Care

During the COVID-19 pandemic, many people were either unable or unwilling to see their doctors in person, paving the way for more advancements in, and acceptance of, telehealth. According to a recent ValuePenguin study, ​​22% of Americans utilized some form of telehealth this year, including phone calls and video conferencing.

"For the vast majority of patients, telehealth works just as well as face to face, and in fact, we see lower attrition rates if it’s remote," says Dr. David Mohr, director of the Center for Behavioral Intervention Technologies at Northwestern University. Specifically, it’s useful for monitoring and counseling patients who have chronic conditions and addressing mental health issues. There’s also evidence to suggest that "remote ICUs" have lower inpatient and ICU mortality rates.

Telehealth, though, can mean a myriad of things, ranging from therapy via text message to talking to a doctor on the phone to texting a health coach. And as with any technological advancements, there’s always a healthy dose of misgivings and mistakes mixed in with progress.

Here’s what you should know if you’re looking to improve your health with a digital option.

Access and acceptance of digital solutions is growing

Telehealth is, by and large, cheaper than traditional appointments, costing an average of $110 less than in-person visits. In some cases, health insurance companies waive copays for those visits, too, and there aren’t any transportation costs associated with it.

And while Dr. Mohr specifically points to the mental health field as being the recipient of increased interest in telehealth, particularly as a result of the coronavirus pandemic, the broader landscape has seen greater acceptance as well. In late 2021, a bill was introduced that would end location restrictions for Medicare recipients receiving telehealth services. In August, the National Cancer Institute announced it will award $23 million to four academic institutions to research the role of telehealth in cancer-related care. Plus, the Agency for Healthcare Research and Quality (AHRQ) indicated an interest in further evaluating the role of telehealth and granted $2 million for the centers of excellence in telehealth implementation.

Telehealth options aren’t as common as they could be in the U.S., but there are plenty of health care systems outside of the country that are doing digital health care well, providing something of a blueprint for American-based services.

In England, for example, the National Institute for Health and Care Excellence provides guidelines around evidence-based recommendations for health and care, including a special division dedicated to digital health care. And in Australia, telehealth already plays a critical role in the universal health care system.

So it’s reasonable to say that a well-integrated telehealth system is possible — though there are certainly obstacles to implementing it in the U.S.

Lack of oversight can lead to lack of accountability

When it comes to the business of health care, lack of oversight can, and has, lead to conflicts of interest.

"A lot of these digital health services are provided by for-profit companies," says Dr. Mohr. "[People] go into it because they care about mental health, but the drivers can incentivize companies to begin to cut things, or do things in ways that are not helpful or are potentially harmful."

"One of the things we need," he added, "is evidence-based guardrails that can provide information to [health service] payers about what is, or is not, a good system." Currently, the Federal Drug Administration (FDA) oversees medical apps but doesn’t regulate health and wellness apps. Hence the surge in apps that suggest a future with ‘less stress,’ or other broad wellness claims but not as many that say they’re designed to treat specific conditions like depression or anxiety.

Beyond quality control concerns, costs for treatment can also be a deterrent, as apps may not be covered by traditional health insurance. Additionally, users in lower income households might not have access to the solid internet connection or stable phone line required for telehealth options.

Evidence-based research is key when identifying quality digital health options

Apps can be helpful, but there are some bad actors out there, as Dr. Mohr warns. (He recalls hearing about an app that recommended drinking alcohol to stave off an oncoming manic episode. Spoiler alert: that’s not a good idea.)

If your telehealth appointment requires access to apps that are not directly connected to your doctor’s office, it’s important to make sure it uses evidence-based treatment, especially if you’re using it to treat a potentially serious condition.

For mental health options, One Mind PsyberGuide can help. It features mental health app reviews from experts, and sorts apps into categories such as stress and anxiety, PTSD, chronic pain, cognitive training, mood disorders and obsessive-compulsive disorder. It rates apps based on their credibility, user experience and transparency.

Another thing to look for is support from a real person as part of the experience.

"If you just give somebody an app, that tends not to be very effective," says Dr. Mohr. "Some of us have probably downloaded an app for something — it’s fun for a week or two and then you lose interest. If they know that there’s a human being on the other end, that tends to increase use."