Dr. Joseph Kvedar’s Three-Decade Quest: Mainstream Telemedicine to Ensure Healthcare Access for All

With patients singing its praises, citing improved clinical outcomes and lower costs, Harvard Medical School Professor Dr. Joseph Kvedar explains why telehealth can help address some of healthcare’s most vexing challenges.

Once again, we have a healthcare problem. Despite progress made by the Affordable Care Act towards universal coverage and a period of modest healthcare cost increases between 2010 and 2015, costs are rising quickly again. What’s different this time, and even more concerning, is the growing disparity between healthcare demand and availability.

In fact, the two overarching trends impacting healthcare are moving in opposite directions: Even as the U.S. ages, with one in six Americans now 65 and older^[1], clinicians are exiting the field. The number of doctors will decline by 7%^[2] and nurses by 4%^[3] by the end of the decade. Hospitals are also being shuttered, resulting in an 8% decline in hospital beds^[4] in the years ahead.

Dr. Joseph Kvedar, one of telemedicine's foremost advocates, believes the mainstream adoption of telehealth is long overdue. Embracing and encouraging it will mitigate the shortfall of clinicians and facilities and address a host of other challenges. Nor does he see telehealth as some new, untested invention. As a leading authority in the field, recently chairing the American Telehealth Association (ATA) and currently serving as an active clinician at Massachusetts General Hospital and Professor of Dermatology at Harvard Medical School, Dr. Kvedar has been actively involved in telehealth for more than three decades.

What, though, will it take to drive telemedicine adoption? According to Dr. Kvedar, patients already want telehealth and give it high marks. They are also more likely to stick with their treatment when telemedicine is central to the program, and this consistency of care often delivers better clinical outcomes.

Patients need to be more vocal, demanding telehealth from their healthcare providers. “It doesn’t occur to patients,” says Dr. Kvedar, “that they should be asking their doctor to make virtual care an option for their treatment.”

He likens the growth of telehealth to the adoption of other transformative healthcare advances that were slow to catch on. The move to laparoscopic surgery is his favored analogy. “Today, a patient would fully expect their surgeon to do minimally invasive procedures to avoid a four-inch incision, whenever possible,” he says. “There needs to be a day, soon, when patients expect their clinicians to feature telemedicine as an extension of their practice.”

From my perspective as someone with a large scar across my abdomen to remove my appendix in the days before widespread laparoscopic surgery, his logic is impossible to fault. Likewise, taking hours out of my day for a doctor visit, compared to interacting with the physician via an app or video chat in a few minutes between meetings, strikes me as a no-brainer.

I’m also the CEO of a company that develops AI technology for telemedicine companies. The innovations and efficiencies that come out of their operating models are undeniable. This efficiency has led to numerous cash-pay telemedicine services. You might think that patients are resistant to paying out of pocket until you realize the costs are often in-line with an average copay.

Despite this good news—which you’d expect everyone from patients to insurers to the government to get behind—one issue telehealth is navigating is the complex reimbursement landscape. Advocates are pushing for changes, but disparities in reimbursement persist, hindering equitable access to telehealth services.

To help policy makers understand why they need to address these disparities, Dr. Kvedar calls for a collaborative and multidisciplinary approach to prove the case for telemedicine. “Robust research efforts are essential to demonstrate telehealth's effectiveness, clinical outcomes, and convenience,” he says. “Investing in evidence-based research and data will challenge stubborn notions among some in the medical community that telemedicine somehow lessens the quality of care.”

Enhancing healthcare’s technology infrastructure and streamlining telehealth integration are crucial to accelerate further adoption. “Improving the usability and interoperability of telehealth platforms will make it easier for both clinicians and patients to embrace telehealth as a viable care delivery option,” says Dr. Kvedar.

Here our conversation turns to Vouched’s AI and the complexity of managing patient identity in telehealth. Dr. Kvedar agrees that patient identity is mission critical for remote care.

“When a patient is standing in front of me in the office, we immediately ask them for their date of birth and to confirm their name.” It’s not so simple in telehealth. The example he uses to illustrate telehealth’s need for thorough patient identity verification, congestive heart failure, is as surprising as it is critical. “The way you monitor [congestive heart failure] is with daily weight because most of our weight is water. If your heart isn't working, you're going to put on more fluid and weight. You need to match those devices with the person’s identity, or some patients will come up with ways to falsify the reading.”

Falsifying identity data to fool your doctor might sound outlandish. The reality is quite different. Patients’ motives for tricking their physician range from guilt for not sticking to their treatment to obtaining harmful or addictive prescriptions to outright medical or financial fraud.

In a world of large, complex health systems, and with electronic medical data shared across numerous providers, secure, sophisticated identity data is also increasingly important for safe patient treatment and to maintain standard-of-care requirements. This complexity contributes to the alarming statistic that 86% of clinicians have witnessed or know of medical errors due to patient identity mistakes.^[5]

We can all agree that healthcare needs to improve, and telehealth has a large and growing role in reducing healthcare costs, improving patient outcomes, and increasing access. The ubiquity of sophisticated devices like smartphones and access to video chat means that telehealth can be more abundant and better than ever.

To achieve that outcome, healthcare professionals, policymakers, and technology innovators have a collective responsibility to champion telehealth as a transformative force in healthcare delivery.

Dr. Kvedar puts it more forcefully: “Eventually, clinicians who have been too busy to add telehealth to their practice will see it as an absolute necessity—or their patients will go elsewhere.”

^[1] U.S. Census Bureau, 2023

^[2] Association of American Medical Colleges, 2021

^[3] National Council of State Boards of Nursing, 2022

^[4] American Hospital Association, 2023

^[5] National Patient Misidentification Report, 2016