COVID-19 pandemic has caused a rapid transformation of the health care delivery system and surgical services across the globe. Millions of elective surgical procedures have witnessed a suspension and surgeons adopted telemedicine for preoperative, follow-up, and emergent surgical care visits to limit the exposure and transmission of COVID-19 between patients and clinicians.

Although surgical care showed some return to normalcy in the summer of last year, the resurgence of COVID-19 cases in the fall and winter again again led to implementation of lockdown.

Substantive changes in regulations permitting telemedicine were made during the pandemic. The most important being the US Centers for Medicare & Medicaid Services, March 2020 (1135 Waivers) making reimbursement of in-person and telemedicine visits equal, which was then followed by other third-party payers. 

Thus hospitals and surgical departments focused on widespread delivery of care by telemedicine. Synchronous (eg, videoconference telemedicine visits) and asynchronous (eg, text messages, email, patient portal) telemedicine modalities were widely utilized, while  remote patient monitoring that used technology like wearable devices to monitor patients outside conventional clinical settings was least popular.

A major drawback of telemedicine is that it hampers a surgeon’s ability to accurately assess surgical physical findings, reduces personal communication and interaction with patients.  

The advantages include improved access, continuity of care,  reduced disparities, and immediate availability (if needed). It saves travel costs for patients and is not limited by the location of the patient or the doctor.

Whether telemedicine would take the place of or supplement in-person visits will be influenced by three factors namely interpersonal relationships requiring targeted implementation of telemedicine, technological innovations in diagnostic modalities to augment its diagnostic capacity and hassle-free fee-for-service payment models, which can be achieved if the insurance companies continue coverage for telemedicine services.

Telemedicine has become a part of surgical services and a wider health care system due to the COVID-19 pandemic, but in-person health care visits still dominate. However, telemedicine has proven itself to be an alternative modality to engage with patients during the COVID-19 pandemic and thus is invaluable.

But, surgical clinical workflow requires further refinement and customization to be adapted routinely, accompanied by much targeted implementation strategies and sustainable reimbursement models.

Ghomrawi HMK, et al. Telemedicine in surgery—beyond a pandemic adaptation. JAMA Surg. Published online July 14, 2021