With a staggering growth rate since the onset of COVID-19, telemedicine has emerged as a primary method for HCP-to-patient interaction. According to Allied Market Research, the Telemedicine Market generated $40.2 billion in 2020 and is projected to generate $431.82 billion by 2030 with an estimated 25.9% from 2021 to 2030. While many larger clinics and hospitals are adopting telemedicine practices, a wide range of new telemedicine and concierge telehealth clinics are appearing. These clinics, while still offering products, are primarily growing through offered services and products. Though beneficial for a variety of reasons, the sudden increase in telemedicine usage throughout the US has ushered in a need for new virtual MSLs, virtual-engaging MSL, and expanded virtual training for current MSLs to ensure adequate scientific exchange and medical education in otherwise limited person-to-person practices.
Advantages and Shortcomings of Adopting Telemedicine Practices
Many HCPs who took the leap into telemedicine are encouraged by the opportunity to see patients who could remain in the comfort of their homes during the pandemic. It also gave HCPs a new avenue to provide care for the underserved and underinsured, resulting in an overall improvement in medical equity. Anecdotally, as medical director of a clinic that began as a health optimization clinic, we transformed into a front-line clinic diagnosing new pathologies. We identified countless new diagnoses of diabetes, depression, adrenal and pituitary tumors, and many other pathologies. These patients would certainly have delayed diagnoses otherwise. Compared to my full-spectrum practice, telemedicine had a new atmosphere to acclimate to, with many advantages and barriers to providing care. The team-based approach to healthcare is especially crucial in telemedicine, largely because the “swiss cheese model” of medical errors has larger holes. The HCP is the end-stop, or the rind, in this paradigm of errors. This is particularly difficult without a nurse to provide an extra layer of support. These holes should be narrowed through the use of technology, clinic staff, and medical affairs personnel. Like any clinic, a telemedicine clinic must consist of experienced healthcare professionals, from the HCP to nurses to office staff. Close-the-loop communication and stringent documentation are vital given the difficulty of virtual handoffs.
The Role of Medical Affairs
Without question, medical affairs and MSLs are necessary for the proper function of telemedicine clinics. One distinct advantage of using telemedicine is that the MSL
and their collaborators have access to a new patient population and modality for conducting clinical trials and surveys remotely. Assuming the providers have an adequate virtual clinic infrastructure, the role of the MSL would be identifying and assessing patient populations for compliance and assessing the performance of HCPs in a virtual setting. Both of these tasks require MSLs to understand how patient and HCP relationships are fostered via virtual visits. Together, the HCPs and MSLs will be able to rapidly identify and address pinch points that are deleterious for patient care. This will allow regulatory bodies and other virtual practices to ensure patient and practice compliance to best telemedicine practice guidelines.
MSLs and HCPs can also help to standardize telemedicine practice across state lines, allowing improved access to telehealth for patients in health care deserts. The MSL is invaluable for helping navigate market intel reports to help identify trends and needs. The MSL will be privy to observing an untapped patient population that can provide inspiration for investigator-initiated trials. The emerging use of HIPAA-compliant biometric data to help monitor patients remotely will bring improved trial opportunities. During the pandemic, KOL’s have certainly been open to engaging with MSL virtually. Thought leaders in telemedicine are apt to be equally receptive (Figure 2). Virtual MSLs would presumably travel significantly less, and their success would rely predominantly on their ability to communicate virtually. In the coming years, we may see a shift in virtual MSLs engaging via virtual reality.
Limitations with Telemedicine & How Medical Affairs Can Help
While there are many benefits to adopting telemedicine practices, there are also limitations to the role of medical affairs in telemedicine that can be addressed with additional training. The main barrier to success for MSLs in telemedicine is technology. There is a need to investigate the “wild west” heterogeneity of virtual infrastructure, including HIPAA compliant EHRs, televisit meeting platforms. It is more difficult to access tools such as PDMPs to study rates of adherence to filling prescriptions without these being built-in to the EHR. Another barrier that will remain is the lack of a physical exam which robs the HCP and MSLs of valuable objective data. The use of non-standard EHRs can make collecting data difficult. Despite these limitations, we hope that the medical affairs community is inspired to take the leap and improve the booming telemedicine community. For MSLs, understanding emerging trends in telemedicine will allow for prompt engagements and medical education with providers in specific therapeutic areas.
Telemedicine has emerged as a permanent healthcare practice, having been solidified during the onset of the COVID-19 pandemic. HCPs utilizing telemedicine practices have increased patient reach. In turn, there is a growing need for virtual MSLs to help
disseminate scientific knowledge virtually. Traditional exchanges (i.e., office visits, didactic in-person lectures, and training) may now often occur virtually and require the MSLs to be well-trained in maneuvering virtual landscapes. There may be several unique opportunities for medical affairs professionals and HCPs to conduct virtual clinical trials in the future, particularly in non-traditional patient populations. In addition, it is crucial for MSLs to ensure regulatory compliance and proper telemedicine best practices by educating clinicians who have limited in-person interactions with other HCPs.
Disclaimer Alec McCarthy is an employee of Merz Aesthetics. His views are his own and do not represent those of his employer.
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 “Telemedicine Market Size and Industry Forecast By 2030,” can be found under https://www.alliedmarketresearch.com/telemedicine-market, n.d.
 S. H. S. Lai, C. Q. Y. Tang, Bone & Joint Open 2020, 1, 203.
 Fu Z. Y., Liu X. H., Zhao S. H., Yuan Y. N., Jiang M., Chinese Journal of New Drugs 2021, 209.
Alec McCarthy, PhD
Alec McCarthy received his BS in Biological Systems Engineering at the University of Nebraska – Lincoln in 2018 and his PhD in Regenerative Medicine & Biomaterial Design from the University of Nebraska Medical Center. He is currently an MSL at Merz Aesthetics and aims to push for the use of new technologies in medical affairs. All views expressed are his own and do not represent those of his employer.
Kyle Gillett, MD
Kyle Gillett received his BA in Biology and BS in Critical Thinking from William Jewell College and his MD from the University of Kansas School of Medicine. Kyle is a practicing physician that enjoys providing holistic individualized care to his patients. His practice includes sports medicine, hormone optimization, obstetrics and infertility, sports medicine, functional medicine, lifestyle medicine, precision medicine including genomics, and preventative medicine. He believes that each human is a unique creation that requires attention to their body, mind, and soul to achieve optimal health. He enjoys caring for others using shared decision-making and an evidence-based, patient-centered approach. He enjoys spending time outdoors on the farm with his wife, two sons, and two wolfhounds.