ZDoggMD on Telemedicine: What COVID Proved and What Comes Next

This article discusses ideas from ZDoggMD — Dr. Zubin Damania, MD , Stanford/UCSF-trained internist and founder of the Health 3.0 movement. Full archive at zdoggmd.com .

ZDoggMD had been arguing for expanded telemedicine well before COVID made it unavoidable. When the pandemic arrived and regulatory barriers fell overnight, he was watching closely — because what happened in 2020 and 2021 was the largest natural experiment in virtual care in medical history.

What the COVID Telemedicine Experiment Proved

When CMS waived telemedicine restrictions at the start of the pandemic, telehealth utilization exploded from roughly 1% of Medicare visits to over 40% almost overnight. What this proved:

  • Patients could use it — including elderly patients who had been assumed to be unable to navigate video visits. Access was a bigger barrier than technology.
  • Physicians could adapt quickly — the clinical community shifted workflows rapidly when the regulatory and reimbursement environment changed
  • Large categories of care work well virtually — medication management, mental health, chronic disease follow-up, dermatology, and primary care check-ins can be done effectively without in-person contact
  • In-person has irreplaceable value for other categories — physical examination, acute presentations, procedural care still require presence

    • ZDoggMD's position: this data should have permanently reformed how we think about what must be in-person versus what can be virtual. The right answer is hybrid — using virtual care where it works, reserving in-person bandwidth for where it's genuinely required.

    The Regulatory Rollback Problem

    As COVID emergency provisions expired, many of the regulatory waivers that had enabled telehealth expansion were at risk of reversal. ZDoggMD has been vocal that rolling back telemedicine access would be a policy failure that prioritizes pre-pandemic institutional inertia over demonstrated patient benefit.

    The access argument is particularly powerful: telemedicine dramatically reduces geographic barriers to care, particularly for rural patients, patients with mobility limitations, and patients with demanding work schedules. Restricting it reimports barriers that don't serve patient health — they serve regulatory and reimbursement structures that haven't updated for what the technology makes possible.

    Telemedicine Documentation: The New Problem

    Telemedicine created a documentation challenge that wasn't obvious until it arrived at scale: virtual visits are, if anything, harder to document in real time than in-person visits, because the physician is working from a single screen that shows both the patient and the EHR, without a separate physical workspace.

    Ambient AI documentation is particularly valuable in telemedicine: the AI listens to the virtual encounter and generates the note automatically, so the physician can give full attention to the patient on screen rather than toggling between the video and the EHR. The documentation problem that existed before telemedicine doesn't get better in virtual care — it gets worse, unless you have a tool that handles it.

    ZDoggMD on telemedicine and virtual care:

    Works for In-Person and Telehealth Equally

    NoPajamaTime ambient AI documentation handles virtual visits the same way it handles in-person ones. The note writes itself. The patient gets your full attention.