As billions of dollars are budgeted to reform health care, legislators in Washington are frantically looking for ways in which the money can truly change the broken health care system without too much of an upset to its key constituents: payers, providers, employers and patients. As in most industries, modernization by the (government-sponsored) introduction of technology sounds like the safe choice. Surprisingly, forcing physicians to implement electronic medical records and to share these records via statewide exchanges is facing a daunting practice to practice "docfight." With the unpleasant possibility of an unrealized promise for change, some suggest we turn the light on the other sleeping elephant in the room -- telemedicine. Brush the dust off this misunderstood (and often misused) technology and health care reform may just live up to its promise, in our lifetimes.
Simply defined, telemedicine refers to the delivery of medical care using telecommunications including: phone, email, Internet and other channels. Over the years, the application of telemedicine was interpreted narrowly to mean the use of technology to overcome physical distance. Specifically, it became synonymous with the use of video conferencing to bring the expertise of specialized physicians (who typically reside in urban America and work in large medical centers) into rural areas where such specialties were scarce or absent. While the supporting technologies have evolved, from ISDN lines to dedicated fiber optics, the principal promise (prejudice) of telemedicine remained frozen in time.
Then came the Internet, introducing the liberating notion that any two places, any two devices, indeed any two people, can connect, reliably and instantly. Armed with the Internet, telemedicine has quickly dropped the expensive dedicated conferencing lines, and swapped them with inexpensive cable modems. Telemedicine could now accomplish the same result for fewer dollars -- an excellent incentive for growth. But, (author is now pointing to an elephant in the room H.P.) looking at the Internet as a cheaper way to do the same thing is perhaps as naïve as thinking of email as a mere replacement to paper mail and a good way to save on stamps. Yes, the Internet can save some cash in connecting two points (e.g. our two physicians), but its promise lies in that it can connect any two points.
So what can we expect if we wake our dormant telemedicine by allowing it to take advantage of the true networked capability of the Internet? By reaching patient's homes, access to medical care will start equalizing across geographies. The variations in its quality will diminish. Primary care physicians could summon specialists to help care for the patients sitting in front of them in their exam room. Physician offices can expand services by tapping allied providers they could otherwise not afford to keep on staff (e.g. nutritional services, sleeping disorders, etc.). The stigma of entering the office of a mental health provider will not keep patients away, as they can engage the therapist routinely, from the intimacy of their homes. Patients can be discharged home earlier after surgery and still be followed during their surgeon morning rounds from the hospital. Live health care can be available in pharmacies, workplaces, airports and handhelds. It can bring additional physicians into crowded emergency rooms to help with triage; it can allow the military to project broader health care to where the troops go. It can allow us physicians to care for patients in Haiti during our lunch break in the office. Fundamentally, we can expect the paradigm to change. Health care goes to where the patient is.
This vision is far from pie in the sky. In fact, it's starting to become a reality in communities across the country. For example, the U.S. Department of Veterans Affairs (the VA) has been enlisting a growing number of telemedicine technologies to help Americans discharged from the armed forces to manage diabetes, high blood pressure and other physical and mental health issues from their homes. Health companies, too, are making networks of providers available to their consumers online, extending care into homes and workplaces. These span from Hawaii (HMSA) to Minnesota (Blue Cross and Blue Shield of Minnesota and OptumHealth), Pennsylvania (Rite Aid) and New York (HealthNow New York), among others.
As with any change, there are real risks involved. Even with its increasingly high-definition audiovisual capabilities, telemedicine does not allow for a hands-on exam. It thus requires physicians to exercise different clinical judgment on the care they render. Patients may abuse telemedicine to scout for physicians who more readily issue prescriptions (for regular or even controlled medications). Indeed, patients may abuse telemedicine as a whole by simply overusing it. After all, it is available at home right after dinner when there are no good shows on cable. Medical boards are rightfully concerned that state lines (which define physician licensure), or even national borders will perforate as patients look far and wide for their doctors. Lastly, since the Internet is open for all, it can become a goldmine for imposters, swindlers and downright poor-quality providers, to disseminate their wares.
But the challenges, real as they are, have been seen and conquered before. Amazon was blasted for taking the joy out of in-store book buying. Expedia eliminated the friendly agent from the travel agency down the street. Online banking and retail were feared to be leaky and insecure. Online grocery shopping did not allow the buyer to physically examine the produce and e-books turned the page on turning pages altogether. And yet they all prevailed somehow, and reached a point where they became an accepted part of our lives. This was done not by the persistence of the entrepreneurs, but by their adaptation. Not every product is sold on Amazon. Not every gourmet dinner is available to order in. Complex travel plans still end up with an agent and few people buy real estate entirely over the Internet.
Telemedicine is no different. It is right for a defined scope of medical care, but is not a replacement for the relationship between a patient and her doctor. Telemedicine needs to be portrayed clearly as such to remove ambiguity and unrealistic expectations. It needs the capability to validate that the people who use it are who they claim to be and that the providers in it are licensed, audited and held accountable to the quality of care they deliver by their state medical boards, as they are in their practices today. Prescriptions could be limited to known safe lists and, as with any other modern computer-based system, measures should be in place to constantly look for abusers, intruders and other forms of mayhem. All of the above is doable. We have done it before.
Telecommunication has changed almost every dimension of our lives within one generation. Telemedicine is its application in health care. It's big, it's powerful and it's mostly asleep. With the current state of health care, isn't it time we wake this elephant up?
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As many commenters have stated, there are very real obstacles to widespread adoption of telemedicine and online care. Whenever anything new is introduced there is resistance to change. That said, these obstacles shall be overcome. Simply put, moving the point (and timeliness) of care from the provider to the patient has huge benefits, from improving patient outcomes to systemic cost savings. Evidence of the value of telemedicine and online care is building. Government and large payers are beginning to understand the return on investment for providing online care benefits under various health plans. The key, as you correctly point out, is to educate users on the proper use of these tools and technologies – and to coordinate care using appropriate business processes which are designed to incorporate these new models of care delivery.
Well done.
it got very political due to some of the doctors seeing a woman and then ok-ing an abortion after their session.
it got ugly here and with the new session of the legislature bout to heat up...it will get even more ugly.
Here is where you are wrong: the "offshoring" comment.
JHACO and ALL state laws requires that a doctor practicing medicine in a state must have a medical license in that state. So, the location of the patient determines the license a physician must have to practice medicine on them, it goes for all MD's and DO's.... So, no matter where the physician is physically located he or she must have a license to practice medicine in any particular state. Also, the income these physicians receive from telemedicine are subject to all taxes applied in whatever state the company is located.
Another thing is that even if a physician outside America was doing this, they have to be trained in their specialty by an American and in some cases Canadian medical institution.
The sky is not falling with this.
There are lots of discussions in the radiology community about the ups and downs of this. I'm not saying it's uniformly bad, and there certainly are efficiencies that can be introduced in this way. Too complex a topic for a 250 word blog post, really.
By the time Republicans finish with repealing healthcare, there should be (if not 50M, then at least) many Americans without health insurance. American health care is fine when you can afford it, but when you can't, your choice is between no health care, and risky health care.
Robots and automation will eventually be applied to medicine. It will be risky in the sense that it might not have human intelligence, or nuanced judgment, and it will not be heavily indemnified. Diagnosis and treatment (when possible) by a robot doctor is probably better than none at all.
Furthermore, there is so much fat in the American healthcare system, that some entrepreneur should see the financial opportunity in serving the needs of the poor, with a lower margin product. Tiered healthcare makes sense, and if there were a healthcare offering for the lower income citizens costing the federal government, say, half of what it currently pays ... well, still a lot of money.
After a while, robot doctors will be much cheaper. The can be cookie cutter copied. They don't forget. They are 100% repeatable. They work 24/7. A bit longer, and they'll be doing better than the expensive human sort. Don't worry about displacing those jobs. Doctors can simply re-educate themselves for the new jobs. :)
No thanks!! We already tried that.
The HHS Secretary was given the regulatory authority to deal with the items you mentioned and in fact, studies have already been commissioned to ascertain the viability of the medical home.
and to reduce costs it really needs to be a public- private process.
Step 1) The private-sector wraps all medical sites across the country in a lowest common denominator SOA. All the legacy databases do not need to be populated they can be mashed up instead. There would be only one EHR and the same with the open workbooks all in one place, multi-user and multi-threaded. No transcription errors, no wrong site surgeries and on and on.
Step 2) HHS and the private sector would create the workbooks, the goal is to provide the patient with the cost, efficacy and statistical prognosis in real-time so they can make an informed decision. The entire workbook is never validated just individual steps, this allows two direction information exchange so the system can learn. The workbooks guide never compel. By using a workbook paradigm they could be FDA approved and updated across the country in minutes matching the speed at which medical knowledge changes.
Step 3) Through the use of registered steps in the workbooks and a public open format, software vendors, medical device vendors, pharma etc. could easily integrate and in many cases eliminate the need for another user interface or database.
By creating the correct backbone\process, costs can be contained and actually guarantee that the health care you receive in 2020 is better than in 2010.
Today with sophisticated telemedicine tools it is possible for clinician (Doctor) to examine / treat patient as he / she doing when patient is face to face. Besides that software tools will give more information than physically presented medical data. e.g. the soft copy of x ray images; it is possible to use zoom, rotate etc. which provide more clarity than hard copy of x-ray images. Using it (Telemedicine) all stake holder saves cost, hence using it one can lower down healthcare cost.
In same line telemedicine can provide quality healthcare to remote people. Quality healthcare as the treatment / opinion is provided by highly qualified doctor. In our view there is no other option left to provide quality healthcare to remote people particularly in developing country except use of technology; that is telemedicine.
Falguni Patel; info@medisofttelemedicine.com; www.medisofttelemedicine.com.
How confusing...lol
If states are looking to cut budgets, department of professional licensing is great place to start. Making this a federal department would end work of 50 offices and save many millions of dollars and paper work. This is what current central 'Data Bank'(s) for each profession do.
Often the excuse is the hurdles are to keep 'problem individuals' out. Yet this policy may be keeping 'problem individuals' in.