In a 2016 article in the Wall Street Journal, Melinda Beck explains that omnipresent smartphones, speedier internet connections, and changes taking place in the insurance industry have aligned in such a way as to allow physicians the ability to provide health care for their patients via electronic communications. This innovation is turning traditional healthcare methodology upside down.
Known as telemedicine, doctors can link to their patients through a webcam, by telephone, and using email. Patients do their part by sending physicians their heart rates, blood pressure levels, and other relevant vital signs to allow doctors to monitor their illnesses and diseases while the patients are in their homes.
Pros and Cons
Telemedicine is an excellent and efficient option for many individuals, and for some, choosing to use telemedicine has been a life-saving decision. Some examples of situations that can be handled best through telemedicine include:
. questions from Doctors Without Borders concerning difficult cases
. providing information and support from large medical centers to smaller hospitals in a state
. home support after major surgeries
. improved implementation of prescribed treatment regimens
. managing chronic conditions
. consistent availability to those in rural communities where health care is unavailable
. treating emergency cases and providing critical care
There are, however, critics of this new technology. Some say these methods should not take the place of traditional approaches used by physicians. But supporters of the telemedicine movement answer that the program is in its beginning stages and, accordingly, attention to education, policies, and research standards must be a part of the new model.
Others say that telemedicine will cause negative competition among the existing lines of service available to the public. But this is not the case, per the Global Med website, since telemedicine will expand and increase traditional services.
When rural communities add technological services to a clinic or small hospital, the healthcare facilities will gain new patients and increase revenue as patients can receive the services they need at their local healthcare sites using technology. As the Global Med site points out to its readers:
“Telemedicine is a means to improve health, lower costs, and help communities sustain their health system, but will require vision, tenacity and a willingness to change outmoded models of healthcare delivery.”
Some of the other benefits offered by telemedicine and recognized by the medical community include:
. reduction of medical costs by remote drug verification and administration
. the facilitation of medical teaching through sharing best practices of experts in specific fields on video recordings
. the elimination of the potential transmission of parasites or contagious diseases from patient to health care providers
. the lessening of “white coat” fear in patients
. improved care for the home-bound
Some in the medical field have reservations about the telemedicine path for the following reasons:
. the possible decrease in human interaction between providers and patients
. a possibility of compromised private health information
. the high cost of technical training for staff and added equipment
. a higher risk of error
. the potential for increasing the time needed for checkups and consultation
. intermittent decreases in the quality of transmitted imagery
. the lack of quality patient care because of the absence of relevant clinical information
. incomplete legal regulation
. the technicalities of insurance and government reimbursement
. the inability to initiate immediate actions, such as an injection or a face to face observation
A Short History
Although some forms of health care services from a distance have been achieved over the years using the radio and telephones, now doctors have methods such as video-telephony, client/server applications, and remote diagnosis capabilities.
As far back as the early 1900s, Dr. Hugo Greenback invented what he called a “Tele dactyl.” Greenback envisioned this small robot-like creature examining patients in another location and sending a video to the attending physician. Then, in the 50s, Pennsylvania doctors experimented with sending x-ray images using the telephone.
In the 1960s, University of Nebraska physicians transmitted neurological information through a two-way television set-up and later expanded to a telemedicine connection with a state hospital 112 miles from their location.
And Dr. Morris Collen, in 1972, began a project to find a “sparsely populated site on earth” to act as a laboratory for testing the systems, equipment, and people included in his “automated self-administered multiphasic health testing lab,” which was to be used by people in space to allow them to provide their own health care services by using the automated equipment onboard.
The isolated area chosen was the Papago Indian Reservation in southwest Arizona, that is now known as the Tohono O’odham Indian Nation. The project title was “Space Technology Applied to Rural Papago Advanced Health Care,” or STARPAHC. This experiment created numerous improvements in the early stages of telemedicine.
Store and forward, the first of three categories of telemedicine, is the practice of attaining medical information and delivering the data to a physician or specialist for their review. This type of telemedicine is “asynchronous,” meaning that the delivery of the data, the review of the doctor, and the delivery of the health provider’s diagnosis to the patient are done at different times. This method eliminates the need for direct physician-patient contact.
Remote monitoring is also known as self-monitoring. By this method of telemedicine, the patient uses specified medical devices to check his vital functions and the recorded information is sent to his doctor or health care provider. This type of eHealth monitoring can be cost-effective and result in quality health outcomes. This type of technology is most often used to monitor the following conditions:
. heart disease
. nighttime dialysis
. joint conditions
Interactive real-time electronic examinations can be achieved using telemedicine services. Long-distance treatment and diagnosis can be easily accomplished in the fields of psychology, psychiatry, dermatology, ophthalmology and more.
The terms telemedicine and telehealth are used interchangeably, per the American Telemedicine Association. In the UK, however, eHealth is used to denote telemedicine, telehealth, electronic medical records, and health information technology, or HIT.
The Status of Telemedicine
Telenursing is a health service that is growing around the world. The reasons for this include that the service is affordable, the number of aging and chronically ill patients is increasing, and coverage for remote communities can be accomplished. Many Tele nurses report that the job satisfaction levels for this career are extremely high.
Tele pharmacies are delivering drug care using telecommunications in areas where pharmacists are a rare commodity. In fact, these technological drug stores are also offering patient drug counseling, medication refills, drug therapy assistance, and oversight of formulary compliance. When medications are delivered via packaging and labeling systems to remote areas, this too is part of the Tele pharmacy field.
Telerehabilitation is the telecommunication service that offers long-distance rehab in these categories:
. speech-language therapy
. physical therapy
. rehab equipment fitting
. rehabilitation for veterans
Tele trauma care connects trauma specialists to paramedics at the location of a mass casualty or disaster scene. Also, telemedicine can be used to substitute for intensive care unit monitoring. For example, teams can conduct rounds in a central conference room by using a video-conferencing device. This method not only decreases the spread of infection but also allows for communication with physicians from patients’ bedsides.
Telemedicine can be utilized for long distance dermatological treatment, dentistry diagnoses, and audiological services, as well.
Soon, surgeons will be accessible to patients whatever their location. This procedure will allow surgeons in specialized fields to operate on individuals worldwide using a “robotic telemotor system.” This new technology will make even tactile feedback available to the surgeon. The issues that must be addressed are the speed, reliability, and time-lapse component of the communication system being used. The use of “smart glasses” and “smartwatches” is already in place for monitoring patient information and sending the data to medical providers in real-time.
But the future of telemedicine strongly relies on the timely progress of technology and the removal of barriers by state legislators, state licensing practices, and the reimbursement policies that determine how physicians are paid.
Medicare, Medicaid, and Insurance
Per Chiron Health, a company that guarantees private payer reimbursement to physicians, Medicare has many restrictions on telemedicine. On their website, they add that depending on the patient’s location, the services that are provided, and the facilities used, reimbursements may or may not be available for medical professionals. The Medicare Chronic Care Management Program, however, is a nationally approved policy and has no telemedicine constraints. Medicaid, on the other hand, has reimbursement policies that are different from state to state.
Bob Herman of the Modern Healthcare website writes that establishing insurance guidelines for telemedicine has been a difficult task. Doctors say that the explanations as to what constitutes a telemedicine service are unclear. Alabama Blue Cross Blue Shield, on Dec. 1, 2015, began to reimburse physicians in several telemedicine categories, such as stroke care and behavioral health. The reason for the change of policy, says the company’s officials, was the dramatic advances that were taking place in technologies.
At the beginning of 2016, more private insurance carriers were paying for telemedicine, and over one-half of the nation had regulations in place to govern telemedicine policies. Insurance companies are now pulling for the expansion and success of this medical technology to assist their rural members who have difficulties accessing medical providers and to win over businesses that have shown an interest in offering the convenience of on-demand support. Insurers also like the idea that telemedicine, in all its iterations, might lure individuals away from more expensive healthcare options.
As for the elderly, Patricia Smith, former CEO of the Alliance of Community Health Plans, said:
“When you’re looking at the chronic condition situations, or simple rural situations (for telehealth), they’re (equally) or more relevant to the older population.”
Doctor on Demand
To find a doctor who will diagnose and treat you online, simply download the Doctor on Demand application to your smartphone. When you do so, you will be able to find a physician who will assess your illness and quickly give you a diagnosis and treatment plan. Your online doctor will also prescribe a medication, if necessary, and send the prescription to your nearest CVS pharmacy so that you can pick it up at a time that is convenient for you.
Doctor on Demand does away with scheduled appointments that can sometimes take weeks to attain. There are no germ-filled, hours-long waiting room visits. The Doctor on Demand application makes it easy to see a doctor within minutes. This technological doctor’s visit costs only $49 or less, making it more affordable than the usual co-pay amount, emergency room visit, or regular office appointments with a physician.
All doctors in the Doctor on Demand program are board certified in the state where you live. The physicians who take part in this system are trained, screened and subject to ongoing reviews to ensure that patients receive the best level of care available. You will be asked to review any doctor with whom you visit.
Per the Doctor on Demand (DOD) blog, in 2016 over 400 doctors join the DOD team, each of whom had an average rating of 4.8 out of 5 stars and an average of 15 years of experience. The doctors’ assistance was available in 49 states, and the average wait time for patients was three minutes.
Television’s “Dr. Phil” McGraw is an adviser to the DOD startup. Brad Stone of Bloomberg, quotes one of the DOD’s officers:
“There are 1.2 billion ambulatory care visits every year, and the clear majority of people are walking in for something like colds or urinary tract infections that are very amenable to an initial consult over video,” says Adam Jackson, the company’s co-founder, and chief executive officer.
American Medical Association President Ardis Dee Hoven said:
“The AMA believes video conferencing services with a physician can be a helpful source of medical information for the public and can be a useful complement to more comprehensive services if used properly.”
It seems that this new model is taking hold and is being used by increasingly Americans for simple medical conditions, such as:
. sinus infections
. pediatric issues
The ease, efficiency, and quality of telemedicine, at this point in history, make it inevitable that this prototype will soon be a natural choice for patients across the globe.