Tag: Telemedicine

What Would You Give Up For a Virtual Doctor Visit?

Sep 13, 2014• 1

By Girish Navani

With the fast adoption of smart phones, tablets and wearable devices, the way people communicate, travel, eat and entertain have all been simplified. Why not streamline the way we experience healthcare as well? A study released in May 2014 from MDLive discovered that 82% of young adults 18-34 would prefer consulting with their doctor via a mobile device than show up for an appointment. Twenty seven percent of patients confirmed they’d be willing to give up shopping for a month, skip their next vacation, even refrain from showers for a week—if it meant they would be able to access their doctor via a smart phone! These results, along with the multiple surveys and studies conducted in the past year, confirm that a new way to conduct healthcare services is in high demand.

The solution to changing up the healthcare system sits at the center of three key advancements: patient engagement, population health and electronic health records (EHRs). At eClinicalWorks, we consider these components of healthcare to be like a three-legged stool where two cannot stand without the other. We recognized this need as an opportunity within the healthcare IT space and created healow in order to provide our customers and their patients with a platform to schedule doctors’ appointments and get immediate access to medical records via an online interface or mobile app. healow empowers doctors and patients by packaging personal health records (PHRs), healthcare tools and appointment scheduling together, making the data readily accessible to patients and their doctors from the palm of their hand.

A Policy Model For Telehealth Technologies

May 30, 2014• 5

By JOSEPH KVEDAR, MD

The nation’s ongoing battle to strike a delicate balance between increasing access to quality health care for all Americans and reducing overall health care spending just scored one of its most substantial victories.

In late April, after several months of thoughtful and robust collaboration, the Federation of State Medical Boards (FSMB) ratified a new model national policy – the Appropriate Use of Telemedicine in the Practice of Medicine – at its annual meeting in Denver.

This marks the first time the medical community has unilaterally acknowledged the impact technology has had on the practice of medicine, and the ability telemedicine — or connected health — has to facilitate and improve the delivery of health care.

Let us first put this in perspective. We all know health care is at a critical juncture. The implementation of the Affordable Care Act means millions of newly eligible Americans will seek access to an already over-burdened health care system.

The nation faces a serious shortage of primary care providers, specialty care is becoming more diversified, and access to care in rural areas is an ongoing challenge. All of these issues are on the rise.

Technology-enabled Care

Enter technology-enabled care. Real-time video encounters between patients and providers reverse the burden on patients to seek care in a hospital or doctor’s office by bringing health care directly to them, in their home. At the same time, remote monitoring, sensors, mobile health and other technologies are helping to reduce hospital readmissions, and improving adherence to care plans and clinical outcomes, as well as patient satisfaction.

Connected health tools also support preventative care efforts for chronic care patients and can empower individuals to make positive lifestyle changes to improve their overall health and wellness.

Momentum for telehealth is accelerating at an undeniable rate. As of March, twenty states and the District of Columbia have passed mandates for coverage of commercially provided telehealth services; 46 states offer some type of Medicaid reimbursement for services provided via telehealth.

A study by Deloitte predicts that this year alone, there will be 100 million eVisits globally, potentially saving over $5 billion when compared to the cost of face-to-face doctor visits. This represents a growth of 400 percent in video-based virtual visits from 2012 levels, and the greatest usage is predicted to occur in North America, where there could be up to 75 million visits in 2014. This would represent 25 percent of the addressable market.

Doctors Without State Borders: Practicing Across State Lines

Feb 24, 2014• 18

By Robert Kocher, MD

In the United States, a tangled web of federal and state regulations controls physician licensing. Although federal standards govern medical training and testing, each state has its own licensing board, and doctors must procure a license for every state in which they practice medicine (with some limited exceptions for physicians from bordering states, for consultations, and during emergencies).

This bifurcated system makes it difficult for physicians to care for patients in other states, and in particular impedes the practice of telemedicine. The status quo creates excessive administrative burdens and like contributes to worse health outcomes, higher costs, and reduced access to health care.

We believe that, short of the federal government implementing a single national licensing scheme, states should adopt mutual recognition agreements in which they honor each other’s physician licenses. To encourage states to adopt such a system, we suggest that the federal Center for Medicare and Medicaid Innovation (CMMI) create an Innovation Model to pilot the use of telemedicine to provide access to underserved communities by offering funding to states that sign mutual recognition agreements.

The Current System And Its Drawbacks

State licensure of physicians has been widespread in the United States since the late nineteenth century. Licensure laws were ostensibly enacted to protect the public from medical incompetence and to control the unrestrained entry into the practice of medicine that existed during the Civil War. However, it no longer makes sense to require a separate medical license for each state.

Today, medical standards are evidence-based, and guidelines for medical training are set nationally through the Accreditation Council for Graduate Medical Education, the Centers for Medicare and Medicaid Services’ Graduate Medical Education standards, and the Liaison Committee on Medical Education. All U.S. physicians must pass either the United States Medical Licensure Examinations or the Comprehensive Osteopathic Medical Licensing Examination.

Although the basic standards for initial physician licensure are uniform across states, states impose a patchwork of requirements for acquiring and maintaining licenses. These requirements are varied and burdensome and deter doctors from obtaining the licenses required to practice across state lines.

A Physician Faces Disciplinary Action For Seeing Patients on Skype — Early Guidelines For Patient Video Visits

Sep 21, 2013• 15

By Joseph Kvedar, MD

The medical board of the state of Oklahoma recently sanctioned a physician for using Skype to conduct patient visits. A number of other factors add color to the board’s action, including that the physician was prescribing controlled substances as a result of these visits and that one of his patients died. This situation brings up several challenges of telehealth — that is, using technology to care for patients when doctor and patient are not face-to-face.

• Legal/regulatory: On the legal side, physicians are bound by medical regulations set by each state. It appears that the use of Skype is not permitted for patient care in Oklahoma.

• Privacy/security: Skype says its technology is encrypted, which means that you should not be able to eavesdrop on a Skype call. That would seem to protect patient privacy. At Partners HealthCare, we ask patients to sign consent before participating in a ‘virtual video’ visit. Because this is a new way of providing care, we feel it’s best to inform our patients of the very small risk that their video-based call could be intercepted. I don’t know if the Oklahoma physician was using informed consent or not.

But the most interesting aspects of this case involve the question of quality of care. Can a Skype call substitute for an in-person visit? Under what circumstances?

Video virtual visits are a new mode of care delivery. Whenever anything new comes up in medicine, it is subject to rigorous analysis before entering mainstream care. That same rigor applies to video virtual visits. Although some studies suggest virtual visits can be useful, the evidence is not yet overwhelming. I can’t say with 100% certainty how virtual visits will best be used, but based on several pilot programs under way at Partners, I have a hunch or two.

We have believed for some time that this technology should be limited to follow up visits, where the patient and physician already have a well-established relationship. Technologies such as Skype and Facetime allow for a robust conversation, but most doctors’ visits require much more than just conversation. For example, any time a physical exam is required, this technology will not work well. That’s why one of our first pilot studies was to implement video technology for mental health follow up visits (as did the doctor in Oklahoma).

Our early results are promising. It seems that virtual video visits for mental health offer both the provider and the patient important benefits. For many mental health patients, it can be stressful to travel to the doctor’s office. When a patient is being evaluated for a medication adjustment, for example, they are not at their best. The convenience of having a follow-up visit from their own home can be a big lift for these patients. On the other hand, doctors often feel that the home environment is particularly relevant in sorting out mental health problems. A virtual visit allows them to, in effect, conduct a virtual house call.

How the Best of Intentions Is Hurting Care for Americans Who Live In Rural Areas

Apr 2, 2013

By Ashish Jha, MD

Ensuring that Americans who live in rural areas have access to health care has always been a policy priority. In healthcare, where nearly every policy decision seems contentious and partisan, there has been widespread, bipartisan support for helping providers who work in rural areas. The hallmark of the policy effort has been the Critical Access Hospital (CAH) program– and new evidence from our latest paper in the Journal of the American Medical Association suggests that our approach needs rethinking. In our desire to help providers that care for Americans living in rural areas, we may have forgotten a key lesson: it’s not about access to care. It’s about access to high-quality care. And on that policy goal, we’re not doing a very good job.

A little background will be helpful. In the 1980s and 1990s, a large number of rural hospitals closed as the number of people living in rural areas declined and Medicare’s Prospective Payment System made it more difficult for some hospitals to manage their costs. A series of policy efforts culminated in Congress creating the Critical Access Hospital program as part of the Balanced Budget Act of 1997. The goals of the program were simple: provide cost-based reimbursement so that hospitals that were in isolated areas could become financially stable and provide “critical access” to the millions of Americans living in these areas. Congress created specific criteria to receive a CAH designation: hospitals had to have 25 or fewer acute-care beds and had to be at least 35 miles from the nearest facility (or 15 miles if one needed to cross mountains or rivers). By many accounts, the program was a “success” – rural hospital closures fell as many institutions joined the program. There was widespread consensus that the program had worked.

Despite this success, there were two important problems in the legislation, and the way it was executed, that laid the groundwork for the difficulties of today. Continue reading…

The Problem with Transformation

Jul 2, 2012• 1

By Rob Lamberts, MD

Eric Topol wrote a post recently put up on THCB where he looks to a future enabled by emerging technology.

Just as the little mobile wireless devices radically transformed our day-to-day lives, so will such devices have a seismic impact on the future of health care. It’s already taking off at a pace that parallels the explosion of another unanticipated digital force — social networks.

Take your electrocardiogram on your smartphone and send it to your doctor. Or to pre-empt the need for a consult, opt for the computer-read version with a rapid text response. Having trouble with your vision? Get the $2 add-on to your smartphone and get your eyes refracted with a text to get your new eyeglasses or contact lenses made. Have a suspicious skin lesion that might be cancer? Just take a picture with your smartphone and you can get a quick text back in minutes with a determination of whether you need to get a biopsy or not. Does your child have an ear infection? Just get the scope attachment to your smartphone and get a 10x magnified high-resolution view of your child’s eardrums and send them for automatic detection of whether antibiotics will be needed.

Now, I am the first to confess my infatuation with technology. I am also a very big believer in patient empowerment, which could be the one force strong enough to overcome the partisan politicians and corporate lobbyists resisting any positive change. But there are several problems I see with this kind of empowerment with technology.

First off, the goal is not to find technologies that simply transform, but ones that move care to a better place. Right now our system is running aground for one reason: we spend too much money. Patient empowerment that improves efficiency of care is good, while empowerment that increases consumption or decreases efficiency is to be avoided if at all possible. The technology mentioned in the article is predominantly data-gathering technology, increasing the amount of information moving from patient to physician. The hope is that this will enable faster and better informed decisions, and perhaps some of it will. But I can see harm coming out of this as well.

How Doctors Are Trapped, Part II

Jan 26, 2012• 13

By JOHN GOODMAN

Of all the people in the health care system, none is more central than the physician. Fundamental reform that lowers costs, raises quality and improves access to care is almost inconceivable without physicians leading and directing the changes. Yet of all the actors in modern health care, none are more trapped than our nation’s doctors. Let’s consider just a few of the ways your doctor is constrained, unlike any other professional you deal with.

No Telephone. Sometime in the early part of the last century, all the other professionals in our society — lawyers, accountants, architects, engineers, etc. — discovered the telephone. It’s a handy device. Ideal for communicating with clients. Yet even today I find that I can rarely talk to a doctor by phone. Why is that?

The short answer is: Medicare doesn’t pay for telephone consultations. Medicare has a list of about 7,500 tasks it pays physicians to perform. And talking by phone isn’t on the list — at least in a way that makes it practical. Private insurance tends to pay the way Medicare pays. So do most employers.

At a time when doctors feel like they are being squeezed on their fees from every direction by third-party payers, most become very focused on which activities are billable and which are not. And most are going to try to minimize their non-billable time.Continue reading…

Overestimating Consumer Demand for Health Care Technology

Nov 1, 2011• 3

By Jane Sarasohn-Kahn

More people with higher levels of concern about their health feel they are in good health, see their doctors regularly for check-ups, take prescription meds “exactly” as instructed, feel they eat right, and prefer lifestyle changes over using medicines.

And 40% of these highly-health-concerned people have also used a health technology in the past year.

At the other end of the spectrum are people with low levels of health concern: few see the doctor regularly for check-ups, less than one-half take their meds as prescribed by their doctors, only 31% feel they eat right, and only 36% feel they’re in good health.

While roughly one-fourth to one-third of U.S. adults have been early adopters of consumer technologies in general across low-moderate-and-high health concern segments, more of those with greater health concerns tended to use health tech products in the past twelve months: 40% of the highest concerned people vs. 25% of those with moderate health concerns and 14% of those at the lowest-concern level.

These insights are discussed in a report, The New Role of Technology in Consumer Health and Wellness from the Consumer Electronics Association (CEA), published in October 2011.

Tele-what?

Mar 16, 2011• 14

By NEIL VERSEL

As a journalist who for the last decade has covered the use of information technology in health care, I’m rather disgusted at some of my brethren in the mass media. I’m none too happy with the medical establishment, either. Both seem hopelessly stuck in the past, refusing to look beyond the status quo. And the public suffers because of it.

This fall, for example, the Los Angeles Times and other news outlets covered a Yale University study that sought to determine whether or not “telemonitoring” heart failure patients recently discharged from the hospital would reduce heart attacks or readmission. The study, published in the New England Journal of Medicine and presented at a November meeting of the American Heath Association, concluded that that telemonitoring, which involved patients calling in their weight measurements and health symptoms after being discharged, made virtually no difference in the outcome. The Times called the trial “a good, commonsense idea that simply didn’t work out.”

Was it, really?

Keeping in touch with one’s physician on a frequent basis after being hospitalized for heart failure is a fine idea, as is monitoring one’s weight. But, as happened in the Yale study, patients generally don’t stick with the program. One in seven study participants never called their doctors, while just 55 percent of patients were making at least three calls per week six months after discharge.Continue reading…

The Race is On for the Next Generation of Healthcare

Nov 9, 2010• 1

By CAROLE HODSDON

I continue to be amazed at the speed at which the mobility and portability of healthcare is developing. It is readily apparent that the technologies, devices and other innovations that we always knew would transform the delivery, consumption and administration of healthcare—but that always seemed years away—are in fact now here.

It’s kind of like that car commercial from a few years ago that asked why we’ve never actually seen the cool and futuristic concept cars that auto manufacturers have teased us with over the years; except in this case, all of the neat and futuristic stuff is right there just waiting for us to put it to good use. It’s called telemedicine, at the risk of oversimplifying, and combined with the change that has actually been legislated for healthcare over the past year, it’s putting the system on the threshold of an entirely new era.

For example: Remember the dark ages of, say, 1998 or 2000 when patients were given heart monitors to wear and then had to phone their doctor to report the various data? Well, it’s pretty safe to say that we can relegate those to the same time capsule as the VCR and the rotary telephone. Fast forward to today and you’ll find wireless, Bluetooth-enabled devices that can deliver the same information—and a lot more, in fact—in real time, 24/7. How about unlimited geographic boundaries for the delivery of medicine? Think of a lung specialist in Philadelphia rendering his expertise to a patient in rural Australia without leaving the comfort of his desk chair. Tired of being handed a clipboard and then interrogated about your medical history every time you see a new doctor? What if that information—in more breadth and detail than you can remember or are probably even aware of—was delivered to your doctor long before you even showed up for your appointment? And how about if, afterward, it was updated automatically and then followed you to your next specialist appointment?