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telemedicine and mHealth in healthcare from a caregiver and medical doctor’s perspective at Slalom Consulting

The perfect healthcare storm

In today’s climate—an aging population, millions of newly-insured Americans, and a primary-care clinician shortage—patients are in the calm before the storm. Telemedicine could very well provide some shelter.

Eric Quinones, MD | July 16, 2015

Technology and the data that it provides are the future of medicine. In an earlier post, I discussed how mHealth promotes better healthcare outcomes and empowers patients and their care teams. Here, I’ll explore how telemedicine has the potential to increase healthcare access at a time when it’s never been more important.

But first, a story about my grandmother.

Makeshift telemedicine to the rescue

Prior to medical school, I lived with my grandparents in my hometown of Los Angeles. I was very close with them, and I looked out for them on many fronts, including their healthcare.

Cut to my third year of medical school across the country in Providence, RI, and my first telemedicine encounter, before I even knew what telemedicine was. During a visit to Los Angeles, I’d moved my grandparents into the information age by installing a computer, video camera, and Internet service in their home, so I could videoconference with them (treatment for my chronic homesickness).

One September afternoon I had a video chat date with my grandmother. She filled me in on all the family gossip and in her usual loving manner asked if I had been eating and getting enough rest. Rest, no; eating, yes! As we talked, I noticed that her breathing was slightly labored. I asked her to point the video camera at her ankles and press down on the skin. She was retaining fluid and had 2+ pitting edema bilaterally: She needed to get to the doctor or urgent care facility immediately.

Fortunately, I was able to contact my aunt to drive my grandmother to the doctor, and we avoided what could have been a much more serious ER visit. But, without our makeshift telemedicine solution, that likely wouldn’t have been the case.

Today, it’s safe to say that telemedicine has come very far from my first improvised experience. The global telemedicine market boasted a $16.3B value in 2013, and is projected to grow to $43.4B in the following six years.

Telemedicine explained

So, what is telemedicine and what can it do for healthcare?

Telemedicine is simply the use of video conferencing technology designed to support remote clinical care situations as well as healthcare education for patients. It can be involved in just about all primary and specialty settings: engaging end-users in live videoconferencing (synchronous encounters); recording, storing, and forwarding (asynchronous encounters); and distant patient monitoring (remote surveillance).

Telemedicine allows a doctor in one location to treat a patient at home or at another healthcare setting. For patients that have difficulty leaving their residence or live in rural areas telemedicine provides a connection with their healthcare provider. In the hospital setting, telemedicine centers are being implemented to triage patients correctly so they can get the right level of care and avoid unnecessary use of emergency services when a clinic or urgent care visit would be more appropriate. It’s also enabling hospitals, in combination with the Patient Centered Medical Home (PCMH) and Accountable Care Organizations (ACOs), to reduce their readmission rates, coordinate longitudinal care, and drive toward superior clinical outcomes—all while lowering the cost to do so.

The “perfect healthcare storm”

Our aging population is contributing to greater chronic disease; 32M newly-insured patients have entered the healthcare continuum secondary to the Affordable Care Act; and there is a primary care clinician workforce shortage. Due to what I call the “perfect healthcare storm,” patients have never been at a greater risk in our country’s history. However, telemedicine holds the promise to increase healthcare access across the U.S.

And yet, despite its immense promise, we’re not rushing to implement this technology across the board. Surprise—it’s not the physicians or patients that are objecting!

While technology advancements have improved markedly to make telemedicine affordable and manageable, regulatory stakeholders and payers have been the main barriers. State board licensing laws are very strict and continue to govern and prevent clinicians from treating patients in states they are not licensed in. Telemedicine guidelines and ethics rules are still being debated by professional medical organizations and lawmakers: interstate and new patient encounters, and medication prescription protocols are a few examples that come to mind.

Another very real concern comes from the Health Insurance Portability and Accountability Act (HIPAA) that oversees patient privacy and security. Some organizations are hesitant to provide telemedicine services to their patients because protected health information (PHI) data is more readily available and subject to breach.

Lastly, payer reimbursements have also hindered full adoption of telemedicine. Many private payers are beginning to reimburse for telemedicine services. However, in the case of public health, Medicare recipients are finding telemedicine access very difficult: Only 1% of Medicare patient are using telemedicine, there are only two Medicare Advantage programs—Anthem and University of Pittsburg Medical Center—in the country offering virtual encounters. Even more limited is traditional Medicare which strictly limits some rural populations that still need to leave their homes or convenient locations to travel to a “health center” to connect to a remote healthcare provider. CMS (Centers for Medicare & Medicaid Services) touts that potential increase in cost is the reason for limiting telemedicine services. They feel patients will use more resources with telemedicine and still not curb preventable urgent care or emergency department encounters.

The good news: Professional health and technology associations, lobbyists, and bipartisan elected officials are working to break down these barriers to provide this exceptional patient healthcare interface and much-needed access. I believe that these challenges will be resolved in the very near future because without increasing access through telemedicine we cannot weather the ominous storm ahead.

StatDoctors: The doctor is in [your phone]

One forward-thinking organization, StatDoctors (disclaimer: also a Slalom client), understands this quite well and recently launched their telemedicine application that overcomes some of these barriers mentioned. Their app can be accessed via computer or smartphone. Users can register and schedule an eVisit with a board-certified emergency physician, who will interact with them virtually to diagnose their problem and provide treatment. It is this type of innovation and transformation that I expect will be commonplace before we know it giving a whole new meaning to “the doctor is in.”

Eric Quinones is no longer with Slalom.

Eric Quinones

Eric Quinones is a Director of Healthcare at Slalom and an innovative senior physician healthcare IT thought leader with more than 13 years of industry experience. He is driven by clinical practice productivity and modernization, surpassing organizational and industry metrics, and superior clinical patient outcomes through the successful influence of IT strategy, tactics, and applications. Follow Dr. Quinones on Twitter: @DrQ4U.


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