Use of telehealth / telemedicine
Share experience with telemedicine / telehealth
More and more I encounter the issue of severe scarcity of clinical talent in various projects around the world. It is particularly applicable in large and populous countries such China, Indonesia, Vietnam etc. We have been working on tele-medicine platforms and applications as a way of addressing this issue. Our pilot projects include clinical specialties that have share aspects of primary care, such as obstetrics and gynecology and pediatrics.
Based on your experience, could you share ideas which clinical specialties and areas are more appropriate for telemedicine. Are there any particular pitfalls that I should be aware of?
Telemedicine is something that I think is vastly under-utilised. I am about to embark on an Orthopaedic project between Europe and the Middle East which will be heavily reliant on Telemedicine.
One aspect I am interested in exploring is how Telemedicine “consultations” between patient and physician will be funded by insurers – I would be interested to hear of any health systems who are using this method effectively in place of face to face consultations.
In the US telemedicine laws vary from state to state. The reimbursement is not yet at a progressive stage in most places. Several reimburse the same as an in person visit, others don’t yet reimburse at all. The concern is fraud, particularly for public payers.
I agree that telemedicine has the potential to be a very disruptive technology. The price point for primary care visits using mobile platforms appears to be in the range of <$20 US. In my rural Western US region, we have found telemedicine to be successful for certain specialty services such as cardiology, psychiatry and anticoagulation management. We think it will also work for some primary care visits, especially chronic disease management. It seems less likely to be effective for more procedurally oriented specialties such as urology, although follow up visits could be done remotely in many cases. Fee for service reimbursement is expanding in the US. However, when it is not available, telemedicine can still provide value in capitated or bundled payment scenarios.
We have found that telemedicine has been successful in population health follow-up scenarios such as monitoring patients with CHF, COPD, diabetes to name a few. We have also used it with mixed success in psychiatry during a significant shortage of providers. We are embarking on expanding its use in primary care, possibly neurology, and the pre and post-care associated with bariatric surgery. We have also used it very successfully with our own employees for urgent care-type visits to avoid ED utilization. A challenge, if you are using your own providers, is the state licensure requirements that come into play if the provider is in one state and the patient is in another at the time of the visit (a challenge for my health system given our geographic location). There is no doubt that this method of care delivery will continue to gain popularity, however, will need the reimbursers to keep up with this change and recognize payment for telemedicine services.
Give the size of WA and the remoteness of many communities telehealth had been used effectively for chronic disease management for many years. In recent years however there has been utilisation of the medium in acute care setting’s also. Dr Fiona Wood heads up the State Burns Unit for WA and has been a passionate driver of the use of telehealth for acute burn assessment and early intervention either prior to the patients transportation down to Perth or to enable the patient to receive appropriate care in their local community. On the back of this the State implemented an emergency telehealth service to support rural hospitals and remote nursing posts. Over a period of 2 years all of these facilities were equipped with camera’s that enable the emergency telehealth consultant to zoom in and out of the patient cubicle and provide real time advice to the local team on patient management. There have been a number of high profile cases where nurses have been coached to provide life saving interventions by an emergency consultant thousand of km’s away. Both of these services have been effective in reducing resistance to using Telehealth on the back of Consultant preference to be in the same room as the patient to provide quality care. Funding for telehealth consultations in an activity based model remains an ongoing challenge. Currently the site where the patient presents receives the funding rather than the site where the medical expertise and advice is being delivered from.
These were some of the issues and points to consider when we started a telemedicine project with Paediatric Cardiothoracic in India :
1. Credibility of the reporting Consultant/service provider.
2. Reliability of transmission of data, to and from a Consultant to the hospital – in terms of technology, internet access/speed etc
3. Country Regulations – recognition of the service provider/Consultant in Malaysia/foreign country
4. PDPA concerns
5. Hospitals’ legal liability of wrong diagnosis or error in reports.