Have Healthcare Organizations Been Overlooking Key Components of Telemedicine?

Telemedicine and telehealth have been gaining support from federal and state organizations as a means to improve healthcare delivery across the country and beyond. In September, for instance, the U.S. Health Resources and Services Administration granted the University of Virginia and several others approximately $1 million each over three years to create telehealth resource centers. The U.S. Department of Agriculture has also awarded grants — totaling approximately $6 million at the end of November for telehealth and other healthcare projects and more than $30 million in December for telemedicine projects.

The major focus of recent telemedicine projects, however, seems to be on real-time video-audio communication. Have hospitals and health systems been overlooking the two other principal components of telemedicine — email and telephone? Douglas Smith, MD, CMO of telemedicine company Consult A Doctor and co-founder of the MinuteClinic, explains why telemedicine shouldn't only be about high-definition images and high-end equipment.

Telemedicine benefits
Telemedicine offers multiple benefits for both healthcare providers and patients, including increased access to care, coordinated care and reduced costs. "Telemedicine is the next evolution of increasing access to medical care, a virtual way to get back to the days when the general practitioner was accessible to a patient when [he or she] needed to be seen," Dr. Smith says. This "virtual general practitioner" can help patients access care and help hospitals and other healthcare organizations access patients by connecting hospitals and clinics with specialty physicians, other hospitals and clinics and patients outside the local community, Dr. Smith says. In addition, telemedicine can expand the global reach of healthcare organizations, enabling them to provide third-world nations with infrastructure needed to access care.

Dr. Smith also sees a role for telemedicine in accountable care organizations. He says hospitals can use telemedicine to coordinate various specialties and areas of care for patients and to coordinate the care team.

Finally, telemedicine can lower costs by "diverting patients who have non-emergent problems from the emergency room to lower cost settings, including telemedicine consultations via phone, email or video," Dr. Smith says. A report by Blue Sky Consulting Group estimated that a telehealth expansion bill passed in California in October could save up to $408 million annually by using telehealth for home monitoring of heart failure and diabetes.

Telemedicine by phone and email
"Telemedicine encompasses not only video, but telephone and email — all the ways a patient can communicate with a physician without being in the [same] room," Dr. Smith says. He says that while telemedicine via video has only recently gained popularity, telemedicine via phone has been practiced for decades. A lack of documentation and a method of billing for telephone-delivered services may have hindered wide recognition of this vehicle as a legitimate means of telemedicine, Dr. Smith says. However, 93 percent of Consult A Doctor patients use the company's service for telephonic consultations with physicians, although the company also offers consultations via email and video, according to Dr. Smith.

Healthcare providers and patients can expand their options by learning not to rely on video as a sole delivery system but instead using each technology for what it is best suited. "Focusing on what you want to get out of the consultation will help guide what technology [should be] available," Dr. Smith says. For example, he says video telemedicine might be best for a patient recently sent home from the hospital after antibiotic treatment for a skin ulcer because an image of the skin would convey useful information to the physician.

In contrast, a telephonic consultation would be more appropriate for a patient sent home after a heart attack because the video would not contribute any information about the patient's chest pain or other related symptoms the physician would inquire about. "For many of the issues patients are calling in for, video adds very little to the ability to make a diagnosis and treatment [decision]," Dr. Smith says. Even in cases where video may be useful, an email with a photo attachment may do just as well and "is much simpler than doing a real-time video consult," he says.  

Overreliance on video telemedicine

If not used appropriately, video telemedicine can recreate instead of solve problems, according to Dr. Smith. Using video telemedicine for a patient's appointment "is an attempt to recreate the clinic visit as a virtual clinic visit," Dr. Smith says. "So, it has the same issues that patients have with regular visits — they don't show up on time, [etc.]." In addition, physicians taking time out of their day to do a video telemedicine appointment with a patient would get paid less than meeting with a patient in the office, creating a disincentive for the practice.

Connecting with a physician over video may also pose a burden to patients, Dr. Smith suggests. "Most patients are comfortable with calling up and talking to a doctor on the phone. Most have done it at some point in their life. [Video] is a little more difficult for them to coordinate," he says. Many patients may not have the technological capabilities for video consultation, for instance, Dr. Smith says.

"From the media and press side they focus on video because it appears to be cutting edge, it looks cool," Dr. Smith says. "But from a practical standpoint of the delivery of care, when it adds something it's nice to have, but it doesn't add something in many consultations. [It can] create a barrier to access, and we need no further barriers to care."

Technological improvements

Dr. Smith says advancements in technology — such as equipment that is more accessible to patients and easier to use for physicians — may give video telemedicine a greater role in healthcare delivery in the years to come. "As technology improves, the ability to do more real-time consultation on the fly [may] occur," Dr. Smith says. Physicians may be more apt to use video consultation if they could fit it into their workflow between appointments because they wouldn't have to sacrifice the more highly reimbursed service of in-office visits.

Learn more about Consult A Doctor.


Related Articles on Telemedicine:

Study: Telemedicine Difficulty Stems From Administrative, Billing Issues
Nearly 75% of Nurses Believe Telemedicine Increases Patient Survival

American Telemedicine Association: "Time is Right" to Update Medicare Conditions of Hospital Participation

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