Monday, March 21, 2011
Telemedicine, e-doctors and getting paid for the work
When I use the term "telemedicine," what does it mean to you?
In current parlance, it usually refers to radiologists looking at digital images of X-rays and other scans from locations remote from the site of acquisition. [Think "outsourcing" where the radiologist could even be as far away as India.]
But according to a recent conference I attended, telemedicine could mean so much more: It can range from synchronous video chat between a patient and a doctor, to conferencing between doctors, to allied health professionals (nutritionists, physical therapists) giving live (or canned) presentations to groups of patients who are geographically far apart.
The technology is already here. The biggest obstacles to widespread adoption of telemedicine is, you guessed it, payment. Or what health care people call reimbursement.
Our current system rewards in-person visits in a fee-for-service model. Each episode of care is monetized. The more episodes, the more charges. Health care reform will supposedly bring about bundled payments, whereby health care teams (not just us doctors) will provide care for patients assigned to us for monthly charges paid to us by insurance companies, as part of an arrangement known by the widgety name "accountable care." In an accountable care model, doctors would be paid for seeing patients in person or not, so suddenly e-mail, video chat and data transfer sound a whole lot more convenient for both parties in terms of time and convenience.
How can a doctor examine a patient remotely, you say?
No one thinks telemedicine will replace the face-to-face encounter; instead, it will augment it. For certain items, a doctor can get readings from a machine,e.g. blood pressures, weights, or glucose levels. Digital photos and video chat work well for skin issues.
In mental health, where resources are often in short supply, telemedicine has taken on an increasing role in doctor-patient virtual visits.
Soon, your smartphone will have a front-loaded camera, which will allow real-time video chat. No more having to use a desktop or laptop to Skype; even basic calling packages will have this functionality built in.
Technology and innovation will drive medicine toward a more patient-centered convenience; there will be more remote diagnostics and consulting, and less face to face time. Patients will respond by taking more charge of their own records, and decide with whom and to what extent to share them from cloud-based, encrypted storage systems.
The day cannot be too far off. After all, we already have a plethora of e-patients.
This post by John H. Schumann, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist in Chicago's south side, and an educator at the University of Chicago, where he trains residents and medical students in both internal medicine and medical ethics. He is also faculty co-chair of the university's human rights program. His blog, GlassHospital, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people that inhabit them.
Labels: accountable care organizations, GlassHospital, guest post, health information technology, John H. Schumann, mental health, radiology, reimbursement, telemedicine
posted by John Schumann, M.D. at
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2 Comments:
I am not a fan of "telemadicine". My husband went to the ER for chest pains. An off-site radiologist read his CT scan and saw what he thought was a dissected aorta. One 11 minute helicopter ride later, we arrived on the roof of the Cleveland Clinic. (Yes, they let me ride with them - I was thinner then). While the team there was AMAZING; it was a wasted trip. They quickly confirmed - his heart was fine. "Must have been a panic attack". (Seriously?) After a weekend in the coronary icu, they sent us on our way.
One mis-read scan by an off-site radiologist led to a very long and expensive weekend.
Side Note: The helicopter company was not in our network per Blue Cross. They should have an "app" for that!
I can see all kinds of uses for this type of checkup in rural areas. I grew up in rural Wyoming and we had to drive 30 minutes to get to a clinic. The local paramedics were called on a couple of occasions to check on concussions. I'm not saying telemedicine can diagnose a concussion, but it is nice to have that option.
Some doctors and nurses don't want to live in these rural areas.
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