Citizen Economists » e-visits

How Telemedicine Can Actually Work

J.C. — Thu, 31 Jul 2008 09:19:21 +0000

My last post generated an interesting comment from a reader questioning whether telemedicine can actually be used to do a physical exam. The reader brings up some great questions about how telemedicine can actually work. Such questions and resistance to new technology clearly highlight the struggle for technological progress in medicine.

While I agree that telemedicine is not fully developed and only in its early stages, there are many fields which currently lend themselves to key physical examination points though video conference. One such field is cardiology in which a tele-stethoscope is placed on the patient to allow the remote consulting physician to evaluate heart sounds. In this example the patient does not usually place the tele-stethoscope but a technician or nurse does. Similarly, an echocardiogram machine with teleconferencing capabilities can allow a consulting cardiologist to view the technician doing the echocardiogram and the results live. The examples of telemedicine in the field of cardiology are many. Another example of telemedicine is the use of a tele-otoscope for ENT physicians to examine the ears, nose, and throat remotely. Being able to get this data remotely clearly would be more efficient and save time and money.

While all of these are just theoretical examples, there are plenty of real-life examples of telemedicine being used to examine patients. Any physician or non-physician can search the literature and find great examples.

One example is a recent report coming out of Virginia Commonwealth University and the Virginia Department of Corrections. The surgeons in that group conducted 55 telemedicine sessions over a year-long period. With the assistance of a nurse at the correctional facility and tele-stethoscopes and dermascopes, they were able to recommend surgery for 27 patients with the only face-to-face meeting being the day of surgery! Using telemedicine, they were able to provide care for a needy population and reduce significant pre-operative work-up and patient transfer costs.

telemedicine, cardiology, health care, health care economics, medical informatics, health care informatics, economics, economy, health care IT, medicine, medical field

How Telemedicine Will Replace the Once-Sacred Doctor’s Exam

J.C. — Sun, 27 Jul 2008 12:21:58 +0000

Despite the advances of “Going Live” that I wrote about previously, there are some areas of the health system where a computer cannot replace the presence of a human doctor. In medicine the sacred territory of the doctor is the “physical exam” – the physical examination of a patient. This is the Holy Grail of medicine – the most powerful thing that allows doctors to be doctors – the diagnostic intuition that impresses upon them after they examine a patient. From this exam, the physician with his wealth of knowledge and years of experience can get a sense of exactly what is going on with a patient. Nothing can substitute for a good physical exam.

Despite the “physical exam” being the secret magic that allows doctors to be doctors, it is also the main hindrance to the one advance that would truly make the healthcare system more efficient. If you don’t know what I am talking about, I am referring to medicine in which the doctor does not actually have to be in the room. Telemedicine is where the doctor is actually not physically in the room but is seeing the patient through a video screen. Another variation of this is robotic medicine in which a robot with a live video camera cruises around the hospital floor going from room to room visiting patients. On the other end is a physician seeing the patient through his video monitor.

Why is this so important? If you think about all of the possible areas to improve efficiency in medicine, the actual practice of medicine – the seeing of patients to diagnose and treat them – is the most time consuming and thus the most costly for the healthcare system. Have you ever wondered what doctors do all day? Well, they go around and visit their patients in the hospital – they “round on their patients.” They also see patients in clinic. The remainder of time is usually spent discussing patient care issues or continuing their education through lectures or talks. Thus making this more efficient of a practice would save enormous amounts of time and money.

Imagine being able to see patients and diagnose their diseases from a different place. Expert physicians could do consultations from across the globe. Physicians could efficiently see more patients. Video files would document all examinations. The physician would not actually need to go to each and every hospital location. How great this would be!

There are many layers of resistance to this movement. Patients, in their state of need, actually want to see a doctor face to face if they have the means to do so and if there is someone available not too far way. Physicians, with their intuitive minds, have gotten the sense that if they could be replaced by computers then they would not be in high demand. If any patient could see another doctor by logging on a computer with video camera and clicking on a button then many doctors would go out of business. Perhaps most importantly, healthcare systems and their prudent risk managers worry about liability issues with telemedicine.

As information technology continues to transform the healthcare system, it will undoubtedly continue to transform the way we practice medicine. Someday probably not too far off, we will be able to do a physical exam via telemedicine. Some of us can’t wait to be accessible to the vast worldwide patient population that awaits.

telemedicine, health care informatics, medical informatics, health care economics, health care, economics

E-Visits: The Next Big Thing in Healthcare?

Jennifer Bunn — Mon, 14 Jul 2008 04:59:44 +0000

It seems that, by 2009, doctors may be able to bill Medicare for electronic consults, a practice that has been discussed in the past but has not been reimbursed by insurers (except in a few remote instances) to date.

Under this new provision, consumers of healthcare will be able to log on to the Internet and consult their doctors from the comfort of their own home, thus saving themselves from lengthy visits to hospitals or busy waiting rooms.

An advantage of this technology, if it should come to pass, is that patients may be able to access a specialist in a more timely and convenient fashion. Also, patients who find it very difficult to travel or mobilize may find this method of care a literal lifesaver.

Physicians may find it easier to monitor their patient’s conditions and prevent complications from occurring if they are able to maintain better contact with them in this manner. And patients in remote areas may have better access to healthcare than they have enjoyed in the past. In fact, remote telehealth has been in use in some areas already.

So what are the potential pitfalls of this practice? The first and biggest area of concern that comes to mind is the measures that will need to be put into place to ensure confidentiality. This will be an important issue, and patients using such a system may have legitimate concerns regarding the security of their personal healthcare information. Secondly, for hospitals that are already having difficulty implementing electronic healthcare records that are very expensive, implementing a system such as this may be too cost-prohibitive. The technology required to capture and store all the data that will be generated by these “visits” will be staggering, not to mention very expensive.

It remains to be seen whether the idea of e-visits will be the wave of the future or simply a great idea that never really took off. Likely what will decide the issue will be the patients who use the system.