Monday, March 7, 2016

The promise and challenges of telehealth

- Kenny Lin, MD, MPH

Last fall, I attended a conference on patient-centered medical homes where one of my fellow attendees shared how after-hours videoconferencing with a primary care physician had allowed him to avoid spending a night with his child in the emergency department. This story made me wonder if primary care practices without virtual visit capabilities might someday be viewed as anachronisms, something like banks before automated teller machines and smartphone check depositing apps.

According to a Graham Center Policy One-Pager in the January 15th issue of AFP, only 15% of family physicians surveyed in 2014 were using telehealth (defined as "the use of medical information exchanged from one location to another via electronic communications to improve a patient's health"), even though most agreed that it improves access and continuity of care. Geographical and generational differences influenced telehealth use; according to the original study report, telehealth users were more likely to see patients in rural settings and have practiced for 10 or fewer years than non-users. Non-users were more likely to cite barriers such as equipment cost, lack of reimbursement, lack of training, and potential liability issues.

Private insurers have been gradually expanding coverage for telehealth services, according to a recent article in Modern Healthcare. Since Medicare has traditionally been less willing to reimburse such services, bipartisan legislation, the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, was recently introduced in the U.S. Congress to remove many of the program's current restrictions. Family physicians and other primary care clinicians are poised to benefit from these changes. In recognition of the changing payment landscape, the American College of Physicians, the American Academy of Family Physicians, and the American Academy of Pediatrics all published policies or position papers on appropriate telemedicine use and reimbursement last year.

Other than payment, what should family physicians consider in deciding whether or not to treat patients virtually? A 2015 article in Family Practice Management reviewed the most common elements of care that have implications for telehealth services:

1) Formation of a doctor-patient relationship
2) Proper evaluation and treatment
3) Responsible prescribing
4) Protection of the patient
5) Safeguarding patient privacy

If you are a family physician who currently offers telehealth servcies, how has this capability benefited your patients and your practice? If you don't, what has been holding you back?

1 comment:

  1. The simple answer to all the above issues you raise is money and tradition. Right now telemedicine is free… no money means no mission and therefore don’t disturb the sacred mythology that every medical problem must be seen face-to-face so that I can watch body language, touch the patient, build relationship of trust, provide some physical exam and produce a billing code. Forget the fact that history trumps physical in sensitivity and sensitivity at least 60% of the time.

    Telemedicine does NOT mean it's impersonal, dangerous, increases lawsuits, ruins the doctor-patient-relationship, undermine trust or mean that you never need to see the patients face-to-face. It just means that telemedicine continues to remain the largest underutilized and unexamined assumption about revolutionizing the primary care business model in most organized medicine settings.

    Urgent care, Minute Clinics, Walmart, Teladocs and thousands more who are members of the American Telemedicine Association understand the revolutionary and disruptive power of allowing patients to access a provider through remote means and are steadily moving towards laying claim to 60-70% of the business of primary care.

    Judging that I am the first to respond to this blog post after a week reassures me that main stream medicine remains bored of this topic and blissfully unaware of what the competition is planning for traditional brick or mortar medical practices.

    I was asked to give a keynote address to the American Telemedicine in 2009
    ATA key note :
    http://getbetterhealth.com/telemedicine-as-the-cost-saving-foundation-to-healthcare-reform/2009.09.30
    6 years have passed since this talk and like many things- not much has changed.
    Alan Dappen, MD
    DocTalker Family Medicine

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