Telemedicine: Healthcare on Your Terms

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10/28/2019

Hanover, PA-based Phyllis Cline, a heart valve replacement patient, who depends on the medication warfarin to reduce the risk of blood clots, used to visit her cardiologist’s office once every three weeks to have her blood tested, so her doctor could get her dosage just right.

Now, instead of getting ready, going out in all kinds of weather, and driving to the office to sit and wait for her test, the 88-year-old Cline uses an at-home monitor, much like a glucose monitor, to test her own blood and sends the results via a smartphone app to her cardiologist, who simply calls with her test result.

“With my health issues, I have so many doctors’ appointments that I have to get to, so having one less appointment to worry about every three weeks is fantastic,” Cline says. “It saves me time and energy.”

This is the future of medicine. Telemedicine.

While it doesn’t suit all medical needs, telemedicine is growing in popularity, and through technology can enhance your options. You can’t always replace the in-office experience of having your healthcare provider in the room with you (your hearing could fall in this category). Yet, even hearing healthcare has adapted some features of telemedicine, including using apps that work with hearing aids.

Where's telemedicine today? On the rise.

About 65% of U.S. hospitals fully implemented at least one telemedicine program between 2016 and 2017, 13% are in the beginning stages of implementation, while 12% are considering implementing a program but don’t currently have the resources to do so. Only 10% of healthcare institutions aren’t considering telemedicine at all, according to the American Hospital Association. A Foley & Lardner survey reports that 90% of healthcare executives say that their organizations either have a telemedicine program or that they’re developing one.

For busy retirees, or those recovering from surgery or dealing with distance or mobility issues, telemedicine might just be an excellent complement to regular in-office visits with healthcare providers.

So, what's telemedicine?

Simply put, the term “telemedicine” refers to the use of electronic communications and software to provide clinical services to patients without the need for an in-person visit to a medical facility. This technology includes things like managing medications, or monitoring chronic health conditions. Patients can take advantage of long-distance consults or quick follow-up visits via convenient video or audio platforms.  According to DigitalOptometrics.com, the top consumer virtual visit case uses are receiving results from an oncologist (44% of those surveyed will definitely make or consider a virtual visit), a pre-surgery appointment (40%), prescription question/refill (39%), ongoing care for chronic conditions (37%), and select post-op appointments (37%).

Teleheath or telemedicine?

The term “telehealth” is sometimes used instead of “telemedicine.” There are some technical differences between the two, although they’re starting to become synonymous, according to The American Telemedicine Association (ATA), which notes, “While there’s no common definition of telehealth (and its many synonyms), the term itself can evoke a limited view of what telehealth does. What was, until recently, referred to as telemedicine now encompasses a much broader array of services and technologies—AI, virtual reality and behavioral economics are a few examples that come to mind—that are transforming the way health and care are delivered. While the term telehealth is sometimes used to refer to a broader definition of remote healthcare that doesn’t always involve clinical services, [the] ATA uses the terms in the same way one would refer to medicine or health in the common vernacular.”

Telemedicine is more clinical in nature, such as a video consult with a specialist across the country. Telehealth more frequently refers to non-clinical medical services, such as health monitoring, provider training and continued education.

Telemedicine options for healthcare delivery still improving

“People typically think of getting healthcare like this: They call their doctor, make an appointment and go into an office for a face-to-face meeting,” says Dr. Joe Kvedar, vice president of Somerville, MA-based Connected Health at Partners HealthCare, and president-elect of the ATA. “We call that healthcare delivery. Here, two decades into the 21st century, we really can do a lot more.”

 

 

“Waiting for an appointment might not be the ideal time for you to see your doctor. Instead, we can put the patient in the driver’s seat.”

Dr. Joe Kvedar, Connected Health at Partners HealthCare

Kvedar notes that patients today can receive services wherever they are—and whenever they need them. “You can use a smartphone or laptop, accompanied by sensors like a scale or blood pressure cuff,” he says.  “In many cases, too, it’s better care delivery. Waiting for an appointment might not be the ideal time for you to see your doctor. Instead, we can put the patient in the driver’s seat.”

Right now, telemedicine has cornered about 25% of the health technology market, with around 200 telemedicine networks and 3,500 telemedicine sites in America. The value of telemedicine is expected to hit $19.5 billion by 2025, according to Healthcare Innovation.

Who’s Taking Advantage of Telemedicine?

A recent Definitive Healthcare study found that the inpatient provider adoption rate for telemedicine services rose from 54% in 2014 to 85% in 2019. In addition, patient usage leapt from 48% in 2015 to 64% in 2018, according to Rock Health. Patients who live in urban areas are twice as likely to use video telemedicine as those living in rural areas, Rock Health also reported. The top ways patients have incorporated telemedicine into their lives? Live phone calls and emails.

Challenges in providing high-tech healthcare to an aging population

Providing high-tech, cutting-edge healthcare to an aging population is one of the top ways telemedicine can change the look of healthcare in the United States. But, this population tends to be the ones who are less likely to use the services that could change their lives, Kvedar notes.

However, Kvedar believes that’s changing, so it’s important to show the benefits of that complementary care.

“Voice interfaces, such as Amazon Echo Show, have encouraged an older demographic to get involved,” he says. “While there may be some reluctance, the user interface on a smartphone or tablet is very straightforward—and in our experience, people adapt pretty quickly to that.”

Supplementing the traditional doctor/patient relationship

Telemedicine is growing in popularity among patients and healthcare providers—and is quickly becoming an accepted practice of supplementing the traditional doctor/patient relationship. In fact, 60% of patients aged 65 and up are open to using telemedicine to manage a chronic condition, according to americanwell.com. “We’ve come a long way, but there’s still a long way to go,” Kvedar says. “Voice is a big part of it and an easy user interface is a big part of it as well.”

 

 

“The monitoring company sent a nurse to my house to teach me and my family how to use the machine. It helped alleviate the stress of trying something new.”

Phyllis Cline, cardiac patient

Cline admits that she’s not very well-versed in technology. “But the monitoring company sent a nurse to my house to teach me and my family how to use the machine,” she says. “It helped alleviate the stress of trying something new.”

Gaining Access to Telemedicine

Since telemedicine is a relatively new concept, getting your telemedical services paid by your insurance company can come with some challenges. Reimbursement rates vary among insurance companies and are constantly evolving as telemedicine becomes a more accepted form of treatment. That’s why it’s a good idea to contact your healthcare insurance provider to learn what’s covered under your particular plan.

Does Medicare cover telemedicine?

Medicare does cover telehealth, but its policy is very restrictive,” says Christine Calouro, policy associate at the Center for Connected Health Policy (CCHP). “Medicare covers certain types of providers, such as physicians and nurse practitioners, and specific types of services. Additionally, the patient must be located in a certain type of medical facility, meaning they can’t be located in their home, with the exception of a few conditions, or they must be located in a rural area.”

However, Washington, D.C. and 48 states now require private insurers to provide telehealth coverage, according to Calouro, but CCHP has found that even when there’s a law, sometimes private insurers don’t cover them. Unfortunately, since telemedicine is still relatively new, 39% of Medicare, 36% of Medicaid and 34% of private payer reimbursement challenges remain unaddressed, according to In Touch Health. Insurers can limit coverage by only covering certain providers or services, or can even require the patient to reside in a specific type of facility, as Medicare does.

Being cautiously optimistic about telemedicine

While telemedicine has a lot of advantages, there are some things to consider before jumping in. For example, not everyone is technologically savvy or has access to the software and tools needed to use telemedicine effectively, so cloud-based medicine might not be the right fit. Plus, about 34 million people in the U.S. don’t have access to reliable broadband internet. And while some insurance companies provide reimbursement for the costs of telemedicine services, the guidelines vary and you may end up paying out of pocket if you haven’t done your research.

A preference for face-to-face meetings

On a more human level, some people simply prefer face-to-face meetings, especially when a doctor or provider shares test results or a diagnosis. The perceived lack of a personal touch or connection turns some people off from using these long-distance tools. However, telemedicine can shorten the average physician appointment wait time of 24 days, persuading patients to give tele-appointments a try.

Still others are reluctant to try telemedicine because of privacy concerns over their information staying safe and secure. “There’s nothing in HIPAA that directly addresses telehealth and telemedicine, so providers are under the same HIPAA obligations whether they deliver services in-person or via telemedicine,” Calouro says.

“Because of that, providers must ensure that they’re protecting patient privacy to the same extent they would, had the service been delivered in person. Since the service is telehealth-based, this might mean doing things a little differently. For example, patient information obtained through live video or other electronic format needs to be encrypted.”

Telemedicine at Your Fingertips

Many medical facilities already offer some form of basic telemedicine to patients. Sometimes, it’s as simple as signing up for a patient portal at your primary care doctor’s office, so that you can schedule appointments, look up test results and ask questions. You may even be able to call a 24/7 toll-free hotline to speak with a nurse. “Hotlines and virtual appointments are also very popular in urgent care, for things like headaches, UTIs or sore throats,” Kvedar says. “You can pick up your phone or tablet to call in and get a doctor. That’s pretty widespread right now.”

Tapping into resources beyond primary care docs

Outside of your PCP, you can tap into online services that patients can use to get treatment from the comfort of their own homes. Two of the top providers are Teladoc and Doctor on Demand. The costs for Teladoc vary by the subscription level you choose. Doctor on Demand has set prices for visits: $75 for medical visits, $79 for therapy visits and a $229 fee for an initial psychiatry visit. Some insurance companies also partner with organizations to offer care by phone or online.

With the use of telemedicine, you can potentially gain access to diagnostic tools your local hospital may not have or consult with specialists located on the other side of the country. If you’ve had an operation, you can access post-surgical visits via video chats as well.

In addition, telemedicine might become more the norm instead of in-person doctor, emergency room and urgent care visits, as 74% of patients are comfortable with communicating with their doctors using technology instead of seeing them in person, according to a Cisco report. Plus, one hospital states that it saves $86.64 each time a telehealth option is used over an in-person visit in the emergency room or urgent care, according to the American Council on Science and Health.

Don't want to visit a therapist? Talk to your provider from the comfort of your own sofa

Mental health therapy and weight loss are two specialties that see the most use of telemedicine among patients. According to the ATA and Kvedar, 44% of mental health providers use telehealth as a tool. The success of the use of telemedicine in mental health patients is multifaceted; some patients still feel a stigma in asking for help, so seeing a psychiatrist in their own homes is more comfortable for them. Telemedicine also allows therapists to have added access to their patients for the monitoring of symptoms and medicines. Patients in some clinics have access to their therapist through text messaging, which could mean the difference between life and death.

Ultimately, some promising studies show that there’s no significant care quality difference between telemedicine and face-to-face visits, according to Fruitstreet.com, so it may be a good time to embrace e-care. Similarly, the Veterans Health Administration’s use of a post-cardiac arrest telemedicine care program showed a 51% decrease in patient readmissions, according to aha.org.

In his book, The New Mobile Age: How Technology Will Extend the Healthspan and Optimize the Lifespan, Kvedar gives us a glimpse of the future in the merging of healthcare and technology: “If these tools and services aren’t already in use (and many are), they’ll soon find their way into your home and your life. And they’ll have a major impact on how you and your loved ones experience your later years.”

Opportunities and challenges with telemedicine

While telemedicine is on the rise and offers exciting new options for patients and providers, there are still certain instances when you want healthcare to happen in the same room. For a wide range of services and diagnostics, from cleaning earwax or teeth, to having an experienced professional know when something feels atypical to the touch, sometimes technology can't replace a healthcare worker's hands. Still, telemedicine is changing the way we experience healthcare; as technology develops, we can expect more. For now, it can start with worldwide consultations from the comfort of your kitchen.