denise tinsley
Sep 3, 2018 · 5 min read

RECENT DEVELOPMENTS AROUND TELEMEDICINE

Recent findings depending on which market report you ascribe to state industry projections for the annual growth rate of telemedicine are between 13 and 27%, with valuation growing to over 20 billion US dollars in the next several years according to (M Waller, C Stotler, 2018). A survey conducted by Software Advice, an Austin Texas based EHR consulting company stated that 75% of survey respondents express an interest in attending online based
medical appointments versus an in-person visit (Levanthal, 2015). The most cited positive reasons among respondents align with the benefits that telemedicine advocates typically promote: quality of care that is similar to or higher than an in-person visit (21 percent), not having to travel to the visit (21 percent); and the ability to enjoy the comforts of home (20 percent). Current and potential patients are comfortable with social media, and technology use but up until recently there has been no direct reimbursement for telemedicine and the security of patient data continues to be a concern.
Recently Medicare has begun to offer reimbursement to providers that offer telemedicine to patients. The new Medicare Chronic Care Management (CCM) program now compensates providers approximately $42 per month for coordinating the care of Medicare patients with two or more chronic medical conditions. Current downsides and challenges will be discussed as well specifically around technology. Telemedicine has great potential as well as challenges but appears to be a viable form of treatment that will be refined over time and will be available to a higher percentage of patients than at present.

Telehealth or Telemedicine as it will be referred to in this paper, is the use of digital information and communication technologies, such as computers and mobile devices to access health care services remotely and manage health conditions, often chronic conditions. These may be technologies used from home or that a provider uses to improve or support health care
services. At first glance many assume telemedicine merely means eleconferencing between patient and physician or other healthcare professional but that is a limited concept of what it means to provide telemedicine. As with most technologies, the idea of telemedicine is not new, it has long been feasible for a healthcare provider to teleconference with patients or consult via phone but technology has advanced to a point where healthcare services can come to the patient in a form they can access
that is more convenient for them such as biometric tracking applications, body mass scales, fitness watches, or the ability to upload images and messages using HIPAA compliant means of transmission.

Provider Benefits
Telemedicine programs can impact various aspects of patient care, including
informational, clinical, behavioral, structural, and economic as outlined by (Klonoff DC, 2009).
Benefits can impact not only physicians and direct care providers, but hospitals can reduce readmission rates by closely monitoring patients with chronic conditions and comorbidities. Chronic diseases can be better managed reducing expensive emergency or in hospital admissions. Patients can better prepare for surgery resulting in fewer cancellations or lack of readiness prior to anesthesia and surgery. Further, 67 percent of patients, combined, respond that using telemedicine “somewhat” or “significantly increases” their satisfaction with their medical care (Levanthal, 2018)

Patient Impact

As stated 67% of patients surveyed (Levanthal, 2018) state that telemedicine increases satisfaction regarding their care. Many feel the traditional in-office visit feels rushed and they benefit from learning more about their conditions through various educational opportunities such as videos, quizzes, and question and answer sessions. Patients can schedule appointments around
other obligations and avoid frustating or costly transportation issues. Some patients are not physically able to drive are required to make transportaion arrangements, this is avoided except for instances where in-office visits are required. Various languages can be accomodated as well, a health coach can speak in the patients’ native language which has the benefit of increasing
patient understanding, treatment adherance, and satisfaction. There are numerous patient benefits.

Various Models of Care
Care can be provided in a variety of means; care will most often be delivered using a combination of traditional models as well as telemedicine. Often health coaches will deliver information and guidance while following a set regimen of care and monitoring. Software applications will often deliver the care along with coaches and physicians. It is vital that data be tracked regarding patient progress and participation. Patients can self-report concerns, and data related to their conditions such a weight, blood sugar levels, pain levels, emotions, or upload images and documentation. Many telemedicine solutions are making data and documents
regarding the patient available to the an EHR system allowing the telemedicine artifacts to be a part of their medical record.

Concerns and Downsides
Within the walls of the hospital, security surrounding patient data is governed by strict guidelines and access is limited to healthcare professionals and concerned parties. When organizations outside of healthcare build solutions it is difficult to ascertain if patient data is being exposed unnecessarily to parties outside of the healthcare environment. Typically, data is handled with care but what are the expectations for 3rd party solutions providers? It is quite unclear and data breaches are an issue that continue to trouble the healthcare industry. Many solution providers are beginning to offer HIPAA compliance as a built-in component of their offerings for such things as cloud hosting, text messaging, and teleconferencing. The healthcare application industry would benefit from standards in security practices.

An additional downside to telemedicine is access to technology, patients will differ in their comfort regarding technology use. Some patients do not have access to wireless networks or network speeds that can smoothly deliver teleconferencing, document and image uploads, or educational videos. When technology is slow or unreliable the patient may well abandon the
telemedicine experience or request more traditional means of interaction. Reimbursement incentives for telemedicine are being defined at this time, without prior planning telemedicine while beneficial may not yet be profitable for many providers.

In Summary
Both patients and providers can benefit from telemedicine. In the long run it can reduce cost, provide a continuum of care, as well as increase patient satisfaction. Currently telemedicine is not the norm but with the recent approval of Medicaid to provide reimbursement perhaps telemedicine will move to the mainstream, providing efficiency, cost savings, and increased
patient satisfaction.

References
Waller M, Stotler C. Telemedicine: A primer. Curr Allergy Asthma Rep. 2018;18(10):4. doi: 10.1007/s11882–018–0808–4

Leventhal, R. (2015). Survey: Patients interested in using telemedicine services. Retrieved from https://www.healthcare-informatics.com/news-item/survey-patients-interested-using-telemedicine-services.

Klonoff DC. Using telemedicine to improve outcomes in Diabetes — An emerging technology. Journal of diabetes science and technology. 2009;3(4):624–628. http://journals.sagepub.com/doi/full/10.1177/193229680900300401. doi: 10.1177/193229680900300401

denise tinsley

Written by

Consultant related to healthcare, Healthcare Informatics Graduate Student

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