What is Telemedicine and Why is it On the Rise?
Access to a doctor is here to stay with a click of a button.
For the Stone family in Bucyrus, Kans., telemedicine has been a godsend. Instead of driving more than four hours to see their daughter’s plastic surgeon at St. Louis Children’s Hospital, they simply drive 45 minutes and confer with the doctor through a computer at Saint Luke’s hospital near the Country Club Plaza in Kansas City.
“Every time we’ve been to St. Louis, we went the day before, we got a hotel, and then we went to her appointment, which have always been in the morning,” says Katie Stone. “So this saves us time and money.”
Katie’s oldest daughter, Kaylin, 7, was born with facial palsy and was unable to move the right side of her face. Kaylin had two surgeries in St. Louis with her surgeon who specializes in facial palsy, one in 2015 and one in 2016, to correct the problem. Her family has since conferred three times through telemedicine in Kansas City with the surgeon for checkups.
“One of the best things about telemedicine is that I was pregnant at the time and wasn’t supposed to travel, so it was really hard to go very far,” Katie says. “Going to Saint Luke’s was a big help.”
WHAT TELEMEDICINE IS ABOUT
Imagine you’re like the Stone family, living in a small town hours away from your medical specialist, and need regular consultations in your own home or clinic about a chronic condition. Imagine needing immediate but non-emergency care for your child suffering from pink eye or nagging allergies. Imagine being in an intensive care unit, talking to your critical-care doctor hundreds of miles away.
Telemedicine, a product of the 20th century, has increasingly become a solution in these situations and is transforming the healthcare landscape worldwide because it provides a rapid transfer of knowledge. Whether called telemedicine, telehealth, eHealth or another related term, healthcare experts say this multi-billion dollar industry is past the tipping point because of new technologies.
This relatively young industry uses telecommunication and information technology that allows physicians the flexibility to provide video diagnostics from a distance while viewing their patients on a cell phone, iPad, tablet or desktop computer. In addition to supporting long-distance clinical healthcare, it also promotes patient and professional health-related education, public health and health administration.
“There is nowhere I go now that I do not hear of a thirst to implement telemedicine at scale in health systems to improve access, to better engage patients in their own care, to provide equity to those disadvantaged by geography, to make best use of providers’ time and talent,” wrote Dr. James Peake, M.D., president of the American Telemedicine Association, in the association’s five-year plan for 2017-2022.
Though it has limitations, telemedicine is indeed the wave of the future, says Steve Kropp, system director of eHealth and Outreach for Kansas City’s Saint Luke’s Health System. From 2013 through last year, telehealth has grown 32 percent in Missouri alone.
Kropp attends medical conferences from coast-to-coast and sees how every health system is up against the same struggles: more patients need or demand care from a stable or shrinking number of healthcare providers.
“So you have to have a force multiplier or some way to leverage that lower population of providers to meet the demand of patients,” he says. “You have to be able to use technology as that leveling force. Instead of having one physician for one patient, maybe you have one physician for 60 patients. We really see it as a way to deliver care where it’s needed, provide patients access and allow our physicians to stay in clinic versus driving two hours on the road up and two hours on the road back.”
Kropp notes that more doctors are coming aboard the telemedicine train.
“Some doctors say, ‘I can’t treat a patient well unless I put my hands on them,’ and we don’t want to interfere with that,” he says. “Others say, ‘I can really see where this is going to allow me to provide a high level of care for a lot more patients than I can put my hands on.’”
Saint Luke’s Health System currently has about 115 physicians representing more than 20 specialties, in addition to primary care through its 24/7 virtual house-call program, who are in some capacity engaged in its telemedicine program. The health system had about 12,000 physician-to-patient telemedicine encounters last year, a 15 percent growth from 2016, Kropp says.
Saint Luke’s telemedicine supports hospitals across the region with its eICU coverage of critically ill patients. Using computers and sophisticated technology, a critical care physician and a team of nurses monitor ICU patients from a centralized location in Lee’s Summit. Secure, high-speed data lines transmit vital signs, medications, blood test results, X-rays and other information in real time, with special two-way cameras allowing the staff to examine patients and interact with them.
Kaylin Stone’s facial palsy has visibly improved, says her mother, Katie. When they teleconference at Saint Luke’s, their St. Louis surgeon and therapist have Kaylin perform certain facial expressions like smiling and making funny faces so that they can see her movements. At least one more telemedicine checkup is in the works.
“I don’t know if she will ever be at 100 percent, but you can really tell she’s improved,” Katie says. “Before when she would smile, her left side would go up and her right side would go down. Now, the right side goes up.”
For members of the Stone family, telemedicine has given them all a reason to smile.
TELEMEDICINE'S THREE MAIN CATEGORIES
Store-and-forward. Patients’ medical data like records, images, and audio and video information are transmitted to a doctor or medical specialist for assessment off-line. This does not require that both parties be present at the same time.
Remote patient monitoring. This allows medical professionals to monitor patients remotely using various technical devices. Primarily used for chronic diseases or specific conditions such as heart disease, diabetes and asthma. Reduces the need for outpatient visits and enables remote prescription verification and drug administration oversight, potentially reducing the overall cost of medical care significantly.
Real-time interactive services. Electronic consultations via videoconference between patient and provider allow management, diagnosis, counseling and monitoring of patients. Beneficial to patients in isolated communities and remote regions because they can receive care from doctors or specialties far away without having to travel to visit them.
Patients are able to stay in their homes and receive services they wouldn’t be able to receive without telemedicine.
Patients are able to go to their home community clinics or medical centers, where a nurse sets up the audio/video system and connects with the doctor through a two-way monitor.
Medical education can be facilitated by allowing healthcare workers to observe experts in their fields and share best practices.
The transmission of infectious diseases between patients and medical staff can be eliminated.
Patients are able to stay in their hometown hospitals, effectively lowering overall costs of the healthcare system and putting less pressure on ambulances.
In-home care allows patients to skip waiting rooms and get medical advice sooner.
Some insurers are opposed. For example, Kansas, unlike Missouri, does not have a “telemedicine parity law” that requires private insurance companies to pay the same rate for these services as they do for in-person services. Insurers, including Blue Cross and Blue Shield of Kansas, believe mandates are the wrong approach.
Some feel telemedicine actually takes longer to assess certain patients than in-person interactions. Dermatology exams are an example.
Potential poor quality of transmitted records.
Costs of telecommunication and data management equipment and technical training.
Unclear legal regulation for some telemedicine practices.
Potential of decreased human interaction and increased risk of errors or that protected medical records may be compromised.