In hospitals and medical centers across the country, telemedicine—the diagnosis and treatment of patients using telecommunications technology—is transforming the delivery of a growing portion of health care services.
Indeed, telemedicine visits are expected to surge in 2017 and beyond, Excellus BlueCross BlueShield officials predict.
Officials late last year said they foresee Upstate New Yorkers embracing telemedicine as an alternative to getting care for minor conditions next year and using that option more than 50,000 times by the year 2018. Telemedicine services are available to anyone with or without health insurance, but platforms are being built into most health insurance offerings throughout upstate, they said.
Relying on national studies, local projections and preliminary results from a pilot program of its own employees’ use of telemedicine, Excellus BlueCross BlueShield said a surge in its use was likely to begin in 2017 and grow rapidly every year through the remainder of this decade and beyond.
“Ideal medical care is when a patient sees his or her physician face-to-face, and both know and trust each other, but in our rapidly changing and fast-paced world, some of those face-to-face visits can’t always take place,” said Martin Lustick M.D., senior vice president and corporate medical officer for Excellus BlueCross BlueShield.
“Telemedicine is an alternative that is in place and will gain popularity across the country,” he said. “It allows people in rural areas to see specialists in urban settings. It serves the needs of patients who find it difficult to get out of work to see their doctor when they need to address a problem for themselves or their children. And, it’s a speedy alternative to going to an urgent care center or even the hospital emergency room for minor medical conditions.”
Upstate New York is not alone in this trend.
In Maryland, intensive care patients in 11 hospitals, 10 of them in sparsely populated rural areas, now have instant access to top specialists across the state through video cameras installed in their rooms.
In Oregon, stroke victims at some two dozen medical sites can be evaluated instantly and around the clock by neurologists.
Minnesota’s Mayo Clinic is using video cameras to connect babies born in distress at small hospitals to neo-natal specialists at their Rochester, Minn., hospital.
One example: Kaiser Permanente CEO Bernard Tyson recently announced his health system is now seeing more patients online than in person.
Experts agree the use of telemedicine is only going to grow.
“It’s starting to really catch on,” said Marc Zubrow, vice president of telemedicine for the University of Maryland Medical System. “I think this is the future. … In 10 years, there’s going to be a huge paradigm shift in a lot of the things we do in medicine—dramatic changes.”
Archit Bhatt M.D., medical director for telestroke at Providence Health and Services in Oregon, said his system’s telestroke program is booming and now provides some 1,000 consultations a year. In the process, he said, it has given thousands of patients access to expert diagnoses and effective
treatments they probably would not have gotten before—a key selling point of telemedicine.
The success has prompted Providence Health to explore other uses for telemedicine, such as telepsychiatry.
Bhatt conceded, however, telemedicine has its limits.
“We have a long way to go for other non-stroke and non-neurological issues,” he said. “There are several barriers.”
That barriers remain for telemedicine is undisputed.
A study published in January 2015 by the American Hospital Association concluded that while telemedicine (sometimes called telehealth) is “increasingly vital to our health care delivery system,” there are also “significant legal and regulatory challenges posed by telehealth technologies.”
Among those challenges, according to the AHA, are licensure (generally, physicians have to be licensed in the state where the patient lives, so treating patients across state lines is tricky), liability, privacy and security and, a “patchwork of reimbursement rules and rates.”
Zubrow mentioned one more impediment: Resistance from some physicians, most frequently, older physicians.
“We rarely run into patient or family resistance, but there’s a lot of physician resistance, for whatever reason,” he said. “It’s not traditional, not the Marcus Welby way of doing things.”
Even the most enthusiastic advocates say telemedicine does not work for some types of medicine.
“Obviously, there are some things you can’t do very well—some things where someone has to touch the patient, to see what’s going on, has to be in the same room,” said Steve Ommen M.D., medical director at Mayo Clinic’s Center for Connected Care.
Ommen expects the medical community to re-examine what needs to be done to advance telemedicine, and not just with video cameras.
He noted, for example, devices already exist that allow someone to listen to a patient’s heart and lungs remotely, not to mention monitor blood pressure, weight and other health factors. Those devices will be used more and more in the future, he said.
“Even just exchanging text messages, in a secure environment, can be helpful,” Ommen said.
To avoid depersonalizing medical care, Ommen said, physicians will have to figure out the proper balance between the convenience and advantages of telemedicine and the need for in-person visits and touch.
“We don’t know all of that yet, but I think we’ll learn it organically,” he said.
As for telemedicine’s advantages, advocates say they are legion. The American Telemedicine Association lists a handful, including: improved access to expert health care, especially in less-populated areas; reduced or controlled costs due to increased efficiency, better management of chronic diseases, shared staffing, reduced travel times and shorter hospital stays; and, equal or even better quality of care, especially in services such as mental health and intensive care.
Jonathan Linkous, CEO of the association, said telemedicine is growing faster than expected. In the past 24 months, he said in an email response to questions, the number of patients served has increased by some 30 percent.
Problems remain, he conceded, including questions involving reimbursement procedures and acceptance by providers, payers and health administrators.
But the future for telemedicine, he said, is bright.
“The growth is expected to accelerate as the payment issue is resolved and as consumers increase demand for these services,” Linkous said.
Nearly five out of 10 Upstate New York adults are aware of telemedicine, and 80 percent of those who have used telemedicine rated their experience as “very good” or “excellent,” according to a survey commissioned by Excellus BlueCross BlueShield, the insurer said last month.
The online survey administered by the polling firm One Research contacted 2,000 upstate adults, a representative sample of the region’s U.S. Census Bureau demographics.
Roughly one-quarter of survey respondents indicated they plan to use telemedicine in the future, while an equal number said they did not plan to use it. Roughly half of the respondents were undecided.
In the Finger Lakes region, some 25 percent of respondents plan to use telemedicine.
Story includes Rochester Business Journal staff reports.
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