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Journal of ASPR - Fall 2013 - Telemedicine: Bringing specialized care to a hospital near you
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Telemedicine:

Bringing specialized care to a hospital near you

By Crystal Peterson, Director, Physician Recruiting and Retention, Specialists On Call, Inc., Reston, VA

A 52-year-old mother of three is brought into the emergency department of an urban hospital, displaying symptoms of a stroke. Nurses and medical staff collect patient data and medical history, the ED physician orders a CT, and asks the nurse to page the on-call neurologist for a consultation.

Fifteen minutes later, a stroke-trained neurologist consults with the ED physician and the patient’s husband. The consultation exam shows the patient suffered a stroke and is a candidate for the clot dissolving drug tPA (tissue Plasminogen Activator), which is administered to the patient. Later that evening, the patient is admitted to the hospital for recovery and follow up care. Eleven hundred miles away, the neurologist who performed the consultation finishes his shift, turns off his video conferencing unit, and turns the case over to a neurologist three states away.

Stroke, sometimes referred to as a “brain attack”, is the third leading cause of death in the US, and the number one cause of adult disability. With stroke, time is paramount. The most commonly used drug, tPA, must be administered within a three-hour window in order to be effective. At the same time, tPA can have significant complications in certain patients, making it critical to bring expertise to the bedside as quickly as possible. Telemedicine can provide the opportunity for this to happen in the right place at the right time.

The concept of treating a patient at a distance isn’t a new one. Advances in the area of telemedicine, from the technology to its application, are more recent developments that are increasing the scope and acceptance of telemedicine.

Telemedicine and telehealth
As a multidisciplinary, dynamic, and continually evolving tool in medicine, researchers and users have developed various definitions for telemedicine. In fact, a Google search for “telemedicine” delivers 3,780,000 results. According to the American Telemedicine Association, “Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve, maintain, or assist patients’ clinical health status.”

While closely associated with telemedicine, telehealth is a term that encompasses a broader definition of remote healthcare that does not always involve clinical services. For example, a smartphone app that reminds patients to take medication (such as MyMeds), is considered a telehealth or mHealth (mobile device use) form of care.

Care at a distance, also called “in absentia care,” is an old practice with a long and successful history. In 1929, a one-year aerial medical service based in Queensland, Australia, utilized a pedal-powered radio to provide communications to remote areas in the Australian outback. This technology allowed patients in isolated areas to call for emergency medical assistance. Today, this service is known as the Royal Flying Doctor Service.

Almost 50 years later, The University of Miami launched one of the first telemedicine programs in the US, under the direction of Dr. Jay Sanders. Dr. Sanders is considered by many to be “the Father of Telemedicine.” This program has grown to one of the largest university-based programs in the country.

There are many more systems as well. A simple Google search found nearly 2,390,000 possible references, some of which included: American Well: PC-based interaction designed to mimic an office visit; Tele Docs: primary care via cell phone; and Health Spot: a private walk-in medical kiosk.

Over the next five years, an InMedica study on the growth and impact of telemedicine, identifies four main drivers of telemedicine and telehealth demand:

Federal-driven demand
Readmission penalties introduced by the US Centers for Medicare and Medicaid Services (CMS) are driving providers to adopt telehealth as a means of reducing readmission penalties.

Provider-driven demand
Healthcare providers want to use telehealth and telemedicine to increase ties to patients and improve quality of care. In many cases, this is taking place irrespective of the lack of a clear financial return on investment (reimbursement).

Payer-driven demand
Telemedicine is also being used increasingly by insurance providers to increase their competitiveness and reduce in-patient payouts, working directly with telehealth suppliers to monitor a patient base.

Patient-driven demand
This is the area with the greatest increase in demand. Patients are actively seeking out and requesting telehealth and telemedicine services from payers and/or providers. Patient-driven demand is not limited to rural/non-metropolitan areas where there is a poor availability of clinics and physicians.

Telemedicine is impacting the treatment of patients across disciplines, geography, and economic status. With its ability to extend care, telemedicine is anticipated to be a big player in the future of healthcare.

Reference:
The World Market for Telehealth: An Analysis of Demand Dynamics 2012. A report from InMedica, part of IHS (NYSE: IHS).

Journal of ASPR - Fall 2013

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