Anyone who has endured spending too much time in a crowded waiting room waiting for a doctor can appreciate the benefits of an early and much-missed aspect of our healthcare system: the humble house call. And if you’ve ever felt so sick that you would much more prefer having a doctor see you at home than endure spending even a minute in a waiting room with other coughing individuals, a house call would be ideal. It helps conserve your strength as well as keep you from infecting others in public.
However, there are too many people and not enough medical professionals currently working (let alone in the educational pipeline) to enable us all to enjoy the benefits of house calls that so many doctors used to make, carrying their iconic black bag with the basic tools and medicines of their trade.
To address the need for more convenient healthcare delivery while acknowledging that in-person house calls are a luxury the system cannot really afford, computer scientists are aiming their talents at developing robust telemedicine systems.
Telemedicine consists of connecting medical professionals with patients over a network, such as phone lines or the Internet, using the audio-visual capability currently built into most smartphones, tablets, desktops, and laptops. Not everyone is going to be on board with telemedicine, especially in the earlier stages. Here are the pros and cons of telemedicine.
A pro of using telemedicine for an initial consultation is that the patient can get immediate access to a medical professional, regardless of location.
A con is that the doctor cannot actually touch the patient or take readings. In the initial stages of general telemedicine adoption, we can expect it will be used more to do things such as diagnose a case of the flu or to conduct a mental health evaluation.
If your office visit to a doctor consists of him or her hearing how much it hurts or doesn’t hurt or to see if a rash has subsided, there may really be no need to physically be there. This is a major pro for telemedicine. A con is that there may be some other changes in the patient that can only be identified through direct examination.
But if a patient is checking in to see if another week of antibiotics is needed and this can be determined through a series of questions, telemedicine is obviously ideal.
Diagnosis and Telemetry
Diagnosing patients can be done through telemedicine, but with so many specialties, a con is that not all diagnoses can be made without actually touching the patient or getting labs on the spot. But when a patient’s description and a visual inspection via camera will suffice, telemedicine has the clear advantage.
When telemetry is involved, there are more pros. A device can keep track of a patient’s cardiovascular system, blood sugar and other levels, and so on and letting a doctor or nurse see these results (with automatic alerts if a threshold is reached).
The patient won’t have to leave the nursing home just to get basic monitoring. What’s more, the information will be more abundant if collected continuously through telemedicine rather than during periodic data dumps during actual office visits.
We’re a long way off from delivering actual treatment via telemedicine, but this is a prospect that we’ll need to keep in mind. Treatment by remote will be possible when we can hook up devices and robotics to the system.
There will be years of quality control and testing to make sure that a doctor can administer a treatment, ranging from an injection to applying a cast or performing a procedure of any type.
It’s easy to imagine that while many patients and doctors would consider this advanced capability to be a pro, the negatives include equipment malfunctioning and a sudden change in patient health status (some kind of emergency or other unanticipated crisis).
We’re a long way from an era when doctors would arrive by horse or on foot with their black medical bag to make a house call. The prospect of routine telemedicine and reducing the number of times patients must actually come into the office for diagnosis, follow-ups and even some kind of rudimentary treatment make telemedicine one of the more exciting developments of the modern computerized age.
- House calls by doctors are a thing of the past, but the convenience of house calls may reappear in the form of telemedicine.
- Security and integrity of the network must be ensured before patients and doctors can routinely use telemedicine.
- Faster data connections, ease of massive data storage, high-resolution camera and universally available, powerful computing finally make telemedicine a real possibility.
- Diagnosis and follow-up visits will be the less complicated types of telemedicine, but eventually, robotic advancements should enable actual treatment from remote.
Telemedicine can improve outcomes while lowering costs. Sounds great, right?
Well, yes, but it can also increase your security and malpractice risks.
We’re covering the two biggest pros and the two biggest cons of using telemedicine, from a physician’s perspective. And we’ll also go over how to mitigate some of the risks.
Pros of telemedicine
1. The ability to provide better care for patients
One of the biggest advantages of telemedicine is that it puts hard-to-find specialists exactly where they need to be, when they need to be there. Case in point: a stroke.
Strokes are the number-one cause of disability and the fourth most common cause of death in the U.S. Every year in the U.S., strokes result in medical costs totaling between $36.6 and $72.7 billion, depending on who’s doing the estimating.
When it comes to ischemic stroke, where a blood clot destroys brain tissue, time lost is brain lost.
Unfortunately, there are nowhere near enough expertly trained stroke doctors in rural and urban areas. Stroke telemedicine, also called telestroke, allows physicians from regional hospitals to treat patients at tertiary stroke centers.
For example, many regional hospitals in Bavaria, Germany do not have neurology and neurosurgery departments. Which meant that only 19% of stroke or mini-stroke patients were being treated at hospitals with telemedicine units or neurologists on premises. Only 2.6% of patients with ischemic stroke were being treated with the right blood clot drug.
In 2003, telestroke units gave patients at 12 of those hospitals 24/7 access to consultations, evaluation of brain imaging, and patient examination via videoconferencing with vascular neurologists and other neurological experts who worked out of two neurological stroke centers.
In the years between implementation and the end of 2012, they set up 15 telestroke units in total and provided 31,864 consultations. They were able to treat 78% of stroke or mini-stroke patients at hospitals with telemedicine units, way up from 19%. They got 15.5% of ischemic stroke patients the blood clot drug they needed, up from 2.6%.
Peter Müller-Barna, M.D., is lead author of the study on the impact of telestroke on Bavaria’s regional hospital patients, and consultant in the department of neurology at the Agatharied Hospital in Hausham, Germany.
“Cooperation within medical networks can be a huge benefit for patients,” Müller-Barna said. “The goal should be closer to 100 percent and we are now setting up further units in administrative districts that lack one.”
2. Cost savings for patients and physicians
A Rand Corporation survey published in the journal “Health Affairs” suggested that telemedicine may encourage over-utilization, increasing net healthcare costs. If it’s too easy to call a doctor, the thinking goes, people may do it when it’s not really necessary.
But this doesn’t take into account the costs that telemedicine helps reduce, such as travel time, telemedicine vendors and health economists pointed out.
In 1992 UC Davis implemented a hub-and-spoke model of telemedicine.
Between 1996 and 2013, 19,246 patients participated in inpatient and outpatient interactive video visits. UC Davis typically did this by having patients visit their primary care doctor, where they would then see a specialist via video consultation.
A recent study of the UC Davis program found that over 18 years, patients saved nearly nine years of travel time, five million miles, and $3 million in costs. The study measured cost savings based on how long it took a patient to travel to a telemedicine center near their home versus seeing a specialist in-person at UC Davis Health in Sacramento. Over 20 years one patient would save about four hours of driving time, 278 miles, and $156 in direct travel costs.
Today, UC Davis patients in 56 out of California’s 58 counties can see a provider from 30 clinical specialties in over 150 locations.
Stroke neurologists and physicians have seen patients more than 4,000 times through the Arizona Mayo Clinic’s telestroke program. Doctors operate through a network of 13 centers throughout Arizona, Florida, and Minnesota that serve more than 20 healthcare institutions in seven states.
Doctors can see more patients than ever before while traveling shorter distances as well. Enterprising doctors can use telemedicine to treat patients from their homes or while traveling.
Over their lifetime, the average telestroke network patient saved $1,436 and gained 0.02 quality-adjusted life-years compared to a patient who lives in a rural area and receives routine stroke care at a community hospital. Patients spent less on inpatient rehabilitation, nursing home care, and caregiver time.
Telestroke robots allow stroke patients in facilities with no neurology specialists to receive real-time consultation from neurologists in other areas via computer.
“A hub-and-spoke telestroke network is not only cost-effective from the societal perspective, but it’s cost-saving,” said neurologist Bart Demaerschalk, M.D., director of the Mayo Clinic Telestroke Program. “We can assess medical services, like telemedicine, in terms of the net costs to society for each year of life gained.”
Cons of telemedicine
1. Security risks for your practice
Health records are big business for enterprising hackers. Healthcare-related cybercrime is increasing, according to a 2016 Intel Security’s McAfee Labs Health Warning report. Medical records are just under financial account data in their value on the black market.
Telemedicine involves sending health information electronically, so it’s got some inherent security risks.
Be aware that HIPAA regulations apply to any Personal Health Information (PHI) transmitted over the internet, including video visits.
There’s also a risk in over-collecting patient data. For example, sensors in a patient’s home meant to detect safety issues or medical emergencies could transmit information about household activities that the patient did not mean to share.
How to mitigate it
If you’re going to use an app like Facetime or Skype to chat with patients, you’re going to need to do a lot of hacking to make them HIPAA compliant. A better option is to choose a telemedicine platform/software/app that meets HIPAA’s strict standards.
Make sure your telemedicine platform/software/app fully encrypts all data transmission.
It’s a good idea for healthcare delivery organizations to prioritize data governance. This includes not collecting more information that you need. You want to beef up your information security and privacy before implementing telemedicine. Not only does this cover you on related compliance issues, but it also increases your data security.
2. Malpractice risk
A recent Gartner report found that when it comes to telehealth, physicians consistently wonder about their legal risk when offering virtual care. (The full report, “Market Trends: How Technology and Service Providers Can Position Telemedicine and Virtual Care in the Healthcare Provider Market,” is available to Gartner clients.)
Two of the most common malpractice risks you take on when offering telemedicine are malpractice claims of alleged negligence when you don’t know a patient’s situation well enough before prescribing via telemedicine, and not conforming to the informed consent requirements for every state whose residents you prescribe for.
How to mitigate it
The first thing you want to do is to make sure your malpractice insurance covers telehealth services.
Then you’ll want to get familiar with the laws for every state you’ll be online prescribing from, through, and to. And before prescribing medicine, make sure you can easily demonstrate that you’ve established an appropriate relationship with your patient, you have been able to adequately assess the patient, and that the patient has provided you with an accurate health history.
For informed consent, be sure you’re recording the names, credentials, and locations of every involved healthcare provider, the names, credentials, and locations of any other staff that may help facilitate the telehealth service, and descriptions of every telehealth service that will be performed and the technology that will be used.
Telemedicine is a great deal for patients and physicians. For patients, it saves time and money. And makes for healthier people. For physicians, it decreases travels costs while increasing the number of patients that a specialist can see.
Yes, it can also increase your security and malpractice risks. However, it’s not hard to mitigate some of the risks.
To find telemedicine software that is HIPAA compliant and fully encrypts all data transmission, check out our telemedicine software directory.
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About the Author
Cathy Reisenwitz helps B2B software companies with their sales and marketing at Capterra. Her writing has appeared in The Week, Forbes, the Chicago Tribune, The Daily Beast, VICE Motherboard, Reason magazine, Talking Points Memo and other publications. She has been quoted by the New York Times Magazine and has been a columnist at Bitcoin Magazine. Her media appearances include Fox News and Al Jazeera America. If you're a B2B software company looking for more exposure, email Cathy at firstname.lastname@example.org . To read more of her thoughts, follow her on Twitter.