PHYSICIAN ALERT: Telemedicine: when patients should/should not use this service
The Institute of Medicine (IOM) defines telemedicine as the use of electronic information and communications technologies to provide and support healthcare when distance separates participants. These encounters are called, interchangeably, telemedicine, telehealth visits or electronic visits (eVisits). Reports estimate there will be 100 million telehealth visits globally in 2016, with a potential savings of $5 billion dollars over traditional office visits.
However, even with the growing number of eVisits in the United States, and the 200+ companies claiming involvement in the telehealth industry, the full impact of telemedicine has yet to be understood.
In 1994, the American Medical Association (AMA) issued a policy statement prohibiting physicians from providing any clinical services via telemedicine. Since then, it has softened its position and endorses telemedicine, as long as there is a valid patient/physician relationship through a minimal face-to-face examination.
Other medical organizations have followed suit. The American Academy of Neurology issued a statement believing that although telemedicine cannot replace many of the hands-on skills and in-office assessments that neurologists provide, patients everywhere should have access to telemedicine regardless of location, and payments should be included in third-party payer benefits. This announcement came after the success of the Telestroke program, a telemedicine project for stroke patients.
The Mayo Clinic supports one of the most successful telestroke programs in the United States. They employ neurologists to remotely evaluate people who have had acute strokes; and they make diagnosis and treatment recommendations to emergency medicine doctors at other sites. The doctors communicate using digital video cameras, internet telecommunications, robotic telepresence, smartphones, tablets and other technology. Other reputable institutions like UCLA and the University of Pittsburgh Medical Center offer telehealth visits on a fee-for-service basis.
In Canada, the Ontario Telemedicine Network (OTN) has been in place for more than a decade. The OTN has become a global leader in telemedicine and connected care by reducing hospital readmissions, helping to transform primary care, and expanding home and community care.
One of the largest supporters of telemedicine use has been the US military. Roughly 20 years ago, they recognized telemedicine’s potential to provide specialty care, reduce cost, improve on-site care, and reduce the need for evacuations from the battlefield. Although telemedicine has been used by the federal government for years, it’s only now that we are starting to see legislation in congress to consider public funding for telehealth.
Another hindrance to the growth of telemedicine in the US is the current requirement that physicians be licensed by each state where patients are located, as well as in their own state. Also, state laws differ regarding internet prescribing and payment for telemedicine services.
There are still more issues to overcome. Most telehealth in the US lacks the video component of a more robust eVisit. Often, patients fill out questionnaires on the internet, or are interviewed by phone, and then the physician takes that information, makes a diagnosis, and often issues a prescription. The prescription is essentially the goal from the patient’s perspective. The pitfalls of this type of practice are numerous, yet it represents the majority of telehealth patient encounters.
Like it or not, telemedicine is here to stay and can only continue to improve. Although virtual consultations may result in satisfactory outcomes for simple medical problems, and offer cost savings compared to an in-person visit, it is unclear whether important diagnoses will be missed. Will the lack of a real-life, face-to-face interaction hamper the diagnosis, or the treatment recommendation? There’s an old saying that is usually learned in medical school, “When in doubt, examine the patient.”
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