Telemedicine: Paving Way for Cost Effective Medical Services for Primary Care

According to an article published in the Herald Journal, the history of telemedicine can be traced back to the 1920s, when patients on ships at sea would connect with physicians on shore through radios. With innovation in technology, telemedicine services were provided through interactive television in the 1970s and via video conferencing in the age of digital technology.

However, the evolution of telemedicine has been curtailed in every period of time – lack of technology in the early 20^th century to government regulations in the 21^st century – which has added to the skepticism of physicians.

Barriers to adopt Telemedicine healthcare

Under the government’s Affordable Care Act, focus has shifted to cost-effective, quality patient care that has given rise to different approaches of healthcare delivery such as Accountable Care Organizations and telemedicine. However, there are certain barriers to adopting telemedicine at a practice:

1.      Barrier to establish patient-physician relationship

This is the major concern for primary care and specialist physicians, who haven’t introduced telemedicine at their practices. Initially, they hesitate that the use of telemedicine will hinder them from developing effective patient-physician relationship, which will affect outcomes.

2.      Barrier to prevalent practice workflow

Another barrier that most physicians face is disruption to prevailing workflows. Physicians have adapted to changes in the health IT industry by implementing EHRs technology at their practices and designing new workflows accordingly.

However, they are hesitant to adopt telehealth, fearing that it will not be possible to incorporate this approach with the current workflow that is suitable for the new technology they have spent heavily on.

3.      Barrier to medical practice beyond state borders

State and federal laws regarding physicians’ license and reimbursement procedures create a barrier to telemedicine adoption. According to the law, physicians should be licensed to provide medical services in the state they have physical presence in and where they provide telehealth services.

Moreover, changes to reimbursements – shift from value to volume – make it harder for practices to collect from patients via telemedicine.

Benefits of Telehealth services

Despite an air of skepticism among providers, telemedicine is growing by leaps and bounds. Medical Economics, quoting statistics from an IMS research, said over 300,000 patients were monitored via telehealth services for various health problems including cardiac, mental health and diabetes in 2012. The report further said that the number is expected to increase to 1.8 million by 2017.

Assisting home care patients

Telemedicine has made a difference in lives of home care patients by providing telehealth services. Its effectiveness can be measured from the success of a healthcare program introduced by the Veterans Health Administration (VHA) Department that aimed to provide telehealth services to home care patients with chronic diseases.

The services were provided via vital sign monitors, videophones, digital cameras – specifically for wounded patients and those having skin-related issues. Within four years of starting the program, 30,000 patients enrolled to receive telehealth services bringing down hospital visits by 19% which helped in saving costs.

Assisting patients in rural areas

Telemedicine has been particularly helpful in providing efficient and quality health service to patients living in rural and remote areas. Rural primary care physicians have used telehealth approach to facilitate their practice and patients by:

• Providing quality healthcare within the community
• Saving cost and time on travelling to city
• Making medical care available round the clock
• Providing emergency care to patient prior to transporting them to hospital
• Making initial diagnosis prior to specialist consultation
• Consulting with specialist

Assisting primary care physicians

Primary care practices have faced setback because of increase in specialist practices and changes in the health IT sector. According to a study, Primary Care: Current Problems and Proposed Solutions, a shortage of over 40,000 primary care physicians is expected by 2025.

Telemedicine has played a role in primary care health as it has proven to be a successful approach to provide cost and time effective healthcare to patients, resulting in patient retention.

• Primary physicians can team up with specialists to provide healthcare
• Facilitate hospitals in providing post-surgery general medical care according to specialist instructions
• Providing cost effective care in nursing homes
• Giving privacy to patients suffering from diseases that are still stigmatized in closed communities, like HIV and mental health issues

 Solutions to Barriers for Telehealth

Dr. Adam Darkins, chief consultant for telehealth services at the U.S. Department of Veteran Affairs (VA) has emphasized on the importance of relationship between patients and their physicians for telemedicine system to function effectively.

Dr. Jason Mitchell, director of AAFP’s Center for Health IT clarified that telemedicine is not different from regular medicine practice. He explained that only difference is the mode of interaction between the doctor and the patient.

However, the government needs to make certain provisions in order to remove barriers that hinder success of telemedicine.

• Flexibility in practice license for telehealth physicians: Telemedicine providers should be given relaxation to practice medicine in states other than their own. This way government can cover the shortage of primary care physicians and facilitate them to recruit patients to meet their costs.
• Modify reimbursement policies: With changes in insurance policies, patient payments have become a major part of collections. This will create further problems for practices to collect payments from patients who have received consultation via telemedicine.

Changes under the Affordable Care Act are all about providing cost effective, quality healthcare services to patients that can be achieved through telemedicine system. This system is particularly beneficial for small to medium practices that can provide services to more patients, while saving time and money.

EMR – What to Expect?

Electronic Medical Records (EMR) has become an essential component of the healthcare industry, given the continuous development and government backing. Once simply recognized as a tool for documenting basic clinical information, EMRs can now help physicians achieve much more with built-in clinical decision support systems. On-going development in health IT is ensuring that EMR systems can improve the quality of care whilst reducing clinical errors and oversights. Like any other industry, the growth in EMR technology will continue to raise the expectations of clinicians and administrators alike.

Health IT experts believe that the increasing rate of EMR adoption has also lead to more expectations from each individual user. Today, almost all physicians want a systematic solution that is easy to use and improves the overall quality of care. According to a healthcare IT executive, physicians were never fond of clinical documentation, but now as they are expected to produce electronic notes on a regular basis, they would rather prefer to have the computer do this for them.

It is not absurd to believe that technology is meant to make our lives easy and our work more convenient. However, thinking that technology would completely replace specialized personnel certainly defies logic. EMRs are designed to support the former statement. They help the healthcare community in accelerating workflow management and reducing the communication barriers. According to research, it is due to EMR adoption that physicians save up to 30 minutes of documentation time every day.

According to a study by HSC, when it comes to improved harmonization of patient care through EMRs, there exists a difference in the expectations of healthcare policy makers and that of clinicians. Another study indicates that physicians across different specialties face integration problems because of poor interoperability. Similarly, health IT experts are working towards the incorporation of Health Information Exchange (HIE) with EMR systems, in order to provide instant access to patient information anywhere across the nation while possibly reducing care disparity.

Physicians believe that, with the present capabilities of an EMR solution, achieving meaningful use stage 2 objectives will be a tedious job. The ONC plans on releasing new certification criteria as soon as the final rule is released. On the other hand, few of the established EMR vendors have already started working on the issues of interoperability in order to comply with the regulations and maintain a good market share.

I believe the adoption of EMR solutions will keep growing with time but so will user expectations. If recent surveys are anything to go by, it is easy to be optimistic about the positive impact of EMRs and one can only hope that EMR systems will keep improving over time.