There are many reasons for the increasingly prevalent use of telemedicine. What may have started out as a way to deliver improved health care services to rural areas, has now exploded to include ways to extend the availability of services to everyone and produce cost benefits both to health care providers and to the patient.
At the forefront in telemedicine are advances in technology, coupled with a potential doctor shortage throughout the U.S., which many attribute to the Affordable Health Care Act, as more Americans acquire coverage under that system.
Telemedicine encompasses a vast array of services, available to a great number of people. Neonatologists at Oregon Health & Science University, use a mobile robot to get their expert medical care to rural and mid-sized community hospitals in the area. The OHSU telemedicine network so far includes 13 other hospitals. In fact, St. John's Hospital in Longview, Washington, (a community of about 35,000) is the first Washington hospital to join the network. It would be rare for any hospital in a community that size to have a neo-natal specialist. St. John delivers 1,000 babies annually, and about 100 need resuscitation after birth. St. John’s specialty care nursery began using their mobile robot on its most urgent post-partum cases which require attention within an hour. For St. John's, the hope is that this could reduce the emergency transportation of critical newborns to Portland. According to OHSU, the Telemedicine consultations allowed more than 200 patients to avoid unnecessary travel over the past two years, saving more than $3.7 million in transportation expenses alone.
The use of a tele-stroke robot, as the name implies, allows a patient who has suffered a stroke to be examined in real time by a neurologist who is located elsewhere. At the Mayo Clinic, tele-stroke care is provided to seven other community hospitals, using a hub and spoke model. The hospitals are the spokes and the Mayo Clinic is the hub, providing more interventional procedures and therapies than the hospitals would otherwise be able to perform. While the cost of this venture is expensive initially, a significant savings is realized over a lifetime, both in actual dollars, and in outcome improvement. For example, a patient treated in the context of a tele-stroke network incurred $1,436 lower costs, and used less resources, such as caregiver and rehabilitation time.
Tablets are being used by local rescue squads in Virginia to diagnose stroke patients before they reach the ER. Clinicians in the UVA Health Care system raised $10,000 to equip a two more ambulances (for a total of three) with the iTreat mobile medicine kit. The goal is to link the neurologist and doctor in the ER with the paramedics to quickly diagnose stroke patients and begin treatment immediately.
Another component to telemedicine is the broader emergency use called tele-emergency which links urban Emergency Departments with remote hospitals. Using this system, rural or remote hospitals can receive 24/7 emergency help with the push of a button. In the upper Midwest, the University of Iowa College of Public Health conducted research in 71 remote hospital locations, and one urban hub. The evaluations showed that this kind of service can address shortcomings in health care emergencies and improve overall patient care.
In the areas of acute medical care, it appears that younger Americans, who have not yet developed a medical relationship with a primary care provider, are very likely to use telemedicine services. These patients are using these services for acute medical care, such as respiratory problems, UTIs and skin issues. These physicians can also write prescriptions when warranted. This branch of telemedicine, called TeleDoc, is being provided through corporations, such as Pfizer, and public worker's health insurance systems, like the California Public Employees' Retirement System. The consultations are covered by insurance, typically with a $10 co-pay or consultation fee.
Perhaps one of the most important and relevant contributions that telemedicine can make is in the health care afforded to deployed military. The strides in camera and Skype-like technology make it possible for soldiers and military physicians to speak with specialists real-time. When Dr. Ronald Poropatich, the now retired deputy director of the Telemedicine and Advanced Technology Research Center in the U. S. Army, was sent to Somalia in 1993 to set up telemedicine capability, he told Fox News, “I took a 1.5 megapixel $25,000 digital camera made by Kodak....now you have a 10 or 15 megapixel camera on your cell phone.” This technology in a military setting helps to spot medical conditions that might have previously been overlooked, and also allows for quick second opinions from physicians stateside.
Savings attributed to telemedicine can be realized in reducing the number of unnecessary transfers, freeing up critical bed space in larger medical centers, lowering staff costs, and speeding up recovery times.
From anyone's perspective, whether payer, patient, large medical center or small community hospital, telemedicine's financial benefits are attractive. And by using telemedicine today a healthcare organization is better prepared to secure even greater savings tomorrow.
