Is Telemedicine a High-Speed Highways for Patient Access?

Saying that telemedicine improves patient access to healthcare is like saying highways improve transportation – of course, it does. In fact, healthcare without telemedicine is like travel before the interstate highway system. It’s a time-intensive exercise involving navigation of disconnected routes that end in frustrating dead ends.

Technology and telemedicine improve patient access for a broad cross-section of patients. Together, they improve healthcare delivery for the underserved, the disabled, the housebound, those in rural areas, and digital healthcare consumers. When people have access to healthcare, three things can happen:

1. Outcomes improve
2. Costs are reduced because care is provided at the right time by the right providers.
3. The best care becomes available to everyone.

Telemedicine isn’t futuristic, it’s here and now, and it’s saving money and lives.

Telemedicine reduces patient wait times and travel. 

There are many examples of how healthcare systems across the United States use telemedicine to improve patient access to health care, just as many show its power to ensure the delivery of the right care, right time, right provider.

Reducing wait times:

New York-Presbyterian (NYP) discovered that telemedicine could reduce 24-hour wait times to less than 1 hour. In 2017 it implemented telemedicine visits for psychiatric and expressed care visits. The healthcare system built NYP OnDemand telehealth suites that replaced in-person visits at NYP Cornell and Lower Manhattan Hospital (LMH) campuses. Video visits cut express care admission-to-discharge times from “an average of 2.5 hours to 31 minutes”.

The hospital used telemedicine to implement a telepsychiatry service in the emergency department, not to return to the ED for follow-up visits. When it did, it reduced patient wait times from “24 hours to under 60 minutes”.

Respecting patient time

The University of California Davis wanted to know how telemedicine reduced patient time, money, and travel spent accessing healthcare. It studied 18 years of patient data (1996-2013). To measure cost savings, researchers studied patients to travel to “a telemedicine center near their home versus traveling to UC Davis Health in Sacramento for specialty care.” The findings were impressive. For the 19,246 patients studied, telemedicine saved approximately nine years of travel across five million miles and $3 million in costs. Researchers also calculated the per-patient savings, which equaled four hours less driving time over 278 miles and $156 less in travel costs.

Improving access to healthcare improves outcomes.

For millions of Americans, access to healthcare is problematic, to say the least, and fraught with obstacles. There are many barriers to access, and some of the major ones are:

• Distance
• Lack of access to transportation
• Lack of providers in rural areas
• Physical disabilities and chronic illness that prevent travel to a physician’s office
• Wait times for appointments.

Telemedicine has the singular power to address these barriers, if not remove them completely. When that happens, it can create access that improves outcomes for underserved populations. Here are a few concrete examples of how telemedicine is achieving that goal:

Pediatrics: Children’s Mercy Hospital in Kansas uses telemedicine to reach children in rural areas who need pediatric rheumatology services. A rheumatologist and RN conduct a 45-minute telemedicine visit four times a year with children who live 157 miles from the hospital. These children suffer from painful chronic diseases, including rheumatic and autoimmune diseases like lupus and arthritis. Many take strong medications, and they need to be watched and checked regularly. Telemedicine allows specialists to visit with these children and their families every few months and provide care that parents might not otherwise be able to access.

Children’s also provides more than half of its 47 pediatric specialties through telemedicine video calls. They connect with clinics in Missouri and Kansas. Families in rural areas travel to the clinics and connect with Children’s telemedicine services there.

Substance use disorders:  Improving outcomes for those in recovery is about improving access to support and self-monitoring compliance tools. Telemedicine does that by removing barriers of time and distance for those in recovery. Last year the Food and Drug Administration (FDA) approved a mobile app for treatment for substance use disorders. It’s a prescription app called ReSET® developed by Pear Therapeutics. It’s designed to be used along with outpatient treatments and helps those in recovery manage substance abuse problems, whether it involves alcohol, marijuana, cocaine, or other stimulants. It is not used for opioid addiction.  The app includes treatment modules and status reporting. Pear Therapeutics reports that the app “increases abstinence from a patient’s substances of abuse during treatment and increase patient retention in treatment when used as part of an outpatient treatment program.”

Clinical trials reported by Pear Therapeutics involving 507 patients showed increased abstinence, retention, and engagement in recovery and treatment over those patients who received face-to-face therapy only. This is a good example of how telemedicine increases access to healthcare and behavioral management support.

Telemedicine makes the best care available to everyone.

One of the best examples of how telemedicine makes the best care available to everyone is in the area of home care services.  Whether patients are housebound by disease, illness, or lack of transportation, telemedicine expands the eyes and ears of providers and helps to avoid adverse health events.

Home health patients: MultiCare Health System in Tacoma, Washington, developed its own “Telehealth Chronic Disease Management” program for home health patients. The program provides 100 remote monitors to patients with the chronic pulmonary obstructive disorder (COPD), pneumonia, and heart disease. The program allows providers to monitor patient conditions, educate them on symptom management and improve compliance that prevents rehospitalizations. Registered nurses work with patients who report their blood pressure and other vital signs important to their conditions. Nurses receive alerts to values outside normal levels, allowing them to intervene immediately before leading to adverse events. It’s responsive and allows clinicians to reach into patients’ homes, educate them on how to address shortness of breath, or take an extra fluid pill to improve their vital signs.

Home dialysis patients: The CHRONIC Care Act includes provisions for two out of three monthly clinical dialysis visits to be conducted via telemedicine. The only caveat is that the home of the dialysis patient is certified as an originating telemedicine site. Beckie Michael, DO, FASN, has been using telehealth to serve dialysis patients in rural areas and underserved communities for three years. She worked closely with the American Society of Nephrology to help pass the CHRONIC Care bill. She believes that using telehealth for home dialysis patients will result in “fewer missed monthly visits and more efficient use of patients’ and providers’ time.”

Telemedicine visits will also provide the nephrologist the ability to evaluate the patient’s home dialysis environment. As it stands now, the patient’s home is usually only seen by the home dialysis nurse. Those are critically important insights. When physicians can see inside a patient’s home, they can see opportunities and obstacles to compliance with care plans. It closes gaps in the continuum of care between doctors’ offices and patients’ homes.

Telemedicine provides access to providers during disasters.

What happens when catastrophic storms and disasters – natural or artificial – create a wall between patients and desperately needed healthcare? Telemedicine can bridge the divide, provide access to the right providers at the right time and improve outcomes.

When Hurricane Irma struck Florida in 2017, mobile apps provided access to essential healthcare to those who couldn’t get out of their waterlogged homes, let alone get to a physician. Florida Hospital Centra Care and Baptists Health of South Florida offered the app free of charge across the state due to their response to the disaster. The mobile app allowed users to have video calls with their physicians in those systems. They removed the download charge during the disaster to give patients much-needed access during the storm. The hospital reported 2,700 new users when the storm hit their area. Nemours Children’s Health System reported a 554 percent increase in downloads of their app during the storm.

Christopher M. Tedeschi, MD, MA, wrote a blog about his experience visiting Puerto Rico in the wake of Hurricane Maria. Dr. Tedeschi is an assistant professor of medicine at Columbia University Medical Center (CUMC) in New York City and director of emergency preparedness for CUMC Emergency Medicine. He writes a compelling narrative of how telemedicine helped providers in the midst of near-total devastation:

“I witnessed the potential (of telehealth) first-hand in Puerto Rico after Maria. A short visit taught me more about island life after the storm than I could have learned from endless hours of cable news or social media.

“The smell of diesel exhaust hung in the air. Our patients’ voices were a combination of anxiety, exhaustion, and hope. Less than two weeks after arriving at a location with no potable water and intermittent electrical power, my team had access to a live video link to an academic medical center in the mainland U.S. A specially outfitted laptop and an on-site satellite dish, along with a temperamental but functional generator, meant that my patients and I could communicate with specialists like pediatricians and psychiatrists — vital caregivers that were scarce on the island and unavailable to my team otherwise. We also faced some challenges: a glitchy connection and a feeling that our tele-resources sometimes didn’t really match our real patients’ needs.  Was it worth it? Mostly. A proof of concept, a trial run, a learning curve. Leveraging telemedicine’s potential during traditional disaster response suddenly seems like a no-brainer.”

It’s not that telemedicine can provide critical care via teleconferencing. Rather, it can facilitate important triage services and support the application of first aid. It can also provide answers for people who are anxious, scared, and isolated. These services can immediately improve outcomes for people in the storm’s path and significantly reduce the number of people flooding emergency departments during and after a storm. Today’s telemedicine technology provides high-definition cameras that clearly allow physicians to see a gash, bruise, or suspicious rash. It can see a child’s feverish face and help to determine if a stormy, risky trip to the hospital is necessary.

Not to be understated is the importance of reassuring and informing people in a storm’s path. People listen to authorities telling them to evacuate or not. As families pack up and move out of danger, they also move out of reach of their pediatricians and primary care physicians. Mobile apps and telemedicine can put them back in touch with the providers they trust and who know them.

Telemedicine improves outcomes across the globe. 

The North Atlantic Treaty Organization (NATO) and its 28 nation members have spent three years field testing portable telemedicine units. It knows that rescue workers have to communicate across the globe to deliver medical care in remote regions effectively. Access improves outcomes under disaster conditions. NATO has employed “suitcase-sized” units that allow rescue workers to access an international network of medical specialists via satellite. Now, they will be able to assess, diagnose and treat a patient with the help of the right physicians across the globe. Through the telemedicine unit, specialists can obtain the patient’s vital signs, ECG, heart rate, skin temperature, location, and body position. Cameras will allow them to conduct a visual exam. You could call it telemedicine on steroids, but it is simply one more stellar example of the powerful application of telemedicine to increase access to healthcare and saves lives.

In Los Angeles, specialty eye surgeons discovered they could use telemedicine to save infants’ eyesight in Armenia – even when surgery had to occur within 48 hours of birth. For premature infants, time is of the essence. Retinal surgeries are required within 48 hours of birth if blindness is to be prevented. It is the perfect example of delivering the right physician at precisely the right time to the right patient.

It all began with the largest pediatric multispecialty medical group in the U.S. – Children’s Hospital Los Angeles, with 564 physicians practicing 32 specialties. They analyzed infant blindness rates in Armenia and discovered they were three times that in the U.S. That’s when they decided to do something about it. Not only did they implement a telemedicine solution, but they also developed a new technology to achieve it. Newly developed hardware compression resolved previous high-definition problems and allowed highly specialized surgeons to be “present” virtually during ophthalmic surgeries. Now specialists can be present across the thousands of miles and help surgeons in Armenia perform those surgeries. The signal can also be transmitted to multiple locations across the globe. Technology and telemedicine are saving the sight of infants across an international distance of 7,000 miles.

Patients know telemedicine improves access to care.

It’s estimated that seven million people will access telemedicine this year alone. There’s a reason for that. People know that telemedicine improves access, eliminates wait times for physician appointments, and reduces costs. Consumers also know that telemedicine puts the physicians they choose in the palm of their hand. Kaiser Permanente (KP) knows this firsthand. According to CEO Bernard Tyson, KP members have more than 100 million encounters with company physicians annually, 52% of which are now virtual visits.

A recent Virtual Visits Consumer Choice Survey from Advisory Board asked 5,000 patients across the U.S. about telemedicine. Seventy-seven percent of survey participants said they are willing to have a virtual care visit with a physician and 19 percent said they have already had one.

Patients are savvy digital consumers. They want physicians and health systems to offer telemedicine because they want to access and efficiency in healthcare. A recent survey showed that patients are waiting for health systems to catch up with their demand for telemedicine:

• 78% of those willing to have a video visit with a doctor would be happy to manage chronic conditions via video consults with their PCP
• 65% were very or somewhat interested in conducting video visits with their PCP.
• 60% of respondents said that they would be willing to use them to manage a chronic condition
• 52% of adults reported that they were willing to participate in post-surgical or post-hospital discharge visits through video.

 

Telemedicine is no longer a thing of the future – it’s the here and now. Healthcare, by definition, is slow to adopt new approaches to care. It is in a physician’s DNA to require evidence that a new technology or system ultimately benefits the patient – advocacy that is time-honored and essential. However, the time has come to acknowledge that telemedicine has the extraordinary capacity to remove obstacles to care. It is time to acknowledge that telemedicine exponentially increases access for underserved populations.

No single individual can fix the U.S. healthcare system. No one doctor or hospital can right what is wrong with it. However, with each mobile app, with each videoconference, we begin to provide citizens access to physicians and the medical care they need and deserve at a reduced cost. That begins to the right the ship.

It’s no longer a matter of if telemedicine should be adopted. It’s a matter of when and how quickly every health system can offer it to improve the delivery of care across the United States. That is when telemedicine truly improves access, reduces costs, and makes the best healthcare available to everyone.