In May 2015, Mercy is expected to open its Virtual Care Center in Chesterfield, a technological monster of a building packed with 170 workstations, each of which sports six to eight computer monitors.
With this new facility, Mercy claims it can provide the “best possible care to people when and where they need it.” The facility is expected to provide 24/7 telemedicine support across Mercy’s network of hospitals. But what exactly does that mean?
What’s in a name?
Telemedicine is defined as the use of telecommunication and information technologies to provide healthcare at a distance, but that clinical definition doesn’t quite do the field justice.
Jonathan Linkous, CEO of the American Telemedicine Association (ATA), said due to the low costs and high availability of technology – and the fact that healthcare providers, consumers and insurers are becoming more accustomed to technology – the telemedicine field is rapidly expanding.
“We’ve grown more in the last two or three years than we have in the last 22 years,” Linkous said.
He said two of the biggest areas of the field include specialty in-hospital consultations and direct-to-consumer (at home) services, although possible applications for telemedicine are much more extensive and can include anything from rehabilitation therapy to neuropsychology. A useful side effect of telemedicine comes in the form of electronic patient data and telemetry, to which telemedicine provides easy access to doctors. However, Linkous said that information, much like a doctor’s stethoscope, is merely a tool of telemedicine, not the service itself.
Many medical specialty fields don’t require the doctor to be in the same room, or even the same state, as the patient. Oftentimes being able to examine a patient, data or an image electronically is sufficient for a diagnosis. Radiology has been utilizing telemedicine advances for many years according to Linkous.
“Radiologists don’t practice usually even in the same place as the patient,” Linkous said. “That same thing is happening in other areas.”
How does telemedicine help?
Andrea Clegg, chief financial officer for Advanced ICU Care, said providing hospitals with access to specialists via telemedicine can greatly relieve the financial burdens placed on those facilities.
Advanced ICU specializes in providing telemedicine services to intensive care units in hospitals over 200 states, including the Barnes-Jewish in West County.
Clegg said a typical intensivist – a physician specializing in intensive care – costs approximately $400,000 per year, and a hospital may need to employ four to five of them to provide 24/7 coverage. In today’s medical world, those numbers may not cut it.
“Most hospitals live off of 1- and 2-percent margins,” Clegg said.
Ongoing medical services have the potential to be improved by telemedicine tools and services as well. Beaming a doctor into an intense situation like an ICU or monitoring a patient’s vitals can add a second layer of security to patient care.
“And add comfort to the primary care physician who may need a little extra support,” Sherilyn Pruitt, director for the Office for the Advancement of Telemedicine, said.
Doctors on staff have to eat, sleep and take breaks like every other human being. Clegg said doctors may leave at 5 p.m. on a Friday, while the patient stays in an ICU, so having a trained physician just a mouse click away can make all the difference.
Telemedicine also may allow hospitals formerly without access to specialists to keep up with larger, cutting-edge hospitals.
Wendy Deibert, RN, vice president of telemedicine services at Mercy, said patients in rural areas often need to drive long distances to see a specialist practicing at a hospital in the nearest city. But by using certain aspects of telemedicine, those patients may not even need to leave their homes.
What’s the benefit to you?
For patients, at-home consultations let them access initial check-ups or consultations without needing to visit a hospital.
Allowing a person suffering from an ailment to remain in their home environment, in their comfort zone, can be extremely conducive to healing according to Deibert.
“It’s what you are familiar with, what you are comfortable with,” Deibert said. “The other side of that is, when you come to a hospital you’re at risk for infection because of all the things that are going on in a hospital, so take away all that risk and stay at home with the people who take care of you. It’s a much better environment.”
Some of the newer advancements in the telemedicine field are the different types of remote monitoring devices, which can be worn on or implanted into a patient’s body, and which then relay vital information to doctors.
Pruitt said this lets a doctor keep his or her eyes on a patient’s condition from a distance and gives them the chance to call patients into the hospital or medical office before any serious problems arise. Information also can be sent to family members, friends or neighbors if the patient needs additional monitoring.
“As our population ages, there’s a big preference for people to stay at home as long as they can,” Pruitt said. “These people want to stay home. They want to be independent, and they can be independent.
“This type of remote monitoring and the technology will help enable people to stay home and stay healthy.”
Securing private information
Keeping patients safe and healthy is only one aspect of providing telemedicine services. Securing their medical information is an equally important task.
The Health Insurance Portability and Accountability Act (HIPAA), adopted in 1996, lays down the law in regard to protecting the security of patient information and privacy. HIPAA laws set national standards for the security of electronic health information and require covered entities and business associates to provide notification following a security breach.
Many companies specializing in telemedicine services invest in technology and services in order to follow HIPAA standards around patient information, according to Clegg.
“If you are working with a telemedicine provider, you want to certainly make sure your records are protected,” Clegg said.
Deibert said privacy has been taken into consideration for Mercy’s doctor-to-patient telemedicine operation.
Doctors utilizing Mercy’s virtual care technology will be required to set their machines up in a secure location in their homes, so that confidential medical information isn’t accidentally observed or overheard. The data will only be transferred via Mercy’s privately owned and encrypted network, and no audio or video from the face-to-face sessions will be recorded.
Where are the risks?
HIPAA and medical providers’ standards may protect patient information, but Linkous said a large number of regulations exist to protect the consumers themselves and guide physicians using telemedicine.
“You can’t prescribe certain types of drugs without seeing the patient in person,” Linkous said. “You have to be in conformance with the state medical board rules about the practice of medicine. You have to be licensed in the state. You have to be in conformance with whoever is paying you. So it’s not exactly a Wild West out there.”
One of the ATA’s roles is to create best-practice guidelines for organizations branching out into telemedicine. These can include ensuring hospitals are using Food and Drug Administration – approved technology, or integrating the health records and telemetry from patients and making that information accessible to primary care physicians, all while keeping those records secure and compliant to HIPAA guidelines.
Beyond the medical and governmental guidelines, human factor issues can also present challenges for patients and doctors, requiring physicians to be conscientious of the situation into which they are broadcasting.
“How does the doctor at a distance relate to the local doctors who are providing care?” Linkous asked. “It can build up a resentment if you aren’t very careful building a team approach.”
Building rapport between doctors and patients is still an important aspect to the job, he said.
“It’s much like broadcasting,” Deibert said. “It’s how you present yourself across the screen, much like a TV news anchor. You’ve got to think about how you dress, how you look, the lighting, etc.. You don’t want a lot of backlighting because it puts a shadow on your face and they (the patients) can’t see your facial expressions … we do a lot of training (and) education around how to be a telepresenter.”
Another challenge lies in not overcomplicating a hospital’s telemedicine system, and not expanding to new areas too quickly.
Deibert said Mercy’s system could be applied to other electronic devices like phones and tablets, but the company is being cautious about such extensions to the service due to privacy concerns.
Making the technology too unwieldy or unintuitive to use also could require doctors to become IT experts, Deibert said.
“And they don’t like that,” she added. “They want to be physicians.”
In the department of legal risks, telemedicine is still a fairly new branch of health care. Linkous said there have been relatively few lawsuits in the field. However, he said it is important for patients and medical providers to establish who is responsible for the patient’s primary care.
“Getting those issues settled right away can make a significant difference,” Linkous said.
The role of telemedicine in ‘quality over quantity’
Value, instead of volume, is becoming the new goal in healthcare, according to Pruitt.
Fee-for-service is still the dominant way of paying for healthcare in the United States, but the field is moving more toward keeping people healthy, and Pruitt said telemedicine can play a key role in doing that.
“In the past, it was good for the hospital’s bottom line if you came back,” Pruitt said. “But that is not where the field is going today. It is going more toward keeping people healthy, which is better for us as a country, better for the patients, better all the way around.”
Linkous said telemedicine has been broadly accepted and promoted by both sides of the political aisle; however, health care reform will still impact the field.
Obamacare has accelerated the practice of paying for quality of care, rather than fee-for-service. Linkous said the change is happening at the state level with Medicaid and through private insurers as well.
As a result of health care reform, more people are coming onto the insurance rolls, he said. A large majority of these people joined under Medicaid, which placed more of a burden on providers, regulators and legislators to provide health care much more efficiently.
“Telemedicine has come around to solve that problem of not enough providers, too many patients and the system being too costly,” Clegg said. “Telemedicine really allows you to provide more care to more patients at lower cost.
“It sounds so futuristic. It’s a paradigm change, but it is something that has to happen. Patients in this country are not being cared for by the best, and given the pressure that we are facing it is one of the best solutions for the payers, the hospitals and the patients. That’s the only way you’re going to get reform in this country, is (when) all three of those participants benefit.”