Telemedicine: A Roadmap to the Benefits and Risks Of Implementation

If you think that telemedicine is a new phenomenon involving iPhones and iPads and laptop computers, think again. Telemedicine, or telehealth, has been around since the 1960s, and it originated with the US space program.

In fact, NASA created telemedicine technology for the astronauts’ spacesuits to monitor their body functions. But it was in Nebraska, in 1964, that telemedicine, using a two-way closed-circuit TV link, was first used for long-distance consultations between specialists and general practitioners.

Since that time, telemedicine has spread and is now well integrated into the American healthcare system. The American Telemedicine Association (ATA) defines telemedicine as “the delivery of any healthcare service or transmission of wellness information using telecommunications technology”. This means that telemedicine is both the remote monitoring of patients AND the delivery of services to them. It is one of the most rapidly growing components of healthcare in our country with approximately 200 telemedicine networks, with over half of all U.S. hospitals now using some form of telemedicine.

Is telemedicine the face of the future?

Many in the industry feel that telemedicine is on the cusp of becoming the new standard of care. Take a look at these stats and you’ll see why:

• 89% of healthcare executives said they expect telemedicine to transform the U.S. healthcare system in the next decade. (Source: iHealthBeat)

• The global telemedicine market is expected to grow from $11.6 billion in 2011 to $27.3 billion in 2016. (Source: BCC Research)

• Worldwide revenue for telehealth devices and services is expected to reach $4.5 billion in 2018, up from $440.6 million in 2013. (Source: IHS)

• The number of patients using telehealth services will grow to 7 million in 2018, up from 350,000 in 2013. (Source: IHS)

  

If you add the fact that telemedicine is called for in the Affordable Care Act, and that members of both sides of Congress are “pro-telemedicine,” explosive growth seems more than likely.

How is telemedicine currently used?

According to ATA, telemedicine is not a separate medical specialty. It’s simply another way of providing healthcare services.

The Affordable Care Act and the subsequent Medicaid expansion have meant that insurers and providers are relying even more heavily on telemedicine to address the growing number of patients who now have health insurance.

Telemedicine uses a wide variety of tools including email, cell phones, and two-way video and has been applied in situations as varied as these:

• Patient consultations via video conferencing
• Electronic transmission of still images
• Online patient portals
• Health and wellness phone apps available for consumers and physicians
• Remote monitoring of patient vital signs, worldwide

An example of telemedicine in action in a large urban center occurred in Boston, where more than 3,000 congestive heart failure patients used at-home monitoring devices. Only 3-4 nurses were assigned to every 250 patients. They received updates of their patients’ blood pressure, weight, and other metrics, and were then aided by “clinical decision support” software to identify the patients who needed interventions. This program reduced readmissions by 44 percent and created $10 million in cost savings.

Studies show that one million people per year are hospitalized with heart failure, and that the majority of those are from worsening congestion in patients already diagnosed. Stats like these reinforce the use of alternate strategies to monitor heart failure patients. With costs soaring to over $37 billion, these kind of savings, due to telemedicine innovations, are extremely timely and relevant.

What are the benefits of telemedicine?

ATA has summarized over 2,000 evaluative studies related to telemedicine that appear in PubMed, a bibliographic database of medical research that is maintained by the National Library of Medicine. Their research outcome paper details telemedicine’s impact on the quality and cost of healthcare and clearly shows that “telemedicine saves money for patients, providers, and payers compared to traditional healthcare practices, particularly by helping reduce the frequency and duration of hospital visits.”

Here’s a quick breakdown of telemedicine’s benefits:

• Improved Access for Patients. Not just for those living in remote locations, where telemedicine brings valuable healthcare services to their homes and communities, many busy consumers are beginning to demand healthcare services that come to them rather than the other way around.

• Enhanced Reach for Doctors. Physicians and health facilities are given the ability to expand their reach and address the issue of medical provider shortages, as well as enhance their ability to meet consumer demand for ‘convenient’ care.

• Cost Savings. By adopting telemedicine technologies, efficiencies such as shared health professional staffing, reduced travel times, and more home management of symptoms are gained. This translates to fewer or shorter hospital stays, which dramatically cuts costs, and less physician time.

• Quality Patient Care. Studies consistently show that the quality of healthcare does not suffer when delivered via telemedicine. In fact, in some specialties, telemedicine actually outperforms the traditional in-person approach and delivers more positive outcomes and higher levels of patient satisfaction.

• Consumer Demand. Undeniably, the greatest impact of telemedicine is on the patient, their families, and their communities. Utilizing the tools of telemedicine has resulted in more convenient care, less stress and greatly reduced travel time, among other benefits.

Some physicians have found that seeing patients ‘virtually’ enables them to cut down on office hours, work from home more, and have greater control over their own schedules. In addition, when supported by a field team there is the potential to actually see more patients in a virtual format.

Does telemedicine prompt a greater risk of malpractice?

The quick answer is “not yet.” In an ironic twist to this question ATA reports that some individuals have actually sued hospitals for not providing telemedicine as an option. We are living in interesting times!

According to an article in Medscape, there is still very little known about the liability risks associated with telemedicine. Why? First, although telemedicine is rapidly growing, the number of patients served is still far fewer than inpatient visits. In addition, of the liability suits that are known, most were settled, and they also included confidentiality agreements that do not allow for details to be disclosed.

The experts quoted in the Medscape article did not express concern about increased liability through remote doctor-patient interactions. One of the reasons cited was that virtual visits generally don’t involve high-risk medical scenarios. It is usually the opposite, where these visits are for minor ailments such influenza, sore throat and the like. Telemedicine, when monitoring patients with chronic conditions, actually increases the likelihood that individuals experiencing problems will be spotted early. This means serious emergency situations can be avoided.

That said, there is another camp that worries that new liability concerns, specifically related to technology, will surface. The expansion of technology into an outpatient or home setting will make it more difficult to ascertain who is at fault when things go wrong – equipment malfunctions? User error? Patient error? 

Adhering to best practices is always an effective way of avoiding malpractice lawsuits. To that end, ATA has produced a series of standards and guidelines for healthcare providers to ensure that they are using telemedicine responsibly.

Have you thought about…?

If you are considering entering into, or expanding your telemedicine practice, here are a few things to consider.

• Do you have reliable infrastructure in place? As a healthcare provider, you need to ensure that you have the technology to provide effective and reliable virtual services to patients. There are many third-party vendors offering medical practices this technology and several come with wrap-around services such as technicians and nurse in the field.
• How will you be reimbursed? Few insurance companies are currently paying providers directly for telemedicine and it has been noted that Medicare has some restrictive payment guidelines. ATA is continuing to push Medicare to reconsider its payment policies and include coverage for telemedicine “regardless of a patient’s geographic location, the services provided, or the real-time nature of the service.”
• Do you know your state policies? Telemedicine policies can vary from state to state, in addition to the legal definition of the “telemedicine” itself. The onus is on you to know and comply with your state policies. These might include state-specific rules for the conduct of video visits or state-specific regulations for e-prescribing. The Center for Connected Health Policy maintains an interactive US map, that details telemedicine law and policies by state. Simply click on any state to find out about reimbursement and state-specific policies and regulations.
• Have you checked your malpractice policy? You’ll want to ensure it includes online patient interactions. If your malpractice policy was issued before the era of telemedicine, you may need to inform your insurance carrier that you have joined a virtual physician network or have added video conferencing functionality to your practice.

Whether you see telemedicine as the next step in the evolution of healthcare or simply an add-on benefit, all parties are in agreement about one thing — the public loves telemedicine. In a world that offers an increasing number of services in an on-demand fashion, it makes sense that consumers also want healthcare at their fingertips and within their homes. It’s convenient, less stressful, and far more accessible. With estimates of roughly 10 million Americans already using some form of virtual healthcare, one thing is certain: Telemedicine isn’t going away.