(Las Vegas) In the 1993 film “In the Line of Fire,” Clint Eastwood enjoys a memorable exchange with co-star Rene Russo:
Frank Horrigan: “Oh, he’ll call back. He’s got panache” (pronounced incorrectly).
Lilly Raines: “Panache?”
Frank: “Yeah, it means flamboyance.”
Lilly: “I know what it means.”
Frank: “Really? I had to look it up.”
Similarly, I had to look up the definition of a “break in a wave.” I sensed from the context of today’s panel on telehealth that it had a positive connotation (as in an observation by Jill Thorpe of Manatt, Phelps and Phillips that “in 2015, there was a break in the telemedicine wave”). So, here it is, according to Wikipedia:
In fluid dynamics, a breaking wave is a wave whose amplitude reaches a critical level at which some process can suddenly start to occur that causes large amounts of wave energy to be transformed into turbulentkinetic energy.
A map of states (blue) that have adopted a model telemedicine compact. Legislatures in the orange states are considering the issue actively.
What was that break, specifically? In the first half of 2015, the number of telemedicine interactions exceeded the cumulative amount of all that had preceded that point. One might argue about the data sources, but even anecdotal data and action last year by many state legislatures indicates that telemedicine is taking off. The drivers that will determine the ultimate impact include consumer expectations, health care reform, health workforce shortages, aging and connectivity. For better or for worse, chronic diseases will also play a role.
A Nielsen survey probed doctors’ opinions on telemedicine. The news is positive. While 19 percent of those polled worried that telemedicine would not be good for their practice revenue, and 21 percent worried it would not be good their personal income, 22 percent saw telemedicine as an important step toward reducing the costs of care, and 39 percent surmised it is good for patients. And impressive 42 percent see telemedicine as “an important evolution in the practice of medicine,” which is heartening since 31 percent shrugged that is “not worth the hype.” But, since “hype” is qualitative (maybe those respondents see it as worth some hype, but not a lot of hype), I’ll place my bets with those who view it as part of the future.
The ultimate impact of telemedicine will be measured well only after years of data can be studied. In the interim, discrete reports that examine the prospective impacts of telemedicine on specific conditions offer encouraging information. A study undertaken by Kaiser examined the use of tele-ophthalmology for diagnosing diabetic retinopathy. The study found that the use of remote examinations could prevent 100,000 unneeded office visits, saving $4.2 million annually. Andrew O’Hara of Chiron Health noted that 20-to-30 percent of all office visits could be as effective remotely, as many may include routine follow-ups or adjustments to medication.
For those attuned to rural uses, it was interesting to hear relatively urban advocates wax eloquently about how telemedicine could save some patients a half-day off from work, perhaps 30 minutes drive to the doctor followed by waiting room time and the drive home. Expand by that by general rural windshield time, and the benefits expand exponentially.
And, yet, there remain hurdles. Despite the fact that 12 state legislatures in 2015 adopted a model licensure compact aimed at easing state regulatory issues that can frustrate the practice of telemedicine across state lines (and several other state legislatures are considering the issue actively), many difficult issues remain. For example, how will the industry address HIPPA regulations in video streams? Who will bear responsibility for failures, and who might be sanctioned? Will compensation models consider the bandwidth needed to complete a particular interaction, enabling greater reimbursement for video interactions while setting lower data exchanges at a lesser rate?
But, people seem to be ready, if not willing and able. A Nielsen survey revealed U.S. demand for telehealth. Thirty-six percent want access to a 24/7 medical line (14 percent reported already having one); 19 percent want access to a video consult with their primary physician (only two percent reported having one); and 26 percent want the ability to submit a photo of their condition or treatment as an antecedent to receiving a telephone or email consult (they must have heard good things from the three percent who already have this). This last category, the notion of effectively an electronic referral, reaches back to the issue of necessary or unnecessary office visits. A dermatological condition coupled with a high definition photo could tell a doctor whether an over the counter remedy or an office visit might be in order. In this vein (no pun intended), it can be used as electronic screening process.
A final thought: the last time I visited my doctor, he bemoaned the reliance that some new doctors are placing on electronic health records (EHRs), including the recently-announced expansion of medical classifications and diagnoses (leg injuries, for example, are sub-categorized based on the manner in which they were suffered). An instructor at a local medical college, he said that he emphasizes to his students that they must look up from their tablets and computers and observe the patient’s walking, breathing and complexion. And, he urges interaction about things beyond the symptoms the patient describes – how are things at home? How are things at work? To be sure, patient care, whether by wire or not, will require sustained personal interaction between the physician and the patient. Surveys and data indicate, however, that those relationships can evolve to provide better care more conveniently, and at lower costs.
