Telecommunication and teleradiology, both innovations of telemedicine, can be beneficial, but some patients and doctors haven’t accepted them

Telemedicine involves a variety of specialties and includes a wide range of functions in different healthcare environments. Some of those include: video conferencing, transmission of laboratory and imaging results, as well as remote monitoring of patients vital signs and recovery.

Since the implementation of electronic health records (EHR), telemedicine has been able to revolutionize healthcare by allowing for communication between doctors or specialists and patients no matter where they are.

Typically via telecommunication, doctors can evaluate patients as well as view their lab or radiology results.

Telemedicine is improving both rural and metropolitan healthcare by increasing access to care by both doctors and specialists.

Telemedicine is helping solve one of the increasing problems in the united states: patient demand and lack of physician and specialist availability. Tackling the problems with patient access to physicians as well as lab and imaging results seems to be the most influential and beneficial aspect of telemedicine in both rural and urban settings.

Telemedicine can not only benefit patients in an urban setting but also patients with limited access to health care. These can be either patients in rural areas who are over an hour from the nearest hospital or patients who work and can't see a doctor in the typical Monday-Friday 9am-5pm window.

According to the CEO of the american telemedicine association, more than half of all hospitals in the U.S. have implemented telemedicine into their health systems.

Furthermore, 200 of those networks are connecting to over 3,000 rural healthcare sites that depend on them for access to specialists as well as continuing medical education.

Luckily, studies show that 75% of consumers indicate they are comfortable with the idea of communicating with doctors and specialists using virtual technology.



Dr. Sarah Berghoff, MD, an Emergency Medicine Physician at Sibley Memorial Hospital in NW Washington DC discusses the benefit of access to specialists in rural and community health care settings.

Dr. Berghoff agrees that access to specialists by telemedicine can allow for improved treatment of life threatening diagnoses such as strokes or STEMI’s, a very serious heart attack resulting from a blocked artery.

Not only is telemedicine increasing access to doctors but it also limits costs incurred by a visit to the doctor. Specifically, studies have shown that in rural communities, the estimated costs for patients were reduced by approximately $40 and access to physicians was increased by 20%.

In urban communities, telemedicine is allowing for more accurate and faster diagnoses of strokes while also limiting costs by decreasing the amount of unnecessary emergency department tests and visits.

Dr. Berghoff explains how the online portals and EMR’s have allowed doctors as well as patients to see previous tests in order to limit the costs of repeating them.

                                       

In urban communities, the portals and EMR’s allow for seamless transitions between a patient's specialists. 

For example, if a patient went to their cardiologist and had a chest X-ray done, and they later visited their primary physician who suspected they might have a pneumonia, that chest X-ray would be a very valuable tool for the physician in making their diagnosis.

In rural regions, the benefit truly stems from the access to specialists that are otherwise unavailable. Strokes, heart attacks, respiratory failure, and other emergent health concerns require the care and direction of a specialist

Telemedicine is allowing for this access in both emergent situations as well as for follow-up purposes while the patient is in recovery.

In both environments, telemedicine is allowing for improved care, reduced costs, and better access to doctors.

Some patients and physicians resist telemedicine due to concerns of inadequate assessments, privacy, cost, as well as lacking insurance coverage.

A study conducted in early 2013 by Cisco, surveyed 1,547 consumers across ten different countries to determine consumer response and satisfaction with new telemedicine initiatives.

Most North American consumers (almost 80%) answered that they are comfortable submitting a complete medical history and diagnostic information to help ensure a better diagnosis and improved quality of care via telemedicine.

However, privacy concerns still exist and while 63% feel that their information is secure, 37% of consumers feel their information is not secure in electronic health records.

Although violations of HIPPA, the federal laws protecting health information, are fully prosecuted, 37% of consumers still feel their information is not secure in electronic health records used for telemedicine.

Unfortunately, with recent increase in cyber attacks, consumer concern for privacy and security is still overwhelming. This puts doctors in a tough position because access to electronic records has now become a vital part of their job.

While some patients feel secure with their health information online, the cost has become a deterrent as many insurance companies have not defined what aspects of telemedicine are covered.

Furthermore, legislation about proper care standards has been in debate. There is bipartisan support from Washington and the federal government; however, insurance companies have limited the environment necessary for successful implementation into rural communities.

Medicare, on the other hand, recently stated that telemedicine doctors visits are covered when the patient resides in a community deemed to have a shortage of healthcare.

So far 45 states offer coverage for some type of telemedicine, but a lot of the resistance comes from insurance companies not fully understanding the benefits of telemedicine. Specifically the potential for reduced cost and risk for rural patients.

Progress is eminent as now 20 states have laws requiring coverage for all patient doctor interactions using telemedicine. Greg Billings, an executive director of the Robert J. Waters Center for Tele-health and eHealth Law in Washington thinks “more and more insurance companies are starting to understand this issue” and coverage is improving as a result.

Physicians, like patients, were worried about costs because billing/coding for telemedicine has been in transition since telecommunication has allowed for virtual care of patients.

For example, in a typical visit, the doctor will ask the patient about the history of their present illness (HPI) then they will conduct a review of systems (ROS), asking about all parts of the body related to the symptoms the patient has.

Then, the physician will conduct a physical exam. While, the HPI/ROS can easily be reported via telecommunication, patients worry that the physical exam will be hindered by the telecommunication.

However, according to University of Missouri healthcare’s CEO, 70% of patients don’t require a physical exam to be adequately assessed by their physician.

While concerns regarding telemedicine are legitimized, many stem from a misunderstanding of the effects telemedicine has on the different healthcare systems and environments.

Telemedicine decreases wait times for results and increases patient satisfaction in many emergency departments with teleradiology and remote management.

Sibley Memorial Hospital Emergency Department utilizes teleradiology to have radiologists read results remotely so that physicians can focus on seeing patients and while still maintaining efficient turnover.

The UMD Baltimore Medical Center uses remote management for real-time transmission of a patient's vital signs as well as a video feed of the patient while the ambulance is en route to the trauma center.

Both of these examples demonstrate the benefits of telemedicine when dealing with not only life threatening cases, but also time sensitive cases.

A study conducted in 2008 showed that almost half (46%) of the ER visits nationwide resulted in some sort of radiology testing whether that be an ultrasound, MRI, Cat Scan or X-ray.

This statistic demonstrates that imaging is a huge part of diagnostic tests in the emergency room and having remote radiology readings is more crucial than ever as this number increases every year.

Dr. Berghoff explains the benefit of teleradiology and how it plays into the success and efficiency of an emergency department.

                                         

Teleradiology allows for a second opinion that not only saves time but also lives by giving patients and physicians peace of mind.

Furthermore, the implementation of telemedicine, specifically teleradiology, has allowed for physicians in the emergency department to spend more time with patients while also decreasing the time it takes to receive results.

As a result, patient satisfaction has improved because patients feel they are given more attention by the emergency medicine physicians.

For example, if the physician was responsible for reading all radiology images themselves, they would have less time with their patients and much more time sitting at a computer viewing images.

Remote management has also had an impact on critically ill or intensive care patients. Specifically, doctors as well as nurses are able to monitor vitals and symptoms remotely since they are unable to sit by their bedside 24 hours a day.

This includes monitoring of vital signs, remotely ordering further tests, as well as video monitoring of the patient.

While overall telemedicine is largely improving both patient and physician experiences in the emergency room, there are still many suggestions for further improvement.

Dr. Berghoff explains some improvements to telemedicine she would like to see implemented in the future.

                                         

Although EMR’s have come a long way from the days of paper charting, improvements in the connections between portals can further benefit physicians specifically in emergency rooms who typically never see a patient more than once.

Not having a previous history for a patient can be nerve-wracking for an emergency room doctor, because it makes their job harder and more risky when they can't be sure they have the full story. Thus these portals are a much needed tool to provide background information on previous diagnoses and medical history that can streamline a patient’s process in the emergency room.