- For years, telehealth advocates have been touting virtual visits as being just as good as the in-person visit. Now they’re saying telemedicine is better.
“Our focus is now on quality,” American Telemedicine President Peter Yellowlees, MD, declared as ATA18 kicked off Sunday in Chicago. “It’s now about how having virtual care really can be better for patients (than) the traditional approach.”
The ATA, marking its 25th year, is pushing the telemedicine agenda quite hard these days, with a focus not only on the benefits to the patient in a rapidly-changing direct-to-consumer landscape but also on the advantages it brings to overworked practitioners.
Yellowlees – as well as several other ATA board members, session presenters and exhibitors – has made it a point over the past two days to accentuate that value, given the fact that the healthcare industry experiences some 400 physician suicides a year. Many here have labeled clinician wellness the fourth leg of the healthcare stool.
“I actually find it less stressful to see a patient online than I do in person,” Yellowlees, a professor of psychiatry at the University of California’s Davis campus, said during his opening remarks.
The mood through the first two days of the three-day conference has been one of empowerment, and of bringing digital healthcare to the forefront to improve patient outcomes, reduce physician stress and, in general, make healthcare a safer and more cost-effective industry.
Yellowlees noted that, where it cost him $170,000 in 1990 to develop a videconferencing platform, today’s technology can do that for a fraction of the cast – and fit into a consumer’s hand. And whereas one in 10 hospitals in 2008 had gone digital, now one in 10 hospitals haven’t made that transition.
“We are past the point of ‘Why do telemedicine?’” ATA CEO Ann Mond Johnson said in opening Monday’s conference. “This is not a bolt-on service. Virtual care is here.”
Evidence of the industry’s reach was easy to find at McCormick Place. In one session, representatives from the Medical University of South Carolina (MUSC), one of two health systems named a National Telehealth Center of Excellence last year, detailed how the health system has launched and fostered a school telehealth program that now extends into more than 80 schools and is held up as a model for similar programs across the country.
In another session, representatives from the Army, Navy, Air Force and Veterans Administration detailed how their organizations are not only making use of telehealth and mHealth but working together to make sure servicemembers – both active and retired – are given access to healthcare no matter where they’re living.
“It’s all about readiness,” noted Navy Commander Marc Hurwitz, Chief Ancillary Informatics Officer and Deputy Director of Clinical Informatics at the Bureau of Medicine and Surgery.
Another session focused on a fast-rising mobile health concept: Remote patient monitoring. While the Centers for Medicare & Medicaid Services and American Medical Association are still trying to figure out how to improve reimbursement, health systems across the country are using mHealth platforms and devices to extend care out of the hospital and into the home.
“We’ve integrated this into our care models and our care pathways,” said Kristi Henderson, DNP, NP-BC, FAEN, Vice President of Virtual Care and Innovation at Ascension Health, which launched an RPM program in Texas about a year ago.
Laurie Poole, Vice President of Clinical Information at the Ontario Telemedicine Network – billed as the largest network in the world – said a 10 year-old RPM program targeting patients with heart failure and COPD has seen a 60 percent reduction in ER visits and a 70 percent reduction in hospitalizations.
“We’re now trying new models of care for other chronic diseases,” she said.
And Andrew Watson, MD, Vice President at UPMC and the ATA’s President-Elect, said his health system is working on several RPM programs as it moves away from episodic care for people with chronic diseases and toward a more comprehensive care management plan.
“How do we really look at long-term care of these patients?” he asked.
But those at the podium were also quick to point out that telemedicine should not replace the in-person visit. Doctors and nurses should look toward a hybrid approach that balances technology with a personal touch.
Robert Wachter, MD, chair of the Department of Medicine at the University of California’s San Francisco campus and author of "The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine's Computer Age,” pointed out in his first-day keynote that telehealth and telemedicine can create problems and lead to medical errors that an all-paper system wouldn’t do.
In fact, he said, while other industries have digitized processes and found ways to reduce their workforce, healthcare’s move to new technology has added to the ranks. Now hospitals are hiring extra scribes to translate the data coming in from mHealth devices into the medical record.
“We are very, very early in the progression,” he said.
Lisa Bielamowicz, MD, co-founder and President of Gist Healthcare and a former CMO of the Advisory Board Company, pointed out in her Monday keynote that healthcare has to learn how to use telehealth and telemedicine to reverse a continuing trend of taking more and more money out of the nation’s budget.
She noted the Baby Boomer generation will strain the nation’s healthcare resources even more as it moves into retirement and old age, turning a system now equally balanced between public and private payers to one where, in five years’ time, 75 percent of the healthcare spend will come in Medicare and Medicaid.
That, in turn, will strain hospital resources. One CBO estimate, she said, puts 60 percent of the nation’s hospitals under water within a decade.
“Healthcare is still very much in the sites of those who are looking to reduce spending,” she warned.
And that’s where telehealth and telemedicine come into play.
Consumers “are changing how they think about healthcare,” she said. And they’re prompting healthcare providers – as well as businesses like Walgreens, Wal-Mart and Amazon – to use telemedicine and telehealth to meet that consumer demand. Wal-Mart, for example, is now paying attention to how much a customer spends on healthcare because that, in turn, will affect how much he or she spends on its products and services.
“And if they double down (on healthcare) those guys will transform the industry,” she said.
Wachter’s and Bielamowicz’s keynotes offered a sort of counterpunch to the mood in the ATA exhibit hall, pointing out that the industry’s innovations and advances are all well and good, but they have to be integrated into the healthcare system in order to work. It’s all well and good to have the latest technology, but it will only work if used appropriately.
“Many uses won’t become clear until it’s actually in widespread use,” Wachter pointed out. “You can try to be smart and creative and clever … but it’s really hard to do until you’re actually using it and seeing the opportunities that flow from those uses.”