Telehealth has been in practice now for over 40 years, yet in the last 5 years it is seeing considerable growth in all sectors. There are a number of reasons for this, primarily, as the use of the internet and various new technologies are becoming more and more advanced and widespread, this has meant that the cost of using this technology for such purposes has decreased significantly.
a greater understanding of how best to make use of and implement telehealth has
improved overtime, with new uses for it continually being developed. The
increase of reliance on telehealth has sparked debate between physicians
regarding the pros and cons of its usage, with particular consideration of the
role it plays in medical malpractice.
The benefits of telehealth
of the most obvious benefits of telehealth is the newfound ability to provide
healthcare to patients in remote areas who otherwise may struggle to get
access, while also being advantageous for elderly or disabled patients with
mobility or logistical issues.
has the potential also to improve patient coverage given a shortage of
physicians in relation to the number of patients in some cases. It also
provides the opportunity for patients with rare conditions to get much needed
medical advice from long distance specialists.
a healthcare systems perspective, telehealth has the potential to both decrease costs and improve outcomes, however
this needs to be weighed up against the potential risks involved.
represents a paradigm shift in medical care, changing the way that doctors operate
and deal with their patients, it could be harder for more experienced doctors
to adapt to these new ways of working as they were not trained that way, and
many want to and are used to seeing the patient in their office.
technology removes the physician’s ability to see and interact with the patient
face to face. It is natural that physicians will fear their ability to do their
job will be reduced at such a distance plus any technological change also
changes medical malpractice thresholds. It will be down to malpractice expects
such as JJS
Justice, and law courts to determine how telehealth and other new
technologies relate to the acceptable healthcare provision threshold for
patients. Doctors will need to adapt and learn to implement these technologies
within these limits.
issues involve the quality of service that is being provided using this
technology, can patients trust in this? Will they receive a quality of care equivalent
to that of a face to face consultation? It also remains to be determined how
exactly physicians will be reimbursed for their work done through this method.
The potential for medical malpractice
is still work to be done to ensure that telemedicine is controlled and
regulated effectively, to maximise its efficacy and minimise the risk of
medical malpractice. The main concerns around the potential for medical
malpractice in telehealth include issues around online prescribing, informed
consent and state licensure.
regard to online prescribing, in some cases it may be insufficient to prescribe
medication on the basis of an over the phone consultation or upon review
of a patient questionnaire submitted online. It Is therefore important that
there are crystal clear guidelines and expectations set around when a physical
examination is required.
around informed consent are different between states, physicians should
therefore be au fait with the requirements on this front for the states where
they are licensed to prescribe medication to patients.
physicians should not operate beyond their jurisdiction, a doctor needs to be
licensed in the patient’s home state in order to prescribe them medication. In
fact, most malpractice issues in relation to telemedicine involve unlicensed
malpractice litigations, it is essential that physicians are licenced, have
full knowledge of their duties and responsibilities, receive adequate
training and that they have taken a full and extensive medical history of all
the patients that they prescribe for.
While you may think of technology in terms of the CT scanner, the advancements made in recent years in cardiac monitors, portable x-ray equipment, sonography, bedside lab testing, even IV needles are all part of how tech is improving healthcare.
Just ask the medical staff of inpatient and outpatient rehab centers. Point of care testing allows blood testing to be done at the bedside. Results for electrolytes, hemoglobin and hematocrit, glucose, blood gases and several other essential blood tests can be in the doctor’s hands in the time it used to take to run the blood to the lab.
Every discipline of medicine is evolving because of the changes in technology. First, there were x-rays then CT scans and MRIs. Now PET scans routinely diagnose very early cancers because they scan the body at a cellular level, often finding tiny areas of increased activity that wouldn’t show up on a CT scan or MRI. Speaking of pets, tech has helped improve the health of our dogs and cats. Whether simply treating a constipated dog or detecting cancer in a cat, the same image scans that serve to help people are being used to help their pets. Robotic surgery sounds like science fiction, but the discipline is gaining acceptance everywhere. Very small incisions have replaced long scars as surgeons control miniaturized instruments from a monitor with magnification that enables very precise work.
Even common health problems, such as diabetes and asthma, are affected by improved technology. Advanced diabetic pumps and monitors help to control blood sugars more exactly as well as improving the quality of life for many diabetics. The newer asthma inhalers deliver a more accurate dose and are easier to use, especially for elderly and young patients.
Computers connect health care agencies and allow researchers to gather data in real time. The diagnosis of a case of influenza or meningitis can be reported to the CDC within minutes to hours, helping to stop the spread of epidemics.
According to the Office of Coordination of National Health Information, 50 percent of healthcare dollars are wasted on inefficient processes. Transformative innovation must not only change the current way things are done, it must be disruptive by having a meaningful impact on time, quality, cost and operational effectiveness – it must dramatically simplify and accelerate the process it enables.
There are very exciting ways in which digital technology is creating transformation across the entire healthcare system in areas such as connected health, artificial intelligence (AI), blockchain, mobile data gathering, analytics, digital therapeutics and remote patient monitoring. All of these technological developments will improve healthcare efficiency, but more importantly they will drive the delivery of individualized care and dramatically improve patient outcomes as follows:
Access to Care
Connected health, or telehealth, is enabling the delivery of care to rural areas, where access is often nonexistent or very limited. It is also being used to address growing medical staff and physician shortages by providing access to timely care through collaborative tools such as eConsults. Telehealth delivers faster, less expensive and more convenient healthcare and in doing so significantly improves patient outcomes.
Conventional patient engagement systems display information at the hospital bedside, which is only one of many relevant ways to connect with patients. Companies are now integrating artificial intelligence or ‘virtual’ health coaches into interactive educational platforms, resulting in higher utilization and engagement, and delivering more robust, actionable content.
Remote Patient Monitoring (RPM)
A vast array of innovative wearables and sensors such as the biosensor bra patch, implantable glucose sensor, electronic tattoos and the cardiac mapping vest are revolutionizing remote monitoring capabilities. These remote monitoring systems have the potential to help achieve triple aim goals by leveraging the latest advancements to collect and analyze patient data beyond the bedside. Patients and providers can use smart phones, tablets and apps to remotely assess, diagnose and monitor their patients. Electronic monitoring can be an effective solution to identifying issues as they happen while also enabling more effective tracking of patients post-discharge, improving compliance and adherence, and reducing the number of re-admissions.
Yet effective January of this year, CMS instituted important changes to their reimbursement policies that encourage the use of digital health tools. Most significant among these changes is the un-bundling of the Medicare/Medicaid CPT code 99091, a decision that specifically affects the adoption and deployment of remote patient monitoring (RPM) devices. In the past, CMS has only offered financial incentives for live, audiovisual virtual visits, excluding RPM—and thus excluding a major demographic from the possibility of affordable and accessible care. With the un-bundling, financial incentives for RPM are not only available, but also are deployed across multiple providers, allowing nurses and care managers as well as physicians to analyze and monitor data, creating efficiencies and lowering costs.
But while the CPT un-bundling represents an important victory for RPM, it also serves to highlight the policy’s inadequacies and the large margin for growth. With the update, care providers no longer have to worry about fully funding RPM from their original operating budgets, but the reimbursement rate ($60 per patient per month) is still far too low to be effective in most cases. Other requirements, such as a prior wellness visit with the patient and a limit of one charge to the code per month, further restrict its effectiveness.
Perhaps most problematic, while the un-bundling will have an immediate positive impact on patients over the age of 65, a large patient demographic could be outside the bounds of its effects. Commercial plans are under no requirement to follow the updated CPT guidelines, and more importantly, neither is Medicaid. And while Medicaid is the smaller of the two government run-healthcare plans (compare Medicaid’s revenue of $565.5 billion to Medicare’s $672.1 billion), it is outpacing Medicare by 10 percent in rates of spending (increasing by 3.9 percent in 2016 compared to Medicare’s 3.3 percent).