• June 2008 FEATURE ARTICLES •
From the Editor
Full Circle
By Michael McBride
Not long ago, doctors made house calls. How
nice it must have been to be treated by one’s doctor in one’s
own bed, with family about and chicken soup on the boil. No
lying in tiled hallways, clinging to cold metal tables waiting
on overworked ED staff. Physicians had time to bond with
patients and build relationships. Could that era come again?
Possibly.
From hospital portals to robotic surgery to
rural telehealth to telehomecare to remote monitoring, the
industry seems poised at the edge of a new era in expanded
caregiving that promises to not only give us back the luxury of
house calls, but also to save U.S. healthcare from almost
certain collapse under the weight of the
impending Boomer onslaught.
Studies clearly show that most ED
overcrowding comes from non-emergency patients, increasing cost.
Were those patients able to receive quality care at home, that
double whammy would diminish. In fact, simply managing the most
common geriatric diseases in a home setting would significantly
reduce the pressure on the healthcare system, not to mention
thousands of ED patients presenting each year with common
ailments. Technology is no panacea, but the possibilities are
too great to ignore, and the results of ignorance too grave.
Representatives have repeatedly introduced
legislation designed to expand telemedicine’s role, with
developmental grants being awarded as far back as the late 80s.
And yet, like regular flights to the moon, the industry can’t
get off the ground. But there is hope.
Currently before the House and Senate are two
bills (H.R. 5765 and S. 631) that, if passed, would "amend title
XVIII of the Social Security Act to provide for coverage of
remote patient management services for chronic healthcare
conditions under the Medicare Program." Once
Medicare reimburses doctors for disease management, other
conditions would surely follow, opening the door for healthcare
organizations to improve patient care and increase the bottom
line through telemedicine.
Clinics would open in rural areas, where
before, none existed. Elderly could receive treatment in their
recliners, with electronically prescribed medications delivered
by courier. Specialized medical call-centers, similar to remote
home security, could monitor hundreds of patients with chronic
conditions, alerting physicians and family members when
necessary.
Imagine a time when we could place a hand on
a telehealth device that reads temperature, pulse and draws
blood. It then transmits the results to a healthcare provider’s
clinical information system, which identifies the patient and
compares the readouts against previously recorded baseline
readings. If necessary, the system alerts the patient’s
physician, assumes a claim will be filed and simultaneously
contacts the payer’s system, which validates the claim and
provides remittance advice. The hospital’s system then makes
contact with the patient and brings a clinician online for
consult or treatment. All this happens in seconds, not days or
weeks. It’s like OnStar for the sick.
This can happen, it should happen, and it
will happen if enough hospital organizations support it with
their purchasing and voting decisions. Then, perhaps, we can all
stay home instead of flooding EDs.