Telehealth: Separating fact from fiction
By Roy Schoenberg, M.D., MPH, October 17, 2011
Doctors, delivery systems, health plans and patients across the nation are now using telehealth to improve access to convenient, quality care. Think you know everything about what is really available today?
From this year's State of the Union address to recent endorsements by the Centers for Medicare and Medicaid Services, it is clear that telehealth and online doctor visits are rapidly entering mainstream medical care — and with excellent reason. The ability for patients and healthcare providers to come together through technology — overcoming barriers of geography, mobility and time — can improve access, even as it removes cost from the system. But as with similar innovations in the retail, travel and banking industries several years ago, misconceptions can arise and cause undue concern.
On the healthcare provider side, those who have been exposed to the large-scale telemedicine systems of decades past may think that new telehealth technologies require investments in complicated and expensive IT equipment. Others may be concerned that online visits cannot uphold the clinical standards needed to properly evaluate symptoms, diagnose or even prescribe, when appropriate.
For patients, most have only ever visited with their doctors in person, making telehealth a new experience. This may result in patients mistaking online visits for simple video chats, and not understanding the potential for doctors to meaningfully treat acute and chronic conditions alike. Patients may also think that doctor visits that don't take place in the office may compromise quality, are expensive or even unsafe.
The reality is very different. Doctors, delivery systems, health plans and patients across the nation are now using telehealth to improve access to convenient, quality care. Telehealth technologies have emerged that not only connect patients and doctors using multiple communications modalities such as high-definition video, secure chat and the telephone, but that truly "speak healthcare." This means they have the ability to integrate with a universe of back-end systems and devices — including claims databases, electronic medical records, predictive modeling systems and even plug-and-play biometric devices, to name a few — in real time to support highly informed care. Let's break it down into a few common myths:
Myth #1: It's the same as video chat
Today's telehealth requires far more than a simple video chat, and with good reason. The application that grandma uses to check in with the grandkids was never intended to help manage her diabetes. True telehealth encounters are secure, for one, not to mention HIPAA compliant. They also bring together multiple modalities for communication and assessment, all at the same time — video, audio, secure text chat and secure messaging — making sure the experience is immersive and highly personal. Finally, video chat alone is ultimately a gadget. During effective online visits, both patient and provider are surrounded by all of the information and tools needed to advance care, from health histories and biometric readouts to e-prescription and other clinical tools.
Myth #2: You need special equipment
Historically, telemedicine connected two physicians in different locations — one treating, one consulting — using dedicated (and expensive) pipes, video, equipment and even consultation rooms. Now, Web-based telehealth applications can use common consumer technologies such as the Web and phone to connect a patient and a doctor. Other supporting devices like Web cams and biometric devices can enhance the experience but are not required.
Myth #3: It's only for general advice
Telehealth is an increasingly effective way to address and treat many issues, from routine acute concerns to intensive chronic condition management, behavioral health and labs. In each case, the patient's care can be advanced without a physical exam, while eliminating delays that would have resulted from waiting for, or traveling to, an appointment. This makes telehealth simply another tier of care, with its own set of appropriate uses (just like no one has surgery performed in the doctor's office). As a result, patient satisfaction with online visits is very high, typically exceeding 90 percent.
Myth #4: It's expensive
Most online doctor visits cost patients less than $50 per consultation. The cost to the patient is often similar to the cost of a co-pay for a traditional office visit and is subsequently submitted for FSA or HSA reimbursement. Some operators even provide telehealth services for specific populations (employees, members, at-risk patients, etc.) at no cost, essentially sharing in the cost savings that result from these encounters.
The most transformational innovations often progress through a period of uncertainty as they hit the mainstream. Remember when industry watchers speculated that Main Street consumers wouldn't feel comfortable doing anything more online than buying the occasional book or CD? Telehealth, too, finds itself becoming part of daily healthcare delivery. With telehealth leaders such as Blue Cross Blue Shield of Minnesota reporting that 85 percent of consumers who have online visits completely resolve their healthcare issues — often while saving hours of time in the process — we are quickly moving beyond myths and misconceptions and toward fully utilizing the potential of these technologies.
About the author
Roy Schoenberg, M.D., MPH, is CEO, American Well Systems. For more information on American Well solutions: http://www.americanwell.com/.
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