Look Into Your Phone and Say “Aaahhh”

For those of us old enough to remember The Jetsons, their flying car was only one of the many futuristic perks imagined way back in 1962 by the show’s creative producers, Hanna-Barbera. The pioneering duo also foretold holographs, robot servants, talking computers . . . and tele-medicine!

Their version of remote diagnostic care was to have a family member stick their arm in a portal in the wall, which would “read” their symptoms and offer a diagnosis. As far-fetched as that might have seen back in the day, today it’s far closer to reality. Patients with congestive heart failure, diabetes and other ailments can step on automated scales in their homes, which measure their weight and send the data electronically to monitoring services. An appreciable weight loss or gain could indicate a problem – it’s flagged by the system, and a nurse then calls the patient to check in. People also can have their blood pressure, heart rate and sugar levels checked remotely using electronic sensors, communicate online with their physician’s offices, and access a wide variety of personal medical information and history via private electronic portals.

More than 15 million Americans received some kind of medical care remotely last year, according to the American Telemedicine Association, a trade group, which expects those numbers to grow by 30 percent this year. And according to the American Academy of Family Physicians, 41 percent of family practice physicians use electronic portals for secure messaging, another 35 percent use them for patient education, and about one-third use them for prescribing medications and scheduling appointments.

For all the rapid growth, however, significant questions and challenges remain. Physicians groups are issuing different guidelines about what care they consider appropriate to deliver in what forum. Complicating matters, rules defining and regulating telemedicine differ widely from state to state and are constantly evolving. In Connecticut, for instance, physicians cannot be compensated for services provided over the telephone, via fax or electronically, and are not allowed to prescribe controlled substances through tele-health services.

Another huge hurdle is physician compensation. Legislation today severely limits telemedicine. And without financial incentives to provide care electronically, physicians are reluctant to get onboard, especially since health insurance, which varies from plan to plan, covers only a narrow range of electronic services.

The future of telemedicine in the United States will depend on how regulators, providers, payers and patients can address these challenges, and the issue of quality versus convenience.  For example, there are a variety of on-line services now available where a patient can connect with a clinician for one-time phone, video or email visits on demand. These, typically, are for non-urgent-care issues such as colds, rashes and headaches. They cost far less than a trip to a physician’s office, or to an urgent care center or hospital.

Many large employers and their insurance providers are offering these services to the employees as a cost-saving alternative.  However, these services lack the bonds of trust and communication that are built over time between patient and caregiver, and can’t replace the value of a personal physician or health expert listening to your heart or lungs, peering into your throat, eyes or ears, drawing a culture sample or tapping other in-person diagnostic skills.

Over the past year, more than 200 telemedicine-related bills have been introduced in 42 states, many regarding what services Medicaid will cover and whether payers should reimburse for remote patient monitoring as well as store-and-forward technologies (where patients and doctors send records, images and notes at different times), in addition to real-time phone or video interactions. Medicare, the federal health plan for the elderly, covers a small number of telemedicine services — only for beneficiaries in rural areas, and only when the services are received in a hospital, doctor’s office or clinic.

There are many additional challenges. Everyone is looking at how to manage state’s rights against national priorities and demands, never an easy task. Malpractice issues are complicated, and many physicians simply do not feel comfortable rendering services online or via a phone. Still, every day brings new technologies, legislation and efforts to respond to changing patient and physician needs.

When you look at emerging smart phone technology and the portable monitoring devices we now wear on our wrists to monitor steps, sleep, heart rate and more, it’s easy to imagine how quickly future generations of health monitoring tools will evolve. And it’s probably a safe bet that we’ll be using them to help manage our health long before we’re flying to work in our own personal aero-cars!


 

Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!