MD, Phone Home

Telemedicine gets ready for its close up

by JP Faber | Updated 15 Dec 2015 at 7:41 AM

When Nelly Nigro needs a checkup to make sure her heart medications are working, the 90-year-old doesn’t have to drive from her home in Westwood to the hospital clinic at University of California, Los Angeles.

Instead, she takes her own vitals at home — weight, blood pressure, heart rate, and oxygen level — which are sent, encrypted, to her medical team. She then has some iPad FaceTime with a friendly nurse.

Nigro, hospitalized two years ago for atrial fibrillation, is part of a new “telehealth” program for heart patients at UCLA’s Ronald Reagan Medical Center.

“We have very sick patients who need a lot of management,” Dr. Richard Shemin, chief of cardiac surgery at the center, told LifeZette. “The idea is to see if we can increase the level of monitoring patients after discharge, something besides, ‘Call us if there is a problem.’”

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So far, the answer to whether more can be done is a resounding yes. In the past, patients returned for a checkup two weeks after their discharge. If there was a problem before then, it typically meant a trip to the emergency room.

With the telehealth program, patients instead check in daily for those first two weeks, supplying their own data from devices they have at home and talking with a nurse over an iPad. In the six months since the program started, emergency readmissions to the hospital for cardiac patients have fallen by 30 to 40 percent, according to Shemin.

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Nigro, who worked in the health care industry as a pharmacologist for more than 50 years, seems amused by the whole thing, and thankful for the convenience.

“You feel more connected to the doctors and nurses who are taking care of you,” she said in a UCLA video interview. “And you can detect things before they become a problem.”

Telemedicine — the ability to examine patients remotely using communications technology — is about to take America by storm. While it still accounts for only a tiny fraction of medical visits, remote medical services are set to explode over the year or two.

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“Telemedicine is transforming health care, making it far more convenient,” John Linkous, CEO of the American Telemedicine Association, told LifeZette. “It’s breaking health care out of the walls of hospitals and brining it to the people.”

Telemedicine — the ability to examine patients remotely using communications technology — is about to take America by storm.

Beyond remote monitoring of intensive care patients, the biggest change in health care will be the ability to have online “virtual” visits with a doctor, said Linkous. It’s the 21st century equivalent of a house call.

Using online connections, companies such as American Well, MDLIVE, and Teledoc offer patients the ability to videoconference with a doctor for about $50 per 10- or 12-minute visit. This year, the ATA predicts 800,000 online medical consultations in the U.S., a figure expected to increase exponentially.

“I see this growing by leaps and bounds,” said Dr. Matthew Faiman, director of telemedicine health services at the Cleveland Clinic, which announced in June a 24-hour MyCare Online program.

In an interview with LifeZette, Faiman predicted video consulting will triple over the next 12 months as it starts to go mainstream.

Faiman said about 80 percent of diagnoses are possible from video communication, as long as doctors have the patient’s history.

“A lot of what I need to see is in a patient’s body language," Faiman said, "I don’t need to see a patient in the office to tell him or her what to use for poison ivy.”

Some doctors are already equipping patients with basic medical devices, such as a blood pressure cuff, glucose monitor, or pulse oximeter — a tiny device that can measure pulse and blood oxygen from the finger. Companies such as Atlanta-based SynsorMed now specialize in helping individual doctors set up telemedical "platforms" with video software and patient hardware.

That may be the easy part, said SynsorMed CEO Theo Harvey.

“The issues now are not with the technology,” he said, but rather with making sure the medical information is encrypted so as not to violate privacy issues. “Reimbursement is another big issue with telehealth, because doctors get reimbursed more for an office visit.”

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That has to change, said Thomas Martin, director of the Personal Connected Health Alliance. Medicare reimburses only a tiny amount for telemedicine — $30 million last year, out of roughly $3 trillion — so the immediate future lies with cash payments or private insurers such as United Health Care that recognize the efficiency of home "video" visits.

Over the next five years, the number of video consultations is predicted to rise from 800,000 to 158 million.

“Some of the private payers are recognizing the cost savings,” Martin told LifeZette, “but most of the opportunity is still just out of reach, because we need the public payers to recognize the value.”

Even with the savings and convenience of telemedicine, advocates such as the Cleveland Clinic’s Faiman still advise an initial visit with a new doctor to establish a medical baseline and records.

As for the future, expect a lot more telemedicine — and more devices that patients can use themselves to record medical data for transmission to their MDs. These tools will become more affordable and accurate as time goes on, said the ATA’s Linkous.

And for those who can’t afford them, they will be available at national pharmacies, some of which are already offering video consultation kiosks.

As for the sign of the times, said Linkous, look to the $10 million Tricorder X Prize being offered by Qualcomm for the first small device (like Dr. McCoy’s tricorder from Star Trek) that can diagnose more than a dozen medical conditions with a single wave of the wand, er, tool.

“The whole thing is mind-blowing,” he said.

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