REMOTE CONTROL

The days of a waiting room full of patients may be coming to an end as there’s a growing awareness that many doctor-patient encounters do not require face-to-face contact. And, while telemedicine was first implemented decades ago to deliver healthcare to geographically isolated patients, more consumers looking for ways to access convenient, round-the-clock care are demanding this type of service.

Secure patient portals and mobile applications now allow patients to video, email, or text with their physicians’ offices, and many are downloading health and wellness applications to their smartphones, refilling prescriptions, and having their vital signs and blood sugar monitored remotely.

“Patient acceptance of this is well documented by hundreds of studies,” says Jonathan Linkous, CEO of the American Telemedicine Association (ATA). “Once patients have a doctor who uses this technology and see how easy it is to make an online appointment or get lab results, they say they’ll never go back to a doctor who doesn’t off er these services. This will be big driver for telemedicine.”

Growing in Popularity

More than half of all U.S. hospitals now use some form of telemedicine, and there are about 200 telemedicine networks with 3,500 service sites across the country, according to the ATA. It reports that the Veterans Health Administration delivered more than 300,000 remote consultations using telemedicine.

“Mobile healthcare is creeping into all areas of medicine,” says Linkous. “For example more than half of U.S. physicians are using some sort of medical application on their smartphones or tablets.” Patients with chronic diseases, such as diabetes and COPD, are among those leading the charge for the new technology, and it appears endocrinologists are responding in favor

David E. Cummings, MD, deputy director of Diabetes Endocrinology at the University of Washington in Seattle, works in a Veterans Administration hospital that serves a large region of the Pacific Northwest, especially Washington and Alaska. He says many of his patients live far from the hospital, so an important component of his work includes video-telephone clinic “visits.”

“A spot in the clinic is reserved for the doctor to talk with the patient via our equivalent of Skype, in which we see each others’ faces on computer screens while the patient is hundreds of miles away,” Cummings explains. “Most of what I do in clinic involves just talking with patients and interpreting data from labs and radiology, so the physical exam is not very important. I think our video-telephone clinic visit system is a valuable tool for patient care.”

Efficient & Convenient

At Peyton Manning Children’s Hospital in Indianapolis, patients communicate with the pediatric diabetes team by secure email to get services such as prescription refills, insulin dose adjustments, and to ask questions. “Many patients prefer this mode of communication as it can be more efficient and convenient when compared to telephone or FAX,” says Andrew Riggs, MD, medical director of pediatric endocrinology and diabetes.

Th e pediatric diabetes department is currently developing mobile applications to assist with education and communication with their patients. Riggs adds that while his department embraces this type of care, insurance reimbursement lags behind their current model of care.

In fact, insurance reimbursement remains a major issue that slows many clinicians from embracing telemedicine. Although a growing number of health plans reimburse for e-visits, only 19 states actually require private insurers to cover telehealth the same as they cover in-person services, according to the ATA. And under Medicare and Medicaid, there are restrictions as to what services are covered under telehealth, and reimbursements can vary by state.

“We have shown that increased accessibility of the outpatient diabetes team by patients and their families can reduce length of hospital stay and readmission rates, thereby reducing costs while improving the quality of care,” says Riggs. “We hope that in the near future this is recognized and translates into improved reimbursement rates for our services.”

— Fauntleroy is a freelance writer based in Carmel, Ind., and a regular contributor to Endocrine News.

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