Why all the big players are pushing their telehealth platforms, and what it means for the future of medicine.
Written by Michael Richardson, Healthy Utah Magazine
Suppose a bank were to announce that it’s online services were terminated. Suppose Amazon said they would only be selling things in physical stores. It would be inconvenient, bad for business, and against the flow of the modern age. One day, we may have similar expectations from healthcare.
“Telehealth is a tool that hopefully 5-10 years from now will be completely indistinguishable from the general continuum of care that a patient experiences,” said William Daines, MD, medical director for Intermountain Connect Care, a telehealth service that gives people access to medical providers 24/7/365.
Intermountain’s commitment to telehealth is strong, and the same can be said for other healthcare systems, including University of Utah healthcare, Mountain Star and Iasis. All of these groups have implemented some from of video medicine, allowing patients to see a doctor from their homes, and these groups have big plans to expand their telehealth services.
In the established medical system, the provider decides the specifics of a visit; the where, when and how of it is really out of a patient’s hands.
“We want to bring it back to where the patient gets to set the terms of engagement,” Dr. Daines says. “The patient gets to decide where they are when they get care, and when they get care.”
This on-demand concept resonates; surveys suggest that most people wish their provider would offer some kind of online healthcare. Truly, illness doesn’t know if it’s the middle of the night or a holiday. It also doesn’t care if you’re 100 miles away from the right doctor, or if you don’t feel well enough to get out of bed. Telehealth breaks down geographic barriers and provides convenience when people most want convenience: when they’re ill.
Telehealth might actually be able to improve outcomes in some cases. Catching an illness early will generally result in better outcomes, and a video visit allows one to contact a provider faster, especially if you live in a rural area.
“It’s not so much that we are inventing a new form of healthcare,” Dr. Daines says, “we are bringing the healthcare delivery system into a more modern age.”
Modern technology means medical innovations don’t have to slowly trickle down from research institutions, meaning progress is faster. University of Utah Healthcare is able to spread the advancements they’ve discovered and developed through telehealth, according to Ted Kimball, MD, Medical Director of their TeleHealth Services. U of U Healthcare has more than 30 established telemedicine programs and works with 60+ healthcare facilities across the Intermountain West.
“Inherent in our mission as a teaching hospital is our responsibility to share clinical best practices, research advances, and provide our community partners with the educational resources we’ve developed as a university,” he says. “We want to be a resource to improve the health and well-being of residents across the West and we can now accomplish that through the use of TeleHealth services.”
Patients are further empowered through telemedicine because of the lowered costs. Besides lower travel costs, telehealth visits don’t demand brick and mortar facilities that traditional visits need, and the lowered expenses are passed on to the patient. Connect Care, for example, says that the most a telehealth visit can cost is $49, and with insurance it’s less. A typical doctor’s visit is twice that, and an urgent care visit costs hundreds of dollars.
Use telehealth for:
- Stuffy and runny nose
- Sore throat
- Eye infections
- Ear ache
- Painful urination
- Lower back pain
- Joint pain or strains
- Minor skin problems
Go to the emergency room/urgent care for:
- Chest pain or pressure
- Uncontrolled bleeding
- Sudden or severe pain
- Coughing / vomiting blood
- Difficulty breathing or shortness of breath
- Sudden dizziness, weakness, change in vision, slurred speech, numbness, or other neurological changes
- Severe or persistent vomiting or diarrhea
- Changes in mental status, such as confusion
- Assault, physical or sexual abuse, or child abuse
Avoiding urgent care and the ER is not only good for the patient; unnecessary visits (if the condition isn’t an emergency) to these centers is a huge burden on the healthcare system in general. Telehealth just might be in an ingredient in the formula that corrects the inefficiencies of our healthcare system.
The Public Response
According to Dr. Daines, the public response to Connect Care has been very strong. Patients have rated their online visits at 4.8 stars out of 5 on average. The University of Utah’s Telehealth Services had 3,000 specialty visits in 2015, and are on track to surpass that number in 2016.
The big hurdle for these services is awareness.
“Lot’s of people are aware in the abstract, that you can see a provider online,” Dr. Daines says, “but they might not be aware that it’s available to them literally today, and with the device that they already own.”
A person who becomes ill often resorts to instinct, meaning telehealth simply doesn’t come to mind, because it isn’t a typical decision to make. There may also be some misgivings about a diagnosis from a video visit. But concern about quality of care isn’t a new issue for physicians and patients alike. As Dr. Daines explains, there is always a concern for a provider that he or she is giving the highest quality of care. Even in a regular doctor’s office visit, a physician may realize that he is not equipped to deal with the patient, and will refer elsewhere.
The same concept is true in telehealth. Many conditions can be safely and thoroughly evaluated with telehealth, while others cannot. Modern medical training must now educate doctors on how to be digitally discerning, to know if a patient would be better served with a visit in-person. These training protocols are already in place.
“We’ve strongly counseled our providers, that if at any point they feel the severity of the illness is higher than should be treated over telehealth, it’s a no brainer: you send that patient on for an in-person evaluation,” Dr. Daines says.
The telemedicine programs of each healthcare group in Utah differ. For example, University of Utah Health Care offers telemedicine in a variety of specialties, including dermatology, cardiology, speech therapy, burn care and behavioral health. Intermountain offers a similar spread of telehealth care for specialty care. On the other hand, Connect Care from Intermountain has full time advanced practice clinicians dedicated to the general telemedicine services, with supervising medical doctors and specialists providing back up. MountainStar’s program is called “Virtual Care,” and it allows patients to choose a doctor from their network online, and talk with him over the phone or video chat. Similar to Connect Care, they promote it as a convenient solution for “minor problems” like headache, sore throat, fever, and pediatric issues like cough and skin rashes.
Before rushing to call telehealth the savior of modern medicine, its limitations must be acknowledged. For example, it is an important service for rural communities, but these populations are generally the ones with poor internet connections. Implementation is another worry. This is somewhat uncharted territory, and healthcare groups have spent years figuring out the best ways to deliver online medicine.
Many obstacles to telehealth are found in public perception. People worry about everything from the accuracy of a video diagnosis to the security of their personal information. While establishing sound telemedicine protocol is a first priority for the hospital groups in Utah, affecting public opinion might be a taller hurdle.
But one idea keeps the future of telehealth bright: it’s good for the patient. As more and more people experience the convenience and affordability of quality medical care from the comfort of their home or mobile device, the more solidified telehealth becomes in the healthcare system at large.
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