Comments on: Are the stars aligning for telemedicine's succcess?

The U.S. healthcare system is in so much trouble, that the economics may finally be compelling enough to make telemedicine a reality in this country.

[dascha1]

UHG has to take inventory of what problems they've already bought and have yet to manage (e.g. many don't know there they own Optional Choice). So, although this appears to be good wetting of the appetite I'm not sure if these guys are the shining yet. Also, it appears to me you elude towards the apple logo (eek) which is something I've complained about in this area before (i.e. I see Windows in ER/cancer centers but where's good/bad Apple et al?). Good report.

[RobertAPierce]

I certainly would not trust my health to examinations by remote viewing. How does the dr check for swollen lymph nodes? How does the doctor listen to your lungs, heartbeat, etc? Simple little things like that can be critical, and no matter how the technology advances, it's going to be inferior (if cheaper) health care.

[dbargen]

Um, crisis? What crisis?

Well, if you're noticing enrollment at med schools dropping in the last year, you may see the beginnings of one.

With ludicrous settlements and a sue-happy tendency for patients and judges, prices for malpractice insurances are driving doctors out of a large number of states. It's just too expensive to do business as a doctor there.

Add in the prospect of a single-payer, nationalized health care system, which is doomed to continue the practices of Medicare which stiff the doctor if they ever do pay him his lower-than-market, gov't.-set fee, and there seems to be no monetary draw to join the field and take on all of that student loan debt.

If there is a coming healthcare crisis, it's not a lack of affordable insurance options, it's a lack of doctors, though a *single-payer* system may change the former into one as well.

[mzjones11]

Requirements for everything from stroke assessment to behavioral health counseling have determined that 320 x 240 x 15 fsp provides a level of video meeting and exceeding clinical needs. More important than the HD capabilities being pushed by the hardware companies (Cisco, Polycom and Tandberg, etc.) is the capability to provide complete HIPAA compliance and integration with other healthcare applications and devices.

Proprietary HD hardware (costing $25,000 to $250,000 per location) and the significant bandwidth required to feed it will limit the use of telemedicine to a select group of federally funded academic institutions. Broad access to telemedicine services will only be possible when the cost per location is drops below $200. Using consumer grade webcams and bandwidth, combined with hosted telemedicine applications (SaaS / ASP), telemedicine would be able to move beyond the ?grant gravy train? and provide cost effective solutions actually improving the quality of interactive care.

[BenjaminWright]

Despite its promise, telemedicine faces legal hurdles -- such as questions about the licensing of doctors who see out-of-state patients. I argue that technology provides part of the solution here, in that smart communications and records management can go a long way toward satisfying regulatory authorities. http://legal-beagle.typepad.com/wrights_legal_beagle/2009/06/transparency-meets-it-compliance.html -Ben

[knowles2]

Why the above system is all well and good, and I see it befiting the NHS in Britain, which is most a single organisation, where all staff in there respected categories earn the same and where costs are strictly control from a central organisation and where you can be seen by one of the best cariologists or neuro surgions in the world for no extra costs.

How ever in highly fragmented market that currently exist in America where no one controles the cost of anything and where they are all looking to make more money than the other doctors, I doubt it will bring down the costs overal.
In fact the artical already mention using lesser trained staff to run these systems.

Also I still think there a lot of progress that is needed in the diagnostic tools available to the adverage patent in there home I got the feeling this will remain niche market which goes no further than the current NHS direct in the UK.
What they need to invent in a tri quarter and affordable holographic systems. I suspect we are at least 30 years from practical and affordable versions of this technology for the averaged home.

What ever the case it seem every country is struggling to make the sums add up when it comes to the health care, some are self denial France, some to entrench to change America, and others like the UK got a rubbish government which take years to make a decision and they do it usally so poorly implemented that it end up cost ten times what they planned for it to cost in the first place, especially when it come to IT systems,

[iabnow]

With IAB, the telehealth aspect is already solved. They are giving away a free month of a telemedicine to every American in August, "National Telemedicine Awareness Month" so that every person in the United States can have access to a licensed physician 24/7, 365 days a year.

This campaign will dramatically change the minds of those who view telemedicine as unaccessable and will save Americans billions of dollars a year on both doctor and emergency room visits.

Thank you.
Shane

[MFox1948]

The main part of any crisis in the US is lack of Single Payer healthcare. OOOOps that means no United Health Care. So they are not part of the solution, they are part of the problem. The techology is interesting, but alas is too expensive and does not solve the cost issue, does not resolve the need for more General Practitioners, and does not as stated in other comments address the bed side issues of physical presence and touching of the patient.

[brian.lee]

Hahahaha the first step to off-shoring health care.... you can get your diagnosis from a doctor located in China or India. I can't wait to see the outcome of this....

Instead of trying to solve the problem at hand head on you guys are trying to make another buck off of it... Ever consider universal health care... a system where everyone pays and people only use it when they're sick so the premiums from healthy people pay for the sick and elderly? I know sounds like a pipe dream right??

Try looking at how some of the European nations do it or even close to home Canada.. ya that country up north? They don't just live in igloos all year round.

[mbenedict]

I live in Canada and would NOT recommend universal health care, at least as implemented in Canada. We have massive issues here including ridiculous wait times, access to critical diagnostic equipment, etc.

The truth is Canadians who can afford it go to the US for medical care. My friend's dad was having kidney issues and was put in a 4 month waiting list (!) to see a specialist. He went to the US, saw a specialist who did a biopsy. Turns out it was cancerous (malignant) and he was in surgery the next day. Had he waited 4 months in Canada it might have been too late.

Even our MPs (Member of Parliament) go to the US for health care. When Liberal MP Belinda Stronach was diagnosed with breast cancer did she trust the Canadian system? No, she went to California for surgery. Imagine that, a sitting Federal MP opting for the US system instead of Canada's own.

The irony is one of the cancer-facilities here in Canada was named after her family, yet she still opted to go to the US for treatment. Another irony is that a first-class cancer facility like the one Stronach went to in California is illegal here in Canada, where the government has a monopoly on care (which only benefits Canadian union workers).

[Laurie_orlov]

There are numerous ways to lower the transactional cost of health care -- including e-mail, telephone, minute clinics -- that enable care to be delivered without visiting the doctor. Think about other industries, for example call center technical support, where attempts are made to understand the customer's problem and route them to the appropriate level of response and expertise. In this industry, telephone-based assessment of degree of care required should precede any use of expensive equipment as proposed. - Laurie Orlov, Aging in Place Technology Watch
http://www.ageinplacetech.com/content/cisco-and-united-health-if-you-have-hammer-everything-looks-nail

[perspectoff]

We have a Polycom rig at our regional rural hospital. it is basically an expensive webcam that works using IP-addresses based connections. It is great for the Emergency Room for quick ER consults to a university emergency consultant, and for ER consults to a subspecialist we might not have at our hospital (if we can find one willing to do Telemedicine consults, which is rare).

It only rarely gets used.

The problem is payment for Telemedicine services. Insurance companies don't pay for it, and it is very expensive to have Telemedicine consultants available 24/7/365.

The problem, indeed, is the insurance companies. It is amusing that they are supposedly supporting the technology.

Most Telemedicine between family practitioners (and many other practitioners) and their patients only requires a good webcam anyway, and Skype (or other widely available Teleconferencing program). Of course, a good electronic medical record system (such as WorldVistA) is desirable to make recordkeeping efficient.

Patients can use a $30 home blood pressure cuff from Walmart and read the numbers to their doctor -- there is no need for some expensive high-tech telemedicine equipment solution for most consumers.

Complex exams (needing specialized equipment) almost always require in-person consults, anyway. Telemedicine is really only to screen (the majority of) patient encounters that are trivial, don't require extensive exams, or to triage problems, so that recommendations as to where the patient ought to go next (ER, specialist, in-person exam) can be determined. Believe me, those "simple" services comprise about 75% of a family practitioner's business and can almost always be accomplished through Telemedicine.

Of course, insurance companies do not reimburse for this type of interaction at all. A savvy practitioner would set up PayPal on their website, where a patient desiring a Telemedicine consult would have to pay prior to a Telemedicine consult.

Such a system is easily configurable using open source solutions (such as a Drupal-based website).

More specialty-specific requirements, such as remote EKG monitoring, has been done for over a decade anyway, using (now) relatively inexpensive solutions. The results only need to be integrated into an EMR, such as can already be accomplished using more robust EMRs (such as the VA's VistA-based systems).

If you want to keep it inexpensive, keep it simple and don't reinvent the wheel. Also, don't invent what is not likely to be used. But don't take my advice. Ask your doctor.