Telemedicine Can Improve Care, Especially for Underserved Patients
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- čas přidán 24. 07. 2016
- Aside from whatever a visit to the doctor costs you in money, it also costs you in time. A lot of it. Can we make that better? That's the topic of this week's Healthcare Triage.
This episode was adapted from a column friend-of-the-show Austin Frakt wrote for the Upshot. Links to references and further reading can be found there: www.nytimes.com/2016/05/17/ups...
John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics
/ aaronecarroll
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/ johngreen
/ olsenvideo
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Telemedicine not only would save time, it would allow for under-served, and rural populations to have access to a doctor, which I think is the most important aspect of telemedicine. In rural areas the nearest doctor may be hours away, and so people choose not to seek medical treatment for ailments simply because they cannot make the trip to see a doctor. Telemedicine would allow for these people to communicate with a doctor to get the treatment that they need. For example, if you have a persistent rash that won't go away with OTC creams, a doctor could look at a picture over email or Skype and with asking you a few questions could probably diagnose you as easily through that medium as they would in person. So then of course the question is how would you get the medicine to treat the rash? Well I can think of a few ways. 1. A doctor can electronically send a prescription to your local pharmacy and you can pick it up there. 2. The prescription can be delivered through a medical taxi delivery service or 3. the prescription can be mailed priority to you. These are just three examples of routes medications can reach you and are not the only ways. A way that this could benefit under-served populations is with the elderly who are home-bound. Instead of making a decrepit elderly woman take the painful journey to the doctor's office in a hard to find wheelchair accessible van, family can Skype with the doctor and patient from the comfort of the patient's home. This would allow for these types of people to acquire medical care with ease. I think that telemedicine is a wonderful idea and should be covered by more healthcare insurances. It should also be promoted and used for under-served and rural populations to improve health outcomes.
My most recent visits have all involved personal contact (skin cancer, blood work, radiation, etc) but I can see that a primary or follow-up consultation need not necessarily require that. I think it would put a greater burden on the physician to notice things remotely that might be obvious in person. But I look forward to continuing to experiment on better ways to treat us patients.
Thanks for all the detailed information you have provided in this video. I like your way of explaining every point. Keep sharing such great videos in the future also.
I would greatly appreciate a telemedicine-esque service that I could use given that I live in a small town about two hours from decent care, and have no car or other transportation. I'm also not particularly good at making phone calls and talking about my issues, and I've often thought that if I could maybe just email my doctor, or write a little note about all my symptoms and why I'm worried, it would make my life a lot easier. I tend to forget to say things in person, so being able to plan everything I'm going to say will be helpful. Also, just the sheer proximity issue will be solved with instantaneous communication, and the convenience is nice. For a college student who works full time in the summer, I have no time to do much. It's not as if I can just make a doctor appointment for, say, 2 am. In short, I support what Dr. Carroll is promoting.
Okay I'm in the UK I've had two experiences of tele-medicine.
The first is the NHS 111 service which is a sort of telephone triage service. This has been beset by problems as was it's predecessor NHS direct. They are supposed to take an assessment of your symptoms and then refer you to the most appropriate medical care. Unfortunately because of the restrictions of the medium (inability to take vitals, relying on a third party's observations etc) and because it's sometimes staffed by people with very minimal medical training there have been a lot of adverse decisions. Some have been really dangerous like children dying because the person on the phone said to see the GP the next day instead of going to A&E. Other times, which is what I have experienced, they send an ambulance for things that don't really need it. I have complex health and when I ring it's because I'm unsure if I should go to the hospital or not. Every single time I rang they INSISTED on sending an ambulance because my normal health issues throw up red flags on their screening questionnaire. It's okay for me because I get extra pain relief and jump the queue at the hospital but it really is a waste of time and money.
The other experience is with my GP practice (primary physician or family dr I think it's called in the US). My practice do phone triaging for urgent appointments, so if you want an appointment that day you'll have to ring up and speak to a nurse or pharmacist first who will either solve the problem or find you an appointment to see a doctor.
For non-urgent appointments that are just simple things like reducing the dose of a medication I have telephone appointments with the Dr. It is easier and quicker for everyone involved.
This sort of thing is usually only taken up by people with chronic medical conditions though, not by people who are acutely ill. People who have muggle illnesses tend to want to actually see someone.
The healthcare system I work for has just introduced an express care clinic with a basis in telemedicine. You can "visit" the doctor via Skype (or similar) for minor issues. It only costs $39, and if they determine you need more care than they can provide, that fee isn't charged and they'll refer you to the right place. They can also provide prescriptions if needed.
I think it's great. I haven't used it myself yet, but I have no doubt that I will at some point. Leaving home or work to go to the doctor can be a hassle, especially if you're not feeling well!
Yes! So glad to see attitudes toward telemedicine might be evolving. It's so vitally necessary in rural areas. So many people are out of touch with the rural experience. I love it personally and it's what I want for myself but I'm very aware that I risk my health in many ways by living in the mountains.
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* healthcare needs met without going into doctor’s office
* good for chronic illnesses
* refill prescriptions
* reduce burden on healthcare system,
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To earn extra $, too, just by SHARING this potentially health and life-saving service, watch a video at: greensunshinepower.justviv.com/opportunity/ and contact Viv Consultant, Danny Tseng, by CALLING 786.441.2727 (canNOT get texts) or e-mailing: greensunshinepowercompany@gmail.com
#GetMediCall.com
When I first moved to a new state, I had phone appointments with both my psychologist and psychiatrist. It saved me the fear of finding other doctors I trusted (since I had long-standing relationships with both), and it also saved hassles with the insurance company and the fact that I didn't have a car. Basically, it was the best thing.
Kaiser patient here. You missed my single favorite telemedicine feature that they offer. In addition to being able to do a voice or video appointment with your doctor, they also have a 24/7/365 phone line you can call and be connected within minutes to a registered nurse.
Whereas before I would ignore ~50% of my body concerns, and take ~40% to a friend or coworker, I now ignore more like 30% and take about 40% to the nurse line. I feel so much better about my body when I have an expert who can give me an up-or-down on seeking further advice!
Just last year our insurer (in Indiana) gave us access to Teledoc. In March of this year, my husband and I went to New Orleans. We picked up a nasty virus, but thought it might have been food poisoning. The Teledoc service kept us home, reducing the spread of the virus which just had to run its course.
I pay $8 per call.
I work for a Nurse Advice Line, which primarily offers 24/7 support to the beneficiaries of the insurance we work with. We have stories about the good we do, be it saving a caller from sitting in traffic to go to a clinic when there is one nearby, providing self-care instructions when the person thinks they HAVE to see an Urgent Care, or even recommending Emergency services that catch a life-threatening illness that can be treated easily.
Medeo in BC, Canada may be something to refer to. Apparently was the first clinic of its kind in the world.
Super convenient if you don't need to be examined. They seem to be much more punctual than regular doctors visits as I've never had a session start late.
I'm a board certified family doctor. I own a federally designated rural health clinic in California. The closest medium sized city is a 3 1/2 hour drive on windy mountain roads. Many of my patients drive 2 hours each way to see me. (They don't live in the direction of that medium sized city.)
As a rural health clinic I can only bill for one-on-one, face-to-face visits at my clinic. I don't get paid for the house calls, telephone, or electronic visits that I do. Regulations say I have to bill everybody the same. Since I'm not allowed to bill MediCare or Medi-Cal (Medic-Aid) except as above I also can't bill patients who have insurance for such services. I would do more asynchronous care if I could get paid to do. As it is business is pretty tenuous.
I can bill for a telemedicine consult if I am with the patient and we are in my office communicating with the consultant.
+Daniel Weiss ancient regulations, the same ones that prohibit us from billing for preventive services
Wait so if you prescribe a statin for someone at risk of heart disease you can't bill for that?
Or for sexual health advice?
+Becca .Boot if I do so at a one-on-one, face-to-face visit I get paid for those things.
Look, you probably know more about this than I do, but "Regulations say I have to bill everybody the same" does not ring true to me. RHCs are not required to have a sliding fee schedule, but you can have one.
"I also can't bill patients who have insurance for such services." Is this on tele-consults? The insurers may be tagging along on Medicare regs on that but aren't required to.
Preventive services are covered, not sure what you meant in the comment below.
I teleconference with my psychiatrist every 3 months. I receive better care from him than I did from any in person dr. I only go into the office for blood draws which require no appointment and I rarely I have to wait for. I wish this service was more broadly available. Also my son's developmental psychologist sent his diagnosis report to myself and his school via email. What would have taken several days via mail or close to an hour via fax took mere seconds. I don't know what I would do without telemedicine.
A big draw back in the USA is state lines - a doctor has a problem treating over state boarders as he might not have a license where the caller is
Telemedicine is something that I can see happening tremendously in the near future. This is something that can help out the patients if there's an emergency or they are out of town. Yes, you can visit another doctor if you are on a trip out of town, but who wants to do that? You want the same doctor that knows about your past and your primary doctor that you have spent all those years building a relationship with. The Greatest Happiness Principle created by Mill's states that actions are right in proportion as they tend to promote happiness and wrong as they tend to produce the reverse of happiness. Creating Telemedicine is a good reassurance for the patients to feel that their doctor is always there.
What about the cost efficency of home doctor/nurse practitioner visits for elderly or those that are too infirmed to get to the doctors' offices but not infirmed enough to warrant an ambulance?
A grad student peer of mine is doing a study on this topic for her thesis!
$$$$$!!!! For a great telemedicine/telehealth service called “MediCall” to have 24/7/365 remote access to a U.S. board-certified doctor for up to 5 family members for just $29.99/month with UNlimited online “visits” and NO co-pay/co-insurance and have the following BENEFITS:
* healthcare needs met without going into doctor’s office
* good for chronic illnesses
* refill prescriptions
* reduce burden on healthcare system,
watch a short video at: greensunshinepower.justviv.com/medicall/ . To share/text, use: GetMediCall.com or tinyurl.com/MediCallVid .
To earn extra $, too, just by SHARING this potentially health and life-saving service, watch a video at: greensunshinepower.justviv.com/opportunity/ and contact Viv Consultant, Danny Tseng, by CALLING 786.441.2727 (canNOT get texts) or e-mailing: greensunshinepowercompany@gmail.com
#GetMediCall.com
I'm a bit confused that this isn't standard.
in the uk if you can't get to your general practitioner, you can get an on the day phone appointment. it's standard to email your consultants to check new med doses and such. Or just to write a letter if it's something small, that doesn't need looking at. Skype calls are rare, but do happen.
it's so odd to think that insurers would block such vital treatment, that reduces everyones' waiting times.
Telemedicine has proven to be a very useful tool in healthcare. Dr. Carroll does a great job highlighting the risks and benefits of telehealth for the patients and physicians. Something I think is important to consider is this, does telehealth have the capability of meeting the ethical standards physicians hold themselves to? Physicians, perhaps more than any other profession, are held to a rigorous ethical code of beneficence, non-maleficence, and autonomy. Telehealth upholds these standards in some aspects but falls short in others. For example, telehealth drastically increases access to healthcare. I have a friend who started doing telehealth several years ago and he enjoys it because he is able to better keep up with his patients who live in rural areas. He also feels like he gets to spend more time with his patients as he does not have to deal so much with a waiting room or other factors that stress his schedule. This supports the aspect of autonomy. Physicians are supposed to help educate their patients so they can best make their own healthcare decisions. However, lets say the patient you are seeing via telehealth needs labs or imaging. They now have the added cost of telehealth and an in person visit. That can become a burden for patients and can unnecessarily over load the system. This can compromise the principle of beneficence simply because the physician isn’t physically able to do what the patient needs at that time. The question then becomes what can we do to make sure we are able to appropriately provide care in a telehealth setting? This is obviously a big question and will not be solved overnight, but as telehealth develops I think it is important to implement state and perhaps nationwide policies that ensure an ethical practice of medicine. Abiding by ethical principles ensures positive healthcare outcomes and deepens the relationship between provider and patient. This, in turn, will allow for positive change in our healthcare system as a whole.
What time does Healthcare Triage Live come on.
When will be next health care triage live?
If you're ever looking at telemedicine in the UK, I've seen it called telecare or telehealth. Heard super-positive things from the GPs that implemented it.
Psych medicine would benefit from this in many cases. How many people with severe anxiety or agorophobia, for example, never get help because they are housebound?
In the UK we have a service to address just this, Improving Access to Psychological Therapies or IAPT. It's a really good service where practitioners teach CBT techniques to people suffering anxiety, depression, OCD and specific phobia. Not sure about other countries though x
Sounds like a good program
+
There are a few apps and websites that offer eCounseling. I use BetterHelp, and it matched me with a therapist who has helped me a lot.
Not only psych medicine, but also internal medicine, and many other subspecialties.
There is a Telemedicine available in Ontario (Telehealth Ontario) EVERY time I have called them they have told me to go to my dr's or the emergency at a hospital. I have tried it multiple times and even when I am calling them about something minor, they send me to the dr's.
Is this the same as Teledoc? Because I've now used Teledoc twice with huge success for the common cold and cold sores.
I just used one of these services.
I used Maven for a birth control renewal. This took only 10 minutes. I'm tired of sitting for 2 hours waiting to be called to the exam room for a pap smear so I can renew by prescription.
Good to know
only three post?! (now four, I guess)
as someone who is Hard of Hearing being able to email at LEAST the receptionist is a life saver
$$$$$!!!! For a great telemedicine/telehealth service called “MediCall” to have 24/7/365 remote access to a U.S. board-certified doctor for up to 5 family members for just $29.99/month with UNlimited online “visits” and NO co-pay/co-insurance and have the following BENEFITS:
* healthcare needs met without going into doctor’s office
* good for chronic illnesses
* refill prescriptions
* reduce burden on healthcare system,
watch a short video at: greensunshinepower.justviv.com/medicall/ . To share/text, use: GetMediCall.com or tinyurl.com/MediCallVid .
To earn extra $, too, just by SHARING this potentially health and life-saving service, watch a video at: greensunshinepower.justviv.com/opportunity/ and contact Viv Consultant, Danny Tseng, by CALLING 786.441.2727 (canNOT get texts) or e-mailing: greensunshinepowercompany@gmail.com
#GetMediCall.com
I've always understood Telestroke to be something different
well, the providing medicine over the phone thing seems wrong to me. In other words I can understand why that would be fined. Are doctors just gonna take someones word for it that they need drugs? I don't think thats a direction you would ever wanna go in.
when all visits will be replaced by tele and video visits? covid could not even change that unnecessary in person visits
No not all ways hipa prohibs certain disclosers over phone web cam
In this country it's only Cancer Care that uses Telemedicine to the and user yet. It's been overwhelmingly (but not absolutely) positive. Likely will be rolled out to more issues.
1. Is telemedicine worse than traditional medicine? And Why?
what do you think would be the biggest driver for telemedicine adoption?
If telemedicine became popular, is there a risk of actually visiting a doctor to become somewhat "taboo" over the span of a generation. People always complain about having to take time away from their day to go to the DMV or other places, I don't think it would be healthy for society and for patients if that became the view for visits to the doctor. Isn't there already a problem of people not wanting to go to the doctor and diseases not being caught when they're early an treatable.
Maybe a term or conditions to be put in the thing everyone signs without reading should be that if the doctor says you need to have an in person visit, you are then legally obligated to do so. Who knows, not me. That's why I'm asking doctors.
FaceTime and Skype is not Hipaa compliant.
So your health care system is fractured and inconsistent. That has to suck.
technology to the rescue
It's all about the compensation. If it's not there than telemedicine goes nowhere.
There are a lot of laws the prohibit doctors from charging for anything unless it involves a face to face examination.
+PolyJohn Oh?
Yeah....but don't worry...in 15 years....an A.I. (Art. Intelligence) will answer any and all queries about anything in medicine, mechanics, or anything else that has a database now....
It's all coming...like it or not.
2 likes, 1 dislike.. that's fast.
The disliker is losing though :)
+AmberFairydust +
+ameli950514 yes?
This is why I never see doctors. Inconvenient hours. That and it's expensive.
first