Telemedicine advances with issues still to be resolved

Telemedicine offers a way to control costs by shifting care away from $10,000 per day intensive-care units to homes equipped with $1 per day mobile devices and apps—a point made by Bill Betten, vice president of business solutions at Logic PD at the recent BIOMEDevice conference in Boston. Perhaps the simplest mobile-device approach to telemedicine is the use of a mobile phone to communicate with a doctor the patient never meets. But in an article yesterday in the Wall Street Journal Melinda Beck questioned the effectiveness of such an approach. She wrote, “Can downloading an app, and describing your symptoms to a doctor you'll never meet, take the place of an office visit? Can sending a 'selfie' of your sore throat help diagnose strep?”

Betten expressed enthusiasm for such approaches at BIOMEDevice (without endorsing the selfies). Evolving technologies, he said, will lead to better efficiencies, lower costs, and improved patient results. Yet Beck in the Wall Street Journal pointed out that state and federal regulators and the medical profession are wrestling with related issues as telemedicine spreads.

RAND Corp. has conducted an initial assessment of national telemedicine services and has found that, in particular, young affluent people without established healthcare relationships are likely to use a telemedicine service that lets them get medical advice and prescriptions by phone.

“Telemedicine services such as the one we studied that directly links physicians and patients via telephone or Internet have the potential to expand access to care and lower costs,” said Lori Uscher-Pines, lead author of the study and a policy researcher at RAND, as reported at insurancenewsnet.com. She and coauthor Dr. Ateev Mehrotra studied 3,701 patient “visits” provided from April 2012 to February 2013 through telemedicine service provider Teladoc. The researchers caution that more research is necessary to assess the quality and safety of such services.

According to Beck in the Wall Street Journal, telemedicine services like Teladoc say they offer a low-cost alternative to emergency-room care and let patients avoid long waits for in-person appointments to deal with minor issues.

She quoted John Sculley, former Apple CEO and vice chairman of MDLIVE, as saying, “Politicians and lobbyists can't solve health care. It's quite simple: Empower consumers with patient-in-control solutions.”

On the other hand, Beck noted, critics express concern that remote doctors may prescribe antibiotics over the phone for conditions that require lab tests for a definitive diagnosis.

Of course, patients needn't be restricted to a choice between in-patient treatment and treatment by phone. As Beck wrote, “The term 'telemedicine' embraces everything from stateside dermatologists scrutinizing images of soldiers' skin lesions from Afghanistan to wearable sensors monitoring elderly patients' vital signs at home.” It includes videoconferencing among local physicians and specialists at medical centers, and it can augment access to physicians in rural areas.

Nevertheless, there are many regulatory as well as technological issues to address. Beck noted than currently a doctor providing treatment must be licensed in the state where the patient is physically located. That, she quoted Jonathan Linkous, CEO of the American Telemedicine Association, as saying, “doesn't make sense in the 21st century.”