Use of tablets and smartphones for secure communications could produce a major change in the way doctors and patients communicate--if reimbursement policies change.
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The FaceTime video chat feature of Apple's iPhone 4 and iPad 2 has the potential to be a game changer for doctor-patient communications, health IT experts tell InformationWeek Healthcare, but only if it's secure enough to satisfy federal privacy regulations.
InformationWeek asked Apple about reports that FaceTime can be configured so that it meets the requirements of Health Insurance Portability and Accountability Act (HIPAA). In response, Apple said that only HIPAA-covered entities, not software applications, can be HIPAA-compliant. But the company also stated, "Our [iPad 2 and iPhone 4] products can be used by HIPAA-compliant organizations."
For FaceTime communications to be highly secure, Apple told a contributor to ZDnet, an iPad2 user would have to configure the device's security settings so that it uses WPA2 Enterprise to access an enterprise wireless network. WPA2 Enterprise has 128-bit AES encryption. Moreover, each video chat is encrypted with unique session keys, and each participant receives a unique ID number, Apple said.
If FaceTime does meet HIPAA criteria, many physicians would be technologically capable of using it to communicate with patients. According to a recent Manhattan Research survey, 75% of physicians already use iPhones and iPads, and many of them can be expected to upgrade to the latest versions. Moreover, these gadgets are very popular with consumers.
"Apple has a pretty good market share, so that reduces the number of applications a doctor would have to support to do this on any scale," noted Steven Waldren, MD, director of the Center for Health Information Technology of the American Association of Family Physicians.
Doctors already address some health problems over the telephone, Waldren pointed out. "The ability to add a high-quality video feed will make that better," he said.
The lack of reimbursement for any kind of non-visit care will be an obstacle to video chat, just as it is to secure email messaging. But Waldren notes, "There's some momentum toward giving providers more flexibility to take care of patients the way they need to be taken care of. As that continues to move forward, apps like FaceTime and other video conferencing solutions will gain more favor."
William Jackson, MD, director of the Telemedicine Institute of Inova Health System, based in Fairfax, Va., agrees that reimbursement changes would encourage physicians to use FaceTime and new telehealth applications that build on it.
"The issue is this: If we're going to pay for the technology and take the time to provide this kind of care, how are we going to be reimbursed?" he said. But once physicians get over that hurdle, he stated, "I think there's going to be a paradigm shift. If you have a technology that's easy to use and lowers the cost considerably, gives you the ability to look at the patient directly, and provides other ancillary technologies around it, I think providers will be more comfortable with it."
He cited the way that neurologists decide how to treat stroke patients who are not physically present in the room with them. Today, they use data gathered by other clinicians along with a CT scan to decide whether to prescribe a clot-busting drug to the patient. If a neurologist could view the patient on FaceTime while a nurse was walking that person through the steps required by the standardized stroke scale, it would give the specialist more confidence in his or her decision, Jackson said.
Eventually, he added, the technology will get to the point where doctors may be able to do a remote abdominal exam or determine whether a patient has pneumonia without examining them in person. It's also possible, he said, that FaceTime may be combined with mobile apps that can monitor a patient's vital signs.
Jackson has already had first-hand experience with FaceTime. Not long ago, he said, he was working the night shift in Inova's e-ICU when his wife called to tell him that their son, who was on an antibiotic for hives, had erupted in rashes all over his body. Both Jackson and his wife had just gotten iPhone 4s, so she was able to send him a FaceTime video of his son at 3 a.m. Based on what he saw, Jackson was able to tell her that their son could wait until morning to go the ER for his antibiotic reaction.
The resolution of the FaceTime video wasn't super, said Jackson, but he's sure it will get better. "As the performance [of FaceTime] improves, I think the provider comfort will improve, and so will the organizational comfort, once we have the fidelity and the security around it."
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