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4/2/2012
04:41 PM
Paul Cerrato
Paul Cerrato
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Telemedicine Dilemma: Savings Or Healing Hands More Important?

Telemedicine has two sides, cutting costs and giving some patients access to previously unreachable expertise, but depriving others of the hands-on human contact they need.

Telemedicine Tools That Are Transforming Healthcare
Telemedicine Tools That Are Transforming Healthcare
(click image for larger view and for slideshow)
There is no Mother Teresa or Darth Vader in technology, which is another way of saying technological innovations are never completely benevolent or malevolent. It's always a combination of the two, and telemedicine is no exception.

According to BCC Research, the worldwide telemedicine market reached $9.8 billion in 2010 and will almost triple to $27.3 billion in 2016. It's clear from these stats that several nations are using the technology to close the gap in healthcare while lowering the cost of treating patients.

In the United States, the Patient Protection and Affordable Care Act, the healthcare law currently being challenged in the Supreme Court, has pushed many healthcare stakeholders to take a keen interest in telemedicine as a way to treat an increasing number of people who'll be seeking health insurance and medical services if the healthcare law remains intact. In fact, the Centers for Medicare and Medicaid Services' Center for Medicare and Medicaid Innovation has been tasked with finding inventive ways to get telemedicine services in use around the nation.

[ Practice management software keeps the medical office running smoothly. For a closer look at KLAS' top-ranked systems, see 10 Top Medical Practice Management Software Systems. ]

But that's only one of many initiatives underway. The Joslin Diabetes Center, an affiliate of Harvard Medical School, recently announced that it would begin offering telehealth services nationwide in conjunction with American Well, a well-known telehealth services vendor. Joslin's world-renowned expertise in managing diabetes will no doubt benefit countless patients who don't have easy access to endocrinologists.

Dr. Ido Schoenberg, chairman and CEO of American Well, said the collaboration is a taste of the "medicine of the future," where care doesn't necessarily revolve around a hospital. "It's moving away from location-centric to person-centric," Schoenberg told InformationWeek Healthcare. "There are limitations to what you can do online, but you can do quite a lot online."

Last year, American Well teamed with the U.S. Department of Veteran Affairs to provide online behavioral health services to patients in Minnesota and remote oncology consultations to patients in Nebraska. The company has numerous other partnerships with providers and payers, including one with health insurance giant WellPoint, which will make online care services available to members of its affiliated health plans by adopting American Well's Online Care platform.

There's little doubt that partnerships like these are reducing healthcare expenditures. In a separate project, a single veterans hospital in rural Oregon has saved more than $88,000 in travel expenses during fiscal year 2011 by shifting 3,224 patient encounters from in-person visits to telehealth services, according to Tracy Weistreich, associate director for patient care services at the VA Roseburg Healthcare System. The U.S. Department of Veterans Affairs' Northwest Health Network, which includes Roseburg Healthcare, was able to trim upwards of $742,000 from its budget during the same period by facilitating 23,580 remote consultations.

But those advantages must be weighed against the potential harm that may result from patients not having in-person contact with their physicians. Of course, in situations where patients are far away from a clinic or doctor's office, that's never going to happen anyway. And in most scenarios, patients have already been in the doctor's office for an initial physical exam and lab work, so the telemedicine "visit" is often a follow-up consult that only requires video and audio links for the exchange.

But what's required and what's optimal are two different things. There's a good deal of research to show that a clinician's physical presence in the room, along with a simple pat on the back, has therapeutic value. I worry that as physicians cope with the financial and time restraints in the emerging pay-for-performance world, that they'll overenthusiastically embrace telemedicine services and deprive patients of the essential hands-on component of care.

Even a brief look at the research supporting the value of "high-touch" medicine suggests its importance. Dacher Keltner, a professor of psychology at the University of California Berkley, recently summed up some of the data in a lecture on YouTube.

Experiments suggest that non-sexual touch encourages cooperation, makes the person being touch feel safer, and calms cardiovascular stress, Keltner said. Some hospital studies have even found touching premature babies can boost weight by 47%, according to Keltner.

Similarly touching patients with Alzheimer's disease has been shown to cause a precipitous drop in depressive symptoms. And investigators at UC Berkley say that physicians who make eye contact and simply pat patients on the back are starting to see better survival rates for complex diseases.

In the final analysis, the value of telemedicine will depend on whether the advantages of reaching out-of-the-way patients with expert advice outweigh the disadvantages of losing an important ingredient of the doctor-patient relationship, namely hands-on care. Time will tell.

The 2012 InformationWeek Healthcare IT Priorities Survey finds that grabbing federal incentive dollars and meeting pay-for-performance mandates are the top issues facing IT execs. Find out more in the new, all-digital Time To Deliver issue of InformationWeek Healthcare. (Free registration required.)

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rdowney852
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rdowney852,
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4/3/2012 | 4:59:28 PM
re: Telemedicine Dilemma: Savings Or Healing Hands More Important?
As far clinician's presence being therapeutic, it really depends on the clinician. If you read the book "Blink" by Malcolm Gladwell, one of the interesting first impressions we make very quickly is about our doctors. A study showed that people can determine within seconds if the physician has a caring nature. The study supported the theory that some physicians who have a bad bedside manner during an in-person visit are sued more often when they make mistakes than doctors with a good bedside manner. I believe the same will hold true for telemedicine. Physicians should not do telemedicine until they understand how to use the equipment effectively and how they need to adapt their bedside manner to see remote patients. One other factor worth mentioning is that the lower level provider at the patient's end of the telemedicine visit needs this same kind of technological and social training. Too often medical, nursing and PA schools depend on the innate "caring nature" of people wanting to practice medicine to take over when they actually start seeing patients. Let's face it. Some physicians would be better radiologists who don't have direct contact with patients.
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