Sunday, August 22, 2010

Teletriage and Other Telemedicine Innovations

In yesterday’s blog, I discussed prospects of innovations cutting costs and improving care at the same time. I was not optimistic. In response to that blog, I received this comment,

"Actually, you should include teletriage on your list. This method, when used in emergency services may reduce costs in the millions. This technique involves proper triage of patients at the outset using clinical reference decision support software and intelligently directs patients to the proper level of care. It is the key to efficient use of healthcare resources. For reference materials on this see"

Roger Heath

To which I responded,

"Thank you Rodger,for bringing attention to my omission. I agree telemedicine can be a powerful innovation, particularly in monitoring home-bound patients, evaluating patients from afar,and directing them to the proper level of care."

Ricahrd L. Reece, MD

This exchange reminded me of an interview I conducted with Ron Pion, MD, an expert in telemedicine

The Internet Will Lift All Clinical Boats - An interview with Ronald J. Pion, MD
Publish date: Apr 27, 2010

Ronald J. Pion, MD, has enjoyed successful careers as a physician, clinical educator, and entrepreneur. He is a leading authority on telecommunications in the health care industry. Dr Pion believes the Internet, and its telecommunications applications, will vastly improve patient care and clinical outcomes, virtually link physicians with each other, and vitally bond physicians more closely with patients. Dr Pion discusses the use of the Internet and telecommunications to help doctors in solo or small group practice in this interview with ModernMedicine’s Richard Reece, MD.

Give us a little of your background out there in Los Angeles, where you hang out as a clinical professor of Ob-Gyn at UCLA.

My current title that I fancy is digital medical entrepreneur. I do business in medical telecommunications. It’s a DBA.\


Doing Business As, as we say in the business world. I am a self-employed individual of 78 years young.

You have a remarkable career, combining media activities in radio and television and the Internet, as well as being an academician, serving as professor, writing multiple research papers, and consulting and leading various medical business enterprises. The breadth and depth of it all amazes me, and I am not easily amazed.
No question about it, I am a hyperactive adult. I enjoy success, and I never recognize the word “failure.” Success is just a question of time.

How can doctors become more efficient and effective through the use of new telecommunications media?

Doctors have to begin to talk in terms of computers, smart phones, and iPods just as easily as they talk of stethoscopes, otoscopes, and proctoscopes. We must talk of telecommunication tools currently available to physicians in any specialty and to any primary care doctor, now becoming known as realtors who own medical homes.

These doctors have to begin to acknowledge nurses, physician assistants, and other health professionals as part of a team anxious to win the game for the patient. The patient should be our focus. That patient wants to get better. Over the years, medical practice has strayed from the goal of the patient. Our main aim ought to be to help patients reach the goal of getting well—and staying well.

As doctors, we have to realize we see patients episodically. Now we must begin to keep tabs on that patient every single day. Automated telecommunications will help us do that. When the patient understands that the doctor cares, he or she will supply that information—gladly, willingly, and constantly.

How does the doctor get into automated telecommunications game?

The doctor does that by outsourcing a lot of his time to competent professionals just like him. These competent professionals create Google, Microsoft, software, and hardware. As Larry Weed, MD, pointed out 50 years ago, you can’t practice medicine without a computer. Today we have much more than a computer. We have knowledge and wisdom accumulated from data and information.

When I spoke to the doctor who started, I discovered that more than 80% of the doctors to whom he had spoken had no online presence.

That’s why it’s up to you and me and others to accelerate the adoption of telecommunications. That’s why we have to get sponsors from the digital world to help us do what needs to be done.

So how do small practices get into the Internet and telecommunications?

They must learn what they have to do and how to make a good living at it. After all they have learned in medical school, residency, and practice, we have to convince them they have to keep on learning and using all the tools available.

You need data to gather information, you need information to gather knowledge, and you need knowledge to gather expertise.

Computers help us keep up with what’s going on in the world. We must advantage ourselves by trying to capture the world’s knowledge.

When you and I went to medical school, we went to the biomedical library to read information that was 18 months old. That meant we were two years behind in the knowledge we were seeking.

So now you need be online, real-time, all the time, 24/7?

Yes, sir, when you’re involved in solving a patient’s problem. The point is that all the ships in the harbor can be raised by sharing each other’s expertise rather than relying on what you learned in medical school or residency on fellowship. We now must be involved in The Now. It’s impossible to keep up without computerized up-to-date knowledge.

So your point is the Internet and telecommunications can lift all boats? And you believe we are in the process of doing so?

Yes, all boats will be lifted. There is no doubt in my mind.

I call your attention to a recent article titled, “What do Dell, eClinicalWorks and WalMart Have in Common?” All are leaders on price and value. Price and value are terribly important in medical practice.

We doctors were never taught about being in business, but that is what we are in. Dell, eClinicalWorks, and WalMart’s shared interest has led them to collaborate on a new product. It will bundle eClinicalWork’s unified application and practice management system with Dell’s hardware into an electronic medical records system, which will be available to WalMart’s Sam’s Club members. Sam’s Club claims to have 200,000 practices among its members, almost 65% of the market for ambulatory care EMRs, and involving 308,000 doctors.

I remember meeting John McChesney, who was head of a company putting computers in hospitals. He came up with a nifty solution to help attending medical staff. He put computers next to radiology, imaging centers, and labs in the hospital. When the doctor went to his office the next day, McChesney’s computers delivered answers from the hospital into his hands. McChesney’s computers sucked up data and delivered it to the physicians’ offices. His office staff didn’t have to waste time calling the hospital for results.

McChesney’s genius was that he noted that most physicians had computers in the back room to meet financial needs, but they didn’t have computers in the clinical part of the doctors’ offices. All they had out there was paper, and you can’t suck up information from paper. So McChesney set up a computer in the clinical section of the office, and trained doctors and nurses to use it efficiently. He created the business model to help doctors pay for that computer among companies who were putting other machines in doctor’s office.

How do these artful applications of computers help doctors in the short term as they scramble to survive and even thrive?

In the short term, it’s difficult. No doctor likes to change his routine if he’s going to lose time and money. That’s a major problem, and if he doesn’t see that day-by-day opportunities to keep renovating the kitchen and the house, he is going to hate clinically oriented computers. Many doctors hate clinical computers now, because they cost money to use. They have heard all these nasty stories about failed promises made by computer companies over the years. They don’t understand, but the youngsters—coming out of medical schools with their PCs, Blackberries, smart phones, and other wireless gadgets— do.

Is there any hope for us old dogs?

Yes, because you can teach old doctors and old patients new tricks. All you have to do is make it valuable to them. They will learn what needs to be done and will buy what it takes to do it, especially those with discretionary income. Leave the people alone who can’t afford a computer, and let’s focus on success. Let’s focus on those successful practitioners who have done what others are afraid to do.


Richard L. Reece, MD said...

I do not read Chinese. I would appreciate it if you would translate your comments into English, so I can intelligently respond.

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