Saturday, May 21, 2016

Telemedicine – Why So Slow to Take Off?
Telemedicine is the use of telecommunication and information technologies to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities.
American Telemedicine Association
Twenty years or so ago, my wife and I travelled to China with a Mayo Clinic Group.  While there I met an American business man, who remarked to me. “The next time I hear the word ‘potential’, I’ll kill myself.” He was referring, of course, to the one  billion potential Chinese buyers of American goods.
Members of the American Telemedicine Association, founded in 1993, at the dawn of the Internet and the Information Age, must feel the same.  Telemedicine or medicine at a distance, has been touted for more than 20 years as the Holy Grail for American health consumers, particularly those in rural regions, or those unable to travel to see a doctor. 

Telemedicine transcends place.   You don’t need to be near them  to see doctors.    Your doctor can communicate with by Skype, or some other form of visual or electronic means.
Telemedicine is full of enthusiasts -  and telemedicine-leaning websites, 3000 by some estimates.

Predictions for Telemedicine in 1999, the Dawn of the Information Age
 In 1999, James Dale Davidson, a venture capitalist, and Lord William Rees-Mogg, director of a private bank in London, wrote,
“One day soon, if you have a stomachache, you will be able to consult a digital doctor, an expert system with encyclopedia knowledge of symptoms, maladies, and antidotes.  It will access your medical history in encrypted form: ask whether  you pains happen after eating or before meals.  Whether it is sharp or dull, persistant or episodic.  Whatever questions doctors ask,the digital doctor will ask, It may determine that you drink too much wine, or not enough .  You may be referred to a cyberspecialist. If you need operation , a cybersurgeon in Bermuda, may do an operation long-distance with the aid of specialized equipment tha performs micro-incisions.(The Sovereign Individual; Mastering the Transition to the Information Age, Simon and Schuster).

Telemedicine in 2014
In 2014,  Jeff Boss . a former Navy SEAL, waxed ecstatic  about the potential  of  telemedicine. In an August  22 Forbes article (“The New Face of HealthCare Innovation: 7 Ways Telemedicine  Changes the Healthcare Landscape and for the Better.”), he cited 7 advantages of telemedicine for health consumers and doctors.
1. Stronger relationships. It offers the luxuries of personalization and convenience without exposing yourself or your child to the 15 other sickly patients normally waiting in your doctor’s office.
2. Convenience.  Rather than having to trek into the doctor’s office for a consult, you can now do so from the comfort of your own smartphone for follow up visits, after hours calls, or while traveling. Additionally, parents gain a stronger piece of mind because they can immediately reach their doctor for relatively benign symptoms such as a cough or runny nose.
3. Reduced complexity. Complexity is defined by the speed at which industries change and the interdependence of relationships therein. Telemedicine reduces both.
4. Greater awareness. For physicians, pop-up windows alert the provider of possible medication side effects for greater drug reconciliation.
5. Shared purpose.  It  makes life easier for parents, caregivers and families in an increasingly complex healthcare envirironoment
6. Improved efficiency. Telemedicine eliminates phone consults and the addiction to answering emails.
7. Enhanced flexibility for physician.The changing landscape of healthcare offered through smartphone apps allows doctors to build stronger relationships with their patients rather than be just another MD—critical to the “patient” component of “patient care.”

Little Telemedicine Market Penetration
In spite of the enthusiasm and hoopla over telemedicine’s potential,  telemedicine has not significantly penetrated health care.   In 2013,  only 1% of Medicare’s 55 million beneficiaries  participated in telemedicine visits,  and just  1.3% of  233,000 California Public Employees Retirement System members chose virtual telemedicine visits over traditional office visits.  In a widely touted and well-funded effort by HealthSpot, in collaboration with Rite Aid drugstore, to market telemedicine kiosks ended in bankruptcy in 2016

Why So Slow?
Why has telemedicine been so slow to be adapted by health consumers and physicians?
Here are a few  reasons why.
1)      Physician office visits do not lend themselves to  virtual visits.  It's human nature.   People like to talk to people , not computers, or algorithms posing at people,  or people at a distance.  Telemedicine visits, are, after all, virtual – i.e. not the real thing -  compared to a face-to-face physical encounter with a physician.

2)     Reimbursement for telemedicine varies from state to state,  and has crazy variations and obstacles which are not easy to surmount.

3)     Due to doctor shortages,  most physicians are already too busy with patients to bother with a new form of reimbursement which takes time away from regular patients. 

4)      There is no evidence that virtual visits significantly  improve outcomes or improvements in care.


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