Saturday, July 16, 2016

Teletruth  and Telehealth
The preface “Tele-” is from the Greek.  “Tele” means “distance,” especially “transmission over a distance,” as in telegraph, television, or telecommunications.
To teletruth,  I have reservations about “telehealth,” a term the describes   providing  health care remotely with telecommunication tools, including telephones, smartphones, and mobile wireless devices, with or without video connections.
My reservations hinge on the words “remote,” “distance,” and “virtual” as replacements for the “real thing” – meaning one human connecting to another face-to face. Perhaps “augmented reality,” will win out over personal connections, as in PokeMan Go,  where when you go near a hospital  or doctor’s office with your mobile phone,  you can hunt and capture tiny monster diseases.
Off My Rocker
You may think I am off my rocker.     After all,  anything related to the computer and medicine and apps, will supposedly expand health care access,  promote convenience, create efficiency,  assure objectivity,  and more the patient-physician relationship more productive.
Telehealth  Beleivers
Telehealth believes telehealth smartphones will allow to teach into peoples’ home; reduce costs for 140 million Americans with chronic disease; allow monitoring people wearing devices and diagnostic systems at a distance; and create low-cost virtual visits (less than $50 a visit taking minutes) rather than visiting a physician, which takes an average of 20 days to get a 20 minute appointment  that with travel and wait time consumes 2 hours to time.
And integrated health organizations like the VA, Kaiser Permanente, and the Mayo Clinic,  are already into telehealth big time.  These organizations foresee that telehealth visits will soon exceed doctor visits.   by 2020, the Mayo Clinic  plans to serve 200 million patients, many outside the U.S.  In any case, within 5 years,  90% of the world’s population will have smartphones, so why resist the inevitable.
Telehealth Problems
So why did I still harbor reservations?  What’s the problem? It’s not one problem, it’s many problems.
In the first place,  clinicians have managed to curb their enthusiasm  over telehealth.
It may replace them.  It’s reimbursements are spotty and low;  it is not as reliable or of the same quality as a person-to-person exam; it does not include a physician examination; it lacks the ability to read, feel, palpate a lesion;  it cannot read body language or patient reliability;  it cannot access mental disease;  it requires a trained assistant to set the telehealth encounter; and so far 93% of telehealth visits are done without the assistance of a video conference.  For most clinicians, seeing is believing  and cannot replace being there with a patient.
Other Telehealth Limitations
Other limitations exist as well – fragmented insurance coverage,   potential overuse,  poor quality of physician-patient relationships,   fragmentation of care among multiple providers  whose EHRs don’t communicate with each others; concerns about malpractice liabilities; and social  obstacles (only 58% if people over 65 use the Internet), and the omnipresent digital divide abetween metropolitan and rural areas, the rich and the poor;  the educated and noneducated,  variable broad band geographic access.
Persistent Optimism
Even in the fact of these obstacles,  the authors of “The State of  Telehealth” in July 14 New England Journal of Medicine, are optimisitic that we are near the tipping point of Telehealth,  that point at which there are more routine users than early adopters.     Venture capital funding has nearly quadrupled from $1.1 billion in 2011 to $4.3 billion in 2015;  smartphones can now monitor a person’s health(as least their vital signs), facilate diagnosis, and connect patients with doctors anyplace anytime;  academic medical centers can expand their reach across the health care spectrum; and “increasingly, with the narrowing of the digital divide and the ubiquity of smartphones,  telemedicine can enable more people to receive care.”
For  all of this to happen  may lead to less personalized care.  And it may require physicians to work harder to maintain relationships with patients; to change their concept of what being a doctor is all about, and to demand more training  in the use and abuse of telehealth whizbangs,  portable diagnostic technologies, and online algorithm.


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