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Delivering Healthcare at a distance.
Practicing medicine at a distance. TeleMedicine is a broad term for many uses. LoginClinics uses both TeleMedicine types in our practice. With our Concierge Program asynchronous communication is utilized. The provider and the patient text, send pictures and email messages through the patient portal on a constant as-needed basis for care and monitoring. LoginClinic’s on-demand medical care uses direct video chatting to provide live, interactive care.
Telehealth, as defined by the Department of Health and Human Services (HHS), is, “The use of electronic information and telecommunications technologies to support remote clinical health care, patient and professional health-related education, public health and health administration.” The use of information technology in conjunction with health professionals allows a variety of health services to be provided across an array of settings and across any distance.
Telehealth can help patients adhere to plan of cares and reach and interact with patients more often thereby improving outcomes and decreasing cost. In addition, TeleMedicine allows for family members and caretakers to be an active participate in care. It allows ease of monitoring, patient education, pro-active care instead of re-active care, health reminders, Health CheckLists by age and medical History ultimately empowering the patient to take control and be an active participant in their care.
The Federal Government has funded 13 TeleMedicine Resource Centers (TRC) across the country. North Carolina’s TRC is the Mid-Atlantic TeleHealth Resource Center. See their website for a list of common TeleHealth applications.
https://www.telehealthresourcecenter.org/big-changes-in-2019-for-medicare-telehealth-policy/
In addition, The Centers for Medicare and Medicaid (CMS) are now funding certain TeleMedicine and TeleHealth Practices. Passed in November of 2018, the goal is “to modernize the healthcare system and help ‘restore the doctor-patient relationship’ by reducing administrative burden”. CMS made billing codes specific to TeleMedicine and TeleHealth so providers can bill for certain remote medical services.
https://www.congress.gov/bill/116th-congress/house-bill/3417/text
In late June the Beneficiary Education, Tools, Telehealth, and Extender Reauthorization (BETTER) Act of 2019 (HR 3417) was introduced by US Reps. Richard Neal (D-MA) and Kevin Brady (R-TX). Concerning TeleHealth, it would expand reimbursement for certain types of telehealth delivered services in Medicare.
https://mhealthintelligence.com/news/ata-announces-first-online-patient-consultation-accreditation
Quality of care, in fact, was the chief concern noted by survey respondents. Others making the list included the fear that a virtual care visit would fail to solve the problem and still lead to an in-person visit, privacy and security, lacking the “human touch” and cost concerns.
https://mhealthintelligence.com/news/senate-eyes-funding-support-for-project-echo-telehealth-programs?eid=CXTEL000000472807&elqCampaignId=9920&elqTrackId=985f29e777cd4e75973e289551cc55ad&elq=77a8f5294226423f8bd8ef0dcf8d0bea&elqaid=10406&elqat=1&elqCampaignId=9920
The 2016 ECHO Act called on the Health and Human Services Department to study the model and deliver a report to Congress. That report, presented in February 2019, “found that the available evidence on such models is modest but consistently shows positive effects, and recommended expanding the evidence base, including by directly funding evaluation and technical assistance,” according to Schatz and his colleagues. Ther 2019 ECHO bills asks Congress to give more congressional funds to new and current programs to be used for “digital health technology, support, training, data collection and evaluation.”
https://compliancy-group.com/what-is-the-hitech-act/?gclid=CjwKCAjw04vpBRB3EiwA0IieavCeGgPaOCw8prQBHzwB7Ym_g3RrXfxqr9-KaCClhHmZep7phwYPlRoCguIQAvD_BwE
https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html
TeleMedicine privacy and security is governed by HIPAA and HITECH. These are the same governing entities that protect patients inside physical health care institutions.
https://www.ncmedboard.org/resources-information/professional-resources/laws-rules-position-statements/position-statements/telemedicine
“[T]elemedicine is a useful practice model that, if employed appropriately, can provide important benefits to patients, including: increased access to health care, expanded utilization of specialty expertise, rapid availability of patient records, and the potential of reduced healthcare costs, increased efficiency, and improved overall healthcare outcomes.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704580:
BMC HealthService Research did a nationwide survey of over 4,000 Americans and found that TeleHealth provided “accessible, efficient care that can reduce costs while maintaining quality of care and patient satisfaction” and “immediate and convenient access to a care provider that usually costs less than a standard in-person urgent care or emergency room visit”. They also found that direct to consumer “telemedicine has also been shown to increase access to care to those without a primary care provider”. The American College of Physicians published a statement in 2015 which endorsed “telemedicine within the context of an established patient-provider relationship in a medical home if it meets the same standards of practice as in-person care”
https://www.aafp.org/about/policies/all/telemedicine.html
“The AAFP supports expanded use of telehealth and telemedicine as an appropriate and efficient means of improving health, when conducted within the context of appropriate standards of care. The appropriateness of a telemedicine service should be dictated by the standard of care and not by arbitrary policies. Available technology capabilities as well as an existing physician-patient relationship impact whether the standard of care can be achieved for a specific patient encounter type.
Telehealth technologies can enhance patient-physician collaborations, increase access to care, improve health outcomes by enabling timely care interventions, and decrease costs when utilized as a component of, and coordinated with, longitudinal care. Responsible care coordination is necessary to ensure patient safety and continuity of care for the immediate condition being treated, and it is necessary for effective longitudinal care (for clarification, forwarding documentation by electronic means, including fax, is not acceptable for coordination of care with the primary care physician or medical home). As such, the treating physician within a telemedicine care encounter should bear the responsibility for follow-up with both the patient and the primary care physician or medical home regarding the telemedicine encounter.
The AAFP defines telehealth and telemedicine as:
Telemedicine is the practice of medicine using technology to deliver care at a distance, over a telecommunications infrastructure, between a patient at an originating (spoke) site and a physician, or other practitioner licensed to practice medicine, at a distant (hub) site.
Telehealth refers to a broad collection of electronic and telecommunications technologies and services that support at-a-distance healthcare delivery and services. Telehealth technologies and tactics support virtual medical, health and education services.
Telehealth is different from telemedicine in that it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services such as provider training, continuing medical education or public health education, administrative meetings, and electronic information sharing to facilitate and support assessment, diagnosis, consultation, treatment, education, and care management.”
https://academic.oup.com/cid/article/68/9/1437/5372646
The ISDA cited in their position statement that TeleHealth has the capacity to improve access to care, patient outcomes, patient satisfaction and reduction of medical costs.
http://www.telemedmag.com/article/physicians-trained-practice-telemedicine/
There are numerous shortfalls that have been cited for the delay in the broader adoption of telemedicine. The usual suspects include; slow payer adoption causing limitations in reimbursement, costs of technology, practice integration issues, cumbersome interstate licensing rules, restrictions in malpractice coverage and many more. These are legitimate issues and despite significant progress being made to address all of these concerns, the adoption rates for telemedicine are still low. Perhaps a more powerful reason for this lack of adoption, is a deficiency in physician training within the field of telemedicine.
https://mhealthintelligence.com/news/ata-announces-first-online-patient-consultation-accreditation
“In an age where the average consumer manages nearly all aspects of life online, it’s a no-brainer that healthcare should be just as convenient, accessible and safe as online banking,” Linkous said in a press release. “This program ensures that online healthcare services are following the necessary standards, guidelines and laws to provide safe care to American consumers.”
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