Healthcare Reform: Could Telemedicine be the Answer?

By Bob Preston

With health care reform a hot current events topic, I thought I would republish a blog post I made in August. It seems even more relevant today since 32 million more Americans will soon be eligible for primary care health services through expanded insurance coverage under the new health care reform bill. With the flood of new patients stressing rural clinics, health care organizations will need to utilize creative solutions to provide doctor-patient collaboration.

I never had a chance to meet my grandfather. He passed away before I was born. I do have a lot of old pictures and have heard countless stories about him. He was a doctor and moved his family from Vermont to the rural San Joaquin Valley area of California in the early 1900s. He was a general practitioner and most of his appointments were house calls to families which he made by bicycle. He prided himself on the intimate well being and collaborative care of these families who were not only his patients but also community members and neighbors.

How times have changed. The primary care doctor - long the mainstay in family medicine - has traditionally played a critical role in controlling medical costs by maintaining overall patient health and keeping them out of emergency rooms. In today's era of modern medicine, however, not only are house calls a thing of the past but the prototypical Marcus Welby family physician has become increasingly rare and in staggering short supply.

More than ever, medical school graduates are becoming specialists or researchers in centers of excellence in major cities and metro areas (USA Today, Doctor Shortage Looms, August 17, 2009), opting for a path to the exciting and financially rewarding McDreamy uberdoctor as opposed to Welbyesque general practitioner. This trend has left our rural communities under served by primary care doctors and in a crises situation with few options for access to quality medical care.

According to USA Today, further burden to our medical systems will be the rising demands on primary care physicians from the 78 million baby boomers born from 1946 to 1964, who begin to turn 65 in 2011 and will require increasing medical care. Combined with the rising costs of health care and the Obama administration’s plan for reform in the United States, the doctor shortage has created a new sense of urgency to consider non-traditional means for patient treatment in rural communities and remote locations. Consider, for example, that the Economic Stimulus Package (aka the American Recovery and Reinvestment Act of 2009) provides for broadband availability to rural areas and funding for health care information technology as new methods are desperately needed to deliver medical service more efficiently without increasing costs and resources.

One such method which allows doctors and medical facilities to reach rural communities is telemedicine. The American Telemedicine Association defines telemedicine as the use of medical information exchanged from one site to another via electronic communications to improve patients' health status. The concept of telemedicine is simple – provide doctors with virtual technology for remote examination allowing them to treat patients in another location and be in more than one place at any given time. In many cases telemedicine utilizes video conferencing and telepresence technology, with high definition cameras and monitors, providing a lifelike and intimate collaboration experience between doctor and patient. The doctor can visually examine the patient while a medical technician on the patient's side of the connection assists with the medical instruments to take vital signs and transmit medical data and records.

Telemedicine is already being used extensively by many health care providers to save lives. At the Sequoyah Memorial Hospital in Sallisaw, OK, patients with stroke symptoms can be connected to a neurologist at Sparks Health Systems in Fort Smith, Ark., via video conference connection to evaluate a patient's condition and prescribe immediate treatment. Mexico's National Center for Health Technology Excellence ( CENETEC) relied on video conferencing systems to help them stem the initial outbreak of H1N1. Organizations like NuPhysicia are providing video conference telemedicine systems for hard to reach locations like oil rigs where doctor visits with patients would otherwise be prohibitive. New Zealand TelePediatric Service established a telemedicine network to connect pediatric centers for access of children in rural communities to pediatric care. These are just some of the examples in which doctor-patient collaboration is being enabled through telemedicine solutions.

It is sometimes hard for us to accept the fact that health care is a business. I know, it just seems wrong. Most of us would prefer the personal interaction and hands-on collaborative care provided by primary care physicians in the time of my grandfather. But those days are gone. The fact of the matter is that current health care systems and methods are on the cusp of reform. Medical treatment will need to be more efficient, productive, and profitable to avoid a health care crisis in our rural communities and with our aging baby boomer populations. Telemedicine is a viable and growing form of connected medicine that deserves our appreciation.