Healthcare IT and healthcare reform are inextricably entwined as healthcare delivery transforms itself from a model based on volume to one based on value. Telemedicine is a disruptive technology that is ripe for driving this change from a provider-centric care model to a patient-centric model. That’s the view of Dennis Schmuland, M.D., chief health strategy officer of Redmond, Wash.-based Microsoft Corp., who believes that the purpose of health information technology has changed significantly as the practice of medicine has changed over the last decade.
As healthcare transforms itself from a fee-for service model to one based on value, the role of technology is undergoing a fundamental change at the point of care, Schmuland says. The IT infrastructure that supports provider-centric piecework to capture, organize and present clinical information and insights to providers who were the prevailing decision makers, is increasingly being called upon to support a care model based on patient-centered teamwork, he says.
“We are now in this era of frugality and growing prevalence of chronic disease and a continuum-based payment model,” he says. “The focal purpose of technology is to improve health, improve outcomes and the experience of care for more patients securely, in less time and at a lower cost.” This requires highly mobile, collaborative care teams that span multi-organizational boundaries and multi-disciplinary teams, he notes. In his view, team collaboration can make a huge difference between a successful rapid recovery and a readmission or life-threatening complications. “It’s collaborative teams that coordinate care, engage patients in self-care, and deliver the preventative care to reduce risk to patients,” he says.
Changing Perceptions of Telemedicine
Against the backdrop of patient-centered, team-based care, some providers are viewing telemedicine with a new lens, Schmuland says. Traditionally, telemedicine was seen as a way to connect doctors to more patients, and expand their practices, he says. Increasingly, as healthcare moves to a continuum-based payment model, more providers are viewing telemedicine as a more efficient patient-centric vehicle, which can connect patients with the resources and teams they need to improve their care experience, he says.
He calls this care delivery without walls, and he predicts that virtual visits will increase significantly in the next five years. “There are about 900 million doctor visits each year, and about half of those visits are candidates for virtual visits,” he says. He adds that many of those visits are visual or conversational in nature; in addition, do-it-yourself tests that can be done by patients in their homes will obviate the needs for many in-person visits.
Yet it is “conversational” telemedicine that is really ripe for take-off, he says. These are like any face-to-face interactions between doctors and patients, and don’t require complex device integration. Just a few examples are tele-dermatology, tele-psychiatry or tele-pharmacy, as well as health coaching, 24-hour nurse care triage and even personal training and employee assistance programs—interactions that can be successful with the use of voice and photos.
Schmuland also notes that another factor behind the demand for care delivery without walls is the shortage of primary care physicians and nurses, at a time when 120 million uninsured are entering the healthcare system in the U.S. “Care delivery without walls is a way of addressing those supply-and-demand imbalances, because expertise isn’t always available where the need exists in the U.S.,” he says.
Tele-Psychiatry: A Solo Practitioner Extends His Reach
One practice that is putting telemedicine to use is The Hopper Group, a solo-physician psychiatry practice in Arlington, Texas. Kenneth Hopper, M.D., says he has been using telemedicine for about two years (through the Microsoft Lync service). In addition to practicing psychiatry, Hopper is also serves as the vice president for the Western Region of WellPoint Government Business Division, for behavioral healthcare.
Speaking of the advantages of telemedicine in his practice, Hopper says, “We are able to change space and time, by having our patients follow up with us using telemedicine’s options out of the house.” He says his patients, who reside all over the state, are initially seen live, face-to-face, but are able to use engage in follow-up appointments off site.
Hopper says that as a solo practitioner, telemedicine has afforded him added flexibility, as long as the patient has access to a quiet space and adequate bandwidth.
He says telemedicine will enable him to reach geographically under-served areas. For example, Hopper is forging a relationship with a rural psychologist in Abilene, Texas to be their “in-office” psychiatrist via a telemedicine link between the two practices. “There are no psychiatrists in this town, and they have to send patients 200 miles away to see a psychiatrist,” he says. “I can see the patients when they are coming in to see their therapist” via a telemedicine link, he explains.
He adds that telemedicine can be a viable tool even for hospitals in major population areas. Some hospitals lack ties to a large health system, making access to psychiatric help difficult when it is needed, he notes.
On the health plan level, Hopper believes that that telemedicine can help enable healthcare reform by lowering barriers to fluid, integrated care. He recently presented at a meeting of America’s Health Insurance Plans in Seattle about bringing psychiatric care into primary care practices, with the correct model of how that psychiatrist can be dialed in for a consultation.
Since implementing telemedicine, Hopper has been expanding the ways that it is being used in his practice. He says that telemedicine is an excellent tool for training other medical professionals to treat certain types of patients. He is currently developing a Long-Term Acute Care facility training program for delirium patients, he says. The program can be used for training as well as for direct patient consultation within another facility, he says.
Hopper is also developing educational vignettes for patients, which can be accessed through a secure link, prior to the appointments.
Hopper says telemedicine has helped him improve the quality of care in his practice significantly. He notes that less than half of the patients who are referred to a psychiatrist will actually go to one. “Anything you can do to change the proximity of that care by reducing the access barrier is helpful,” he says. In addition, having engaged with the patient initially, follow-up appointments are a real challenge. Telemedicine helps in that regard as well, he says.
Hopper notes that in psychiatry, verbalization is the primary method of care. “That’s what makes this unique, even the ultimate expression of where telemedicine can be used,” he says. People who are busy in their daily lives can have a consultation during their workday, as long as they have access to a private space. It saves time, space and money, and it has dramatically helped in terms of follow-up and outcomes for our patients,” he says.
Overall, Hopper is bullish on telemedicine as an efficient and natural way to deliver care. “It will get more and more woven into what patients see and expect” in their care, he says.
