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When You’ve Got Telehealth…"Snow Problem”

January 30, 2015
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In some areas of Boston this week, two-plus feet of snow fell and trapped people inside their homes. In this hopeless situation, you’re pretty much destined to wait a day, break out the Netflix, and eat the food you quickly grabbed from the grocery aisle in the hectic run-up to the storm. Your options are pretty limited.

What if you’re sick, though? Of course, ambulances can make their way through the snow and rescue you. Of course, hospitals will stay open and be there for you like they always are during natural disasters. Unless it is life threatening though, that seems unnecessary and costly. What if you’ve got an outpatient visit though that doesn’t require emergency? What if you don’t want to delay that visit?

You pulled your back trying to shovel. You have the flu – it is flu season, after all. You twisted your ankle on an icy floor. You’re not going out in the snow to see a doctor, but you still wouldn’t mind some help.

Good news Bay Staters, Massachusetts General Hospital is giving you that help. They did it this past week with the Juno snowstorm and they did it with telehealth.

According to an article in The Boston Herald, MGH conducted 20 outpatient visits over its telehealth platform during the snow storm. The software, which allows doctors to counsel, assess symptoms, prescribe, or go over lab results, can be used on desktop and mobile systems, according to the MGH website. It can be used for a lot of different areas including pediatrics, pathology, psychiatry, neurology, and more.

Connecting patients to a provider directly is a departure from the historical usage of telehealth, which mostly occurred between a provider in a remote location and another at an academic medical center. It’s a trend—in fact, an HCI tech trend—that has blossomed over the last few years, with the emergence of companies like TelaDoc, MDLive, AmericanWell (which recently received $81 million in funding), and more providing these services.

I’ve gotten a chance to write about direct-to-consumer telehealth extensively—for the trend piece as well as some extras. Having talked to people who use it, who don’t use it, who like it, who don’t like it, who like it with a provision, I believe it’s clear that this method of care is going nowhere. It’s here to stay and that’s a good thing. It’s convenient, affordable, and practical.

It’s not just the snow storm. It’s everyday life. Here’s an example from Kevin Biese, M.D., emergency medicine residency director and an assistant professor of emergency medicine and internal medicine at the UNC School of Medicine in Chapel Hill. Biese uses a telehealth app from TouchCare, which connects him to patients that are in the UNC health system.

Here's an example: a ten-year old boy playing soccer twists his ankle badly, it's Sunday evening, he is at home. I know the patient. They contact me through the app and make an appointment. We do it online. The kid is sitting there with his dad. I'm looking at the kid's foot. I can tell no one is going to operate on it tonight. It might be broken but no one can operate on a Sunday night at 6 pm. I ask him to tell me where it hurts so I can see if he's OK, if not I can set him up with orthopedics the next day. And if he went to the ED, he'd end up in the same place but would save four hours.

That’s huge. Every doctor who uses telehealth services to care for patients has told me of a story that like that. This is why we need more states like Ohio, Colorado, and others that are working to ensure telehealth services reimbursed at the same rate of in-person visits, when appropriate. The Centers for Medicare and Medicaid Services (CMS) need to act, as was recently noted by the American Hospital Association, to push this trend forward.

Indeed, I believe that this direct-to-consumer telehealth trend is a great thing…with a caveat.

Telehealth, in any way, shape or form, cannot disrupt coordinated care. I respect the work that all doctors are doing to expand the usage of telehealth. It just can’t get in the way of a cohesive, patient-centered health system. Let Biese explain:

I wouldn’t do it if I wasn't part of network that is providing continuous care for that patient. The North Carolina Board of Medicine has emphasized continuity of care with telehealth. I don't think you need to know the patient. You can establish a relationship with telehealth but you've got to have a way for the patient to follow up and get them back into system. It's dangerous to prescribe medicine from five states away and being like, "Good luck." The patients don’t always know their medical history. It has to be part of healthcare system. So the first visit can be telehealth but only if they are backed by the system. 

One hundred percent agreed. I’m fine with Teladoc, because as Tim Howard, M.D., a Teladoc doctor, explained to me, they’re making the primary care doctor the priority. “Our goal is to bridge them back to the primary care physician. We are not their primary care physician,” he said.

If all telehealth companies can do that, the potential is limitless. The snowstorms of the world won’t hold you back from receiving timely, coordinated care. Nothing will.