In an effort to provide better healthcare access, trim costs and time, and better manage availability and operations, telehealth is being reinvented. Providers are looking to telehealth programs and telemedicine technology to help them provide care at home, in mental health and walk-in clinics, even in prisons.
Jeffrey Bauer, partner at Chicago-based ACS Healthcare Solutions and co-author of "Telemedicine and the Reinvention of Healthcare" recently spent a Monday at New York Presbyterian hospital in Manhattan, and a Tuesday at a small Tennessee rural hospital, speaking on the topic. Telehealth, once hailed as an answer to rural healthcare and a lack of local specialists, appears to be migrating.
"It's just as relevant in New York City," Bauer says, noting that telehealth services benefit house-bound dwellers as well. "All the more so with the gridlock you find in Manhattan."
To Bauer, telehealth fits healthcare's evolution. "20th century medicine was face-to-face. 21st century medicine is going to become not entirely face-to-face."
In fact, face-to-face healthcare has taken a whole new meaning at the 10-year-old Northern Arizona Regional Behavioral Health Authority (NARBHA) because of telehealth. Through its Flagstaff-based NARBHA telemedicine network, psychiatrists practice telepsychiatry doing intake evaluations, crisis evaluations and medication monitoring via two-way interactive video on a 27-inch TV with a camera sitting on top.
Finding a psychiatrist in urban Arizona where most residents live is easy, but far away in the five-county, 62,000-square-mile area that NARBHA was in charge of, things were different.
"It's very difficult to recruit a psychiatrist to live in a tiny out-of-the-way community," says Nancy Rowe, NARBHA telemedicine program manager. "Not everybody in these tiny little towns in remote rural frontier Arizona can afford a car, or afford to be driving around or afford to take time away from their job."
Another benefit of telehealth is that it addresses accessibility and challenges patients face before arriving at providers' doorsteps.
In fact, sometimes even arriving at a provider's doorstep is the just the beginning of the challenge to receive care. Glenn Hammack — University of Texas Medical Branch (UTMB), Galveston, assistant vice president and executive director of the electronic health network — notes that some large healthcare facilities are a prime example of sprawl, and far from easy to navigate, especially for those with chronic conditions.
"It's time we got out of building buildings (named) after dead people, connected with more and more skywalks to more and more parking decks, and then wonder why people in wheelchairs have a hard time getting (around the facilities)," he says.
Prime targets for telehealth
The general population isn't the only segment that can benefit from telehealth. Because of the high cost of transporting prisoners, the technique of giving care is increasingly being seen as an answer to providing inmate care. "In the correctional environment, we have documented over 177,000 grievances about medical care in the general prison operation, zero are due to telemedicine," Hammack says, "even though telemedicine makes up for about 20 percent of the ambulatory care."
Joseph Kvedar — director, Boston's Partners Telemedicine and associate professor, vice chair in the department of dermatology at Harvard Medical School — sees homecare as a major push for telehealth. It's being seen as a tool for saving money and involving patients in their own care, particularly with the chronically ill.
"If you can care for a particular cohort of patients better in their home and then use your beds to admit others that you had to divert before, you could be a higher quality provider for all," says Kvedar, who has been involved in telehealth for 12 yeas. Telemedicine tools are not designed to quell provider visits, but to allow for more meaningful medical involvement, he says. "Hospitals are becoming very interested in using these tools, ironically, to keep people out of the hospital."
Online asynchronous communication for routine checks, for things such as blood pressure monitoring, are starting to look more and more attractive to providers. Currently, Kvedar's group has a dermatologic trial under way with acne patients in which they use McKesson's RelayHealth (Emeryville, Calif.) messaging to upload facial pictures. Telehealth programs such as this allow patients to "do it from their living room or office, as opposed to traipsing into the office," Kvedar says. "Patients feel connected and the doctors are more efficient."
Healthcare in an instant
Ronald Weinstein, M.D., chairman of the board at Phoenix-based UltraClinics, a University of Arizona spin-off, is also interested in how telehealth can be utilized to manage time.
UltraClinics, a rapid-results clinic, takes the idea of walk-in mini-clinics for non-complex diseases such as sore throats and ear aches, and ups the ante. Leveraging technology from DMetrics Inc., a Tucson company Weinstein co-founded, UltraClinics bundles radiology, oncology and clinical services and provides same-day breast and prostate biopsy results.
"A woman can come in and get a mammography in the morning. If she needs a biopsy, she has it done immediately," Weinstein says. "We can process her tissue within an hour and a half. We don't need a pathologist on site because we can do it from telepathology. And if she has a malignancy, she talks immediately by video conferencing to an oncologist."
Weinstein, who has been a chairman of pathology for more than three decades, says diagnostic accuracy should be a key metric to delivering quality care, but that speed and efficiency are also very important. "We're constantly disrupting people's lives making them wait," he says.