The Rise of Telemedicine

John D. HalamkaAs reimbursement evolves from fee for service to alternative payment models, incentives will shift from treating sickness to keeping the population healthy. New investments will be made in technologies that reach into the home and enhance care team communication. 2016 saw an acceleration of telemedicine/telehealth. 2017 will see exponential growth.

Telemedicine is hard to define. It could be real time video teleconferencing between clinicians (a consult), between a patient and clincian (a visit), or group to group  (tumor board discussion). It could be the transmission of a static photograph, such as the poisonous mushroom/plant teleconsultation I do 900 times per year.    It could be secure texting to coordinate patient care.

Patients might provide care teams with objective data from devices in their homes.  Patients might answer surveys about their mood, activity, or pain.

All of these are telemedicine.

Many companies will offer cloud-based tools and technologies to support these new workflows. Some organizations will  use bridging technology to link together every kind of endpoint (Skype, Facetime, commerical telemedicine apps) with every kind of endpoint.

There are so many use cases and so many possibilities that one approach will not serve all needs, so most organizations will have a multi-faceted strategy.

There are some unanswered questions

1.  How do you bill for telemedicine?  There is a new CPT code, but it’s not clear how it should be used.

2.  How do you address multiple conflicting state laws when consulting across borders?

3.  How is the record of a virtual encounter stored and who is the steward of the record?

For my personal telemedicine practice, toxicology consultation, I use an iPhone and email to review cases and images.   No protected healthcare information is exchanged.

I am credentialed by BIDMC for telemedicine practice

I am malpractice insured for telemedicine practice.

When consulting across state lines, I provide advice to licensed physicians in that state and never interact with patients directly (or prescribe).

I do not bill for these services, they are a public good.

Medical records are kept by the physician consulting me and that physician is the steward of the record.

As hospitals expand to serve patients at the national and international level, as payment models require more home care/wellness care, and as consumers demand the same kind of convenience  from healthcare that they get from other industries, telemedicine will expand and mature.

Telemedicine at BIDMC (part of Media Services) reports to me and I’ve requested additional staffing and investment for 2017. Technology, business needs, and customer demand are aligning to make telemedicine an increasingly important service offering for clincians and hospitals.