Help Patients By Allowing More Telemedicine

This article originally appeared on Forbes by Paul Hsieh.

Americans can use the internet to buy groceries, pay bills, watch movies, and talk to loved ones in faraway cities, all from the convenience of their homes. But for too many Americans, seeing a doctor has changed relatively little since the 1950s. A patient has to make an appointment, drive across town, and sit in a crowded waiting room until their name is called, before they finally get to see their doctor.

We can do better than this in 2017. Fortunately, there is growing interest amongst both patients and physicians in “telemedicine” (also known as “telehealth”) — where doctors utilize modern technology to provide medical care to patients remotely.

In my own field of radiology, this is already well-established. My colleagues and I routinely interpret x-rays, CT scans, and MRI images from patients in other cities. Radiology image data is digital, which means I can consult with a ER physician in Hawaii about their patient’s CT scan while in my office in Colorado as if we were in the same room.

Similarly, “telestroke” programs like this allow specialist neurologists in Denver to evaluate patients remotely in rural Colorado and Wyoming hospitals and decide if they need to be sent urgently by helicopter to an advanced stroke treatment center in Denver:

From laptop computers, they can examine patients closely, even focusing in to look at subtle eye movement that may be important in delivering care. The neurologist can read vital signs on bedside computers and talk in real time with the patient, family members and emergency department professionals.

Rapid diagnosis and treatment of a developing stroke can prevent devastating permanent disabilities. “Telestroke” programs such as these give patients in remote locations rapid access to diagnostic expertise that would been unavailable 20 years ago. (Disclosure: I don’t participate in this hospital’s telestroke program, but I am on the hospital’s medical staff. There are many excellent telestroke programs around the country, but this is the one I’m most familiar with.)

Of course, not all health issues can be addressed with telemedicine. But many can, with excellent results. As Austin Frakt noted in a 2016 New York Times article:

A systematic review published in 2015 found that heart failure patients receiving telemedicine died at no higher rates than those not receiving it. Outcomes of care were the same for mental health, substance abuse and dermatology patients who used telemedicine relative to those who did not.

The review also found that telemedicine helped diabetics maintain better control of their blood sugar, and that it led to lower cholesterol and blood pressure. Other reviews came to similar conclusions.

Properly used, telemedicine can improve access to health care, especially for patients in underserved rural or remote locations. And telemedicine can save patients valuable time — which isn’t always considered in discussions of health care costs.

So what’s preventing the wider use of telemedicine? As Frakt noted, the most significant barrier is not technological, but rather political — namely state regulatory agencies:

The biggest hurdle may be state medical boards. Idaho’s medical licensing board punished a doctor for prescribing an antibiotic over the phone, fining her $10,000 and forbidding her from providing telemedicine. State laws that restrict telemedicine — for instance, requiring that patients and doctors have established in-person relationships — have drawn lawsuits charging that they illegally restrict competition. Georgia’s state medical board requires a face-to-face encounter before telemedicine can be delivered, while Ohio’s does not.

Fortunately, some states and federal agencies are recognizing the value of telemedicine and taking concrete steps to make this option more available to patients and physicians.

For example, in New Jersey:

Gov. Christie signed Senate Bill 291 into law last summer, making New Jersey a considerably more telemedicine-friendly state. In some cases, patients will be able to secure prescriptions without an in-person visit to the doctor. The law eliminates the need for a “telepresenter” — a nurse or other person who physically sits with the patient during electronic communications with a physician.

At the federal level, “The Department of Veterans Affairs has issued a proposed rule that would allow VA providers to treat patients in any state via telehealth, regardless of where they are licensed to practice.”

A key element of the VA proposal is exemption for physicians from onerous state-level regulations and restrictions:

The proposed rule would override state licensing restrictions that the agency says are limiting its telehealth program and allow VA physicians to treat patients anywhere in the country using the VA’s telehealth technology…

According to the proposal, “many VA medical centers” have not expanded telehealth programs because of state laws, and “many physicians” refuse to practice telehealth out of fear they will jeopardize their medical license.

“As VA’s telehealth program expands and successfully provides increased access to high quality healthcare to all beneficiaries, it is increasingly important for VA health care providers to be able to practice telehealth across State lines and within states free of restrictions imposed by State law or regulations, including conditions attached to their State licenses,” the rule states.

A recent article in the New England Journal of Medicineon telemedicine similarly observes that legal concerns over licensure and liability are hindering wider adoption.

But these problems are surmountable. Legal rules are created by man — and can therefore be fixed by man. To use an analogy, my Colorado driver’s license lets me drive in all 50 states. I don’t have to apply for a separate drivers license for each state I drive through. And if I were to get in a car accident outside of Colorado, my auto insurance and the US legal system would allow proper settlement of liability claims in all 50 states. We should be able to do something similar for patients and physicians who want to take advantage of the power of telemedicine.

There are still some important unanswered questions about the optimal use of telemedicine, for example: Which health conditions are suitable for telemedicine vs. in-person care? Will telemedicine displace local physicians in detrimental ways? Will telemedicine lead to depersonalized care or help facilitate more personalized care?

But used properly, I believe telemedicine can provide enormous benefit to patients. State and federal legislators can help by reducing legal barriers to wider adoption. If  the US government believes telemedicine can help doctors take better care of our nation’s veterans, perhaps we can make this option more available to all Americans.

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