Telemedicine is supposed to increase access to care, reduce cost, improve patient satisfaction by improving diagnosis and provide better health outcomes. In 2012, active users were being monitored remotely for cardiovascular disease, chronic obstructive pulmonary disease, diabetes, hypertension and mental health issues. The number of active users of Telemedicine system is expected to increase 6 fold by 2016, due in main part to technological advancements and assisted living arrangements.
Telemedicine is the ability to use telecommunication and technology as a way to provide clinical healthcare and its applications including video consultation to mobile monitoring devices. Telemedicine include real time interactive services, remote monitoring and “store and forward” or capturing medical data and using electronic means to forward that information to other physicians.
Telecoms Monetize Telemedicine
Three telecom giants once sitting on the side lines have all begun to jump on the telemedicine bandwagon. AT&T, Verizon and Sprint all announced telehealth service initiatives. All three companies are unveiling different version of telecommunications services including; increase wireless deliverable, upgraded networks, partnering with software developers and cloud based systems specifically for the health care industry.
Reports indicate that telecom providers will be seeking to monetize their services directly to their customers. Providers are likely to recommend customers turning their smart devices into health monitoring devices (glucometers, blood pressure monitors, body composition monitors), aging in place technologies (remote monitoring appliance, home and fall sensors, medication dispensers) and mobile health applications to promote health and wellness. Telecoms are going beyond recommendation to actually providing devices and service to “help” their customer become more efficient users.
There are good reasons for the increase in telemedicine use including; increased access to health care (passage of the Affordable Care Act), controlling the increasing expense of health care with a growing aging population and increasing medical care deserts in disadvantaged areas. Does telemedicine actually improve health?
Access to care is the easiest to measure for results and observe benefits. According to the National Rural Health Association, 25% of Americans live in rural areas while only 9% of doctors practice in those areas. Telemedicine enhance patient’s access to primary care and specialist physicians without the need for traveling to urban medical facilities. Access to care has reduced both travel and waiting room times.
Cost containments are challenging to analyze the economic benefits, making it difficult to measure cost savings. Technology is credited as a major contributor to rising health care cost. Telemedicine advocates report that there are cost savings in remote monitoring which reduce travel and increase accessibility. Recent studies are beginning to compare telehealth with traditional medical visits. These studies reveal telemedicine to be less expensive than traditional medicine delivered in person. However, other studies indicate that the cost savings are inconclusive when compared to traditional medical care.
Physicians are concerned about the cost of implementing telemedicine; technology purchases like video equipment, electronic stethoscope, otoscope, document camera and handheld patient camera cost approximately $10,000. Cost for these items are expected to decline as time evolve. Promoters of telehealth believe the return on investment is less than three months. They also believe the investment will add value to the physicians practice. The value proposition is enhanced by keeping patients actively engaged in their care, bring specialist directly to the patient, keeping the patient and revenue onsite (without actually having the specialist onsite) which reduce the possibility that the patient will not return.
Telemedicine’s effectiveness is measured medically by patient satisfaction, patient quality of life, accuracy of diagnosis, reliability of health outcomes. Studies have shown a lack of sound research and limited numbers of randomized clinical trials. According to studies on diagnosis approximately 70% support telemedicine, these studies reveal telemedicine as a viable alternative to traditional medicine. Specialties such as telepathology, teledermatology and teleradiology were all supportive of telemedicine.
Ten out of fourteen studies were supportive of teleradiology, these were synchronous echocardiograms examination and showed no difference between in person and live video. Stethoscope examinations showed mixed results with accuracy. Accuracy was based on the experience of the cardiologist, while electrocardiograms demonstrated higher accuracy, specificity and sensitivity. Teleophthalmology exams’ were inconclusive, with improved diagnosis of glaucoma and retinopathy. Telemental health were supportive, especially in areas of vitals monitoring.
Measuring patient satisfaction is easy, however the patient responses may be irrelevant. A systematic review of patient satisfaction studies revealed most are superficial. The studies show positive responses from patients, however further research need to occur in relations to the effectiveness of collecting this data. Most studies have focused on patient satisfaction and diagnostic accuracy, teleradiology appears to be the most studied and accurate in diagnosis.
Consensus exist regarding the need for technology in health care, but progress has been slow. There are several factors to examine for the lack of progress. Will patients view telemonitoring their medical progress as an intrusion in their lives? For telemedicine to be effective remote video monitoring to facilitate checkups are a must. Data protection is another concern. I wrote about in an IoT of Health. Medical information is more vulnerable when it stored in one central location, versus decentralized and stored by individual patient.
Telemedicine practices and procedures will continue to expand moving forward. Telemedicine to improve health outcomes the data is primarily inconclusive. The pressure to adopt telemedicine to reduce cost and increase reimbursement payments are driving acceptance. Physicians are slow to comply because most do not understand how they will be able to make money using this technology.
Consumers can be excited for this technology because it is moving medicine in the right direction. Although, remote monitoring can be frightening for older consumer, education and transparency should ease most fears. However, data collection and storage should remain a major concern. Especially, since it is conceivable that the medical industry will want assume control of our medical data. There is no full proof way to secure centralized data from hackers. Instead of being afraid of data security, consumers should focus on data privacy and transparency. Consumer information privacy rights should be standard operating practices throughout the country.
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