Telemedicine issues shift from technology to usage

Those who attended a breakfast panel discussion April 30 at the American Telemedicine Association (ATA)’s 2012 Conference and Exposition in San Jose, Calif., learned quickly that usage now overshadows technology in telemedicine’s path forward.

“The patients are ready – they’re enabled,” said Andrew Watson, MD, a surgeon and executive director of telemedicine at UPMC and medical director of the Center for Connected Medicine in Pittsburgh. “[Telemedicine) is not an emerging technology anymore. It’s emerged.”

Watson was part of a lively panel discussion, titled “The Doctor Will See You Now Wherever You Are.”

The session, sponsored by Verizon and Polycom, also featured Donald J. Kosiak, Jr., MD, an emergency physician at Avera McKennan Hospital in Sioux Falls, S.D., chief of staff of the Avera McKennan Hospital and Health System, and medical director of Avera eCARE; Ron Emerson, RN, BSN, global director of healthcare for Polycom; and Col. Ron Poropatich, MD, deputy director of the Telemedicine and Advance Technology Research Center (TATRC) of the U.S. Army Medical Research and Material Command (USAMRMC) at Fort Detrick, Md.

Nancy Green, managing principal of virtual care/telemedicine for Verizon’s Connected Healthcare Practice division, moderated the panel.

The panelists agreed almost immediately that the challenges facing telemedicine are no longer focused on the technology, but on how that technology is used by physicians and their patients. The primary pain points now, they said, are access, reimbursement and the shift in emphasis from pay-for-performance to accountable care and patient-centered medical care.

For Kosiak, that means connecting the many remote healthcare providers and residents in his five-state area with teleconferencing, virtual ICU care, virtual ER care and services that enable nursing home residents to get care at the home instead of at the hospital.

“I firmly believe right now that geography dictates the quality of healthcare you will get,” he said.

Kosiak noted that recent pilots are proving the value of telemedicine, ranging from a reduction in emergency room visits by seniors in nursing homes who instead get their healthcare via video-conference, to millions of dollars saved in transport and travel costs by senior living centers, emergency response services and home healthcare agencies.

For Poropatich, a former president of the ATA, telemedicine can “fill in the white space” that exists between a patient’s face-to-face encounters with a primary care physician. If that patient meets with a doctor twice a year for an hour-long check-up – for a grand total of 120 minutes a year – that’s a lot of time to cover.

The ideal model for telemedicine, Poropatich said, calls for “very frequent, pulsed care.”

Watson, meanwhile, called it “touch-and-tune” care, which enables patients and providers to interact whenever and wherever needed, be it at home, at work, or anywhere in between, via mobile devices. This, he said, will prompt a “tremendous sense of behavioral change” among physicians, who are used to the old standard of face-to-face care.

Watson said cloud-based services will help healthcare providers maneuver through the health information exchange landscape by giving them a resource to access and store data from any location, but he worries how EHRs will fit into the equation.

“Beware of having EHRs get in the way of telemedicine,” he said, adding that EHR interoperability is “one of the greatest challenges our country faces.”

For many in the audience, the key challenge lies in getting paid.

“Really, the reimbursement structure is the only thing that is holding me back,” offered Robert Smith, a solo physician practicing in the Finger Lakes region of New York who is taking part in the Rochester, N.Y.-based PCMH initiative.

Emerson said reimbursement will be driven by business cases – in other words, once providers can prove that telemedicine saves money and improves outcomes, it will gain acceptance (and financing) from private payers and the government.

He urged the audience to take those business cases to their congressional representatives.

“The rules structure isn’t there yet to support that,” he said.