The AMDIS Connection: Getting Away from Just-in-time Care
New federal interest and stimulus money will help to spur telemedicine in the U.S., but this field also is enjoying a convergence of four factors that are organically driving it forward.
- A new generation of sensors. In a telemedicine session at the American College of Chest Physicians meeting a couple of years ago, participants were discussing their experiences with older generations of smartphone-type technology. Patients were not uploading the information correctly, having trouble using the small styluses, etc. Now, this is seamless and wireless, and patient information is automatically logged and transmitted back to the physician.
The reason the sensor revolution is so important is that it finally makes routine some things that were arduous. It gives a more complete care picture, especially for chronic illness management and monitoring. For example, as an aid in obesity management, there is a Bluetooth scale that can automatically upload weights on Twitter—motivating weight loss and sharing with others.
The notion of access. In American healthcare, just-in-time care delivery is more problematic than ever. Hospital emergency rooms aren’t emergency rooms anymore; a patient can’t walk in and be seen immediately, and the idea of getting primary care there is horrendous. Telehealth can allow greater access to specialty care by communicating what is needed regardless of patient location. This is where the new generation of telehealth technologies are significantly going to change the way we manage chronic disease, one of the biggest portions of healthcare dollars.
The new generation entering medicine. This generation is using social networking for everything from communicating with friends to finding out who is where. They’re comfortable with geolocation and the idea that someone can be at the gym and send heart rate data wirelessly to his or her office.
- Work/life balance. For the new generation of practitioners, it’s not a desire, it’s an expectation. Physicians want to leave the office at 5:00 p.m. on a Friday, but everyone knows that’s when things are most likely to go wrong. Now, if a patient is concerned about a condition, he or she can self-monitor, sync it to a smartphone and send the data to the physician. This kind of decentralized monitoring and management is well beyond a trick or a study to see whether it can be done. It is something that will allow mobility of the clinician as well as the patient.
Major issues yet to be addressed include credentialing. The idea of practicing telemedicine is still problematic across state lines. However, there is vigorous activity going on—and a number of states, particularly in the West, are saying, if you’re credentialed for telemedicine in one state, you’re credentialed in three.
Reimbursement is another issue. That’s part of new legislation—to assist in making telemedicine more rewarding. Is it going to be as much as high-complexity inpatient? No, but if these systems are properly designed, patients can stream information to a PC in the physician’s office. The physician will have the complete report on Monday when he or she gets in, giving the patient reassurance of knowing the doctor knows what transpired.
Leveraging our ubiquitous wireless networks and our multifunction smartphone devices is not just another way of using some toys in the care of patients to prove it can be done. It’s demonstrating that this new generation of patients and physicians will use these technologies to remain in touch, in excellent information exchange, maintaining their own workflow and lifestyle.