Dr. Shivesh Kumar is a Family Medicine Specialist with over ten years of experience. He is a member of the American Board of Family Medicine, focusing on partnering with large insurance companies and hospital systems. Standing in the middle of the two prominent health...
Telehealth – The Doctor’s House Call for the 21st Century
The doctor may see you now… literally
When we think about the future, a lot of things come to mind. For some, it might be the jet pack, hover boards and moving sidewalks. For others, perhaps a Jetsons-like-world of semi-automated ‘everything’ with the zip, boom, pow of 50’s-inspired space cars and glass-domed houses spread across the clouds. In any scenario, everyone could fancy a world that simplifies the way medical care is handled. To that end, there is a resounding; “the future is now!” And, that future is called remote health.
What is remote patient monitoring?
To be more specific, the future of medicine is remote patient monitoring, or (RPM), defined as the use of ”digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations. This type of service allows a provider to continue to track healthcare data for a patient once released to home or a care facility, reducing readmission rates.”
This means that remote patient monitoring programs collect everything from vital signs to patient weight, blood pressure, blood sugar, oxygen, heart rate, and they can even perform electrocardiograms. This data can be collected from primary care, hospitals, intensive care, nursing facilities, and wherever the skilled medical professionals are available to assess the results.
The aim is for RPM to help “keep people healthy, allow older and disabled individuals to live at home longer and avoid having to move into skilled nursing facilities. RPM can also serve to reduce the number of hospitalizations, readmissions, and lengths of stay in hospitals—all of which help improve quality of life and contain costs.” RPM is a part of an even larger world of complex medical connectivity called telehealth, where every aspect of healthcare is gathered together, outsourced, driven by software, and designed with the intent to simplify an entire system.
How is telehealth different from telemedicine?
Telehealth deals with a wide range of medical services beyond the scope of clinical sessions alone. Where telemedicine “refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.” Telehealth includes assessing and diagnosing patients, intervention, doctor consults, and shared access to results.
Often, things sound easier in theory compared to the reality. For instance, in this video produced by the Mayo Clinic, we see an example of an elderly patient whose participation in a remote monitoring program prevented the need for a clinical visit. By monitoring the patient’s weight at home, they were able to adjust their diuretic medication by phone.
Getting patient information to their healthcare professionals is partly carried out by a process called Store and forward, which involves the transfer of data using a “camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous or “store and forward” applications would not be considered telemedicine but may be utilized to deliver services.”
If everyone can benefit from fewer doctor visits, and those tests we’re used to experiencing in person can be handled remotely, then what’s the hold up? Technology isn’t the only challenge in the booming telehealth industry. Medicaid and insurance providers have to work with state and federal rules regarding what is permitted, how different services are categorized and thus billed, and the logical organization of how these things are handled isn’t always the most obvious choice.
A one-size-fits-all blanket of rules and codes simply cannot address the immense variance of service and classification across every state border. If other aspects of medical insurance are an indicator of the pace at which these challenges will be resolved, one can assume the red tape in proper billing and coverage for telehealth will be an ongoing, perhaps indefinite process. Regardless of the immense organization of systems that is taking place, the answer to solving these problems is found in remote patient monitoring. Everything from reimbursement policy to state and national laws, cost-cutting and billing are all a part of RPM. In fact, the possibilities are so expansive, 3rd party technology companies provide turnkey Remote Patient Monitoring solutions to assist with regulation and billing, training and everything in between.
RPM in the time of COVID-19
As one can imagine, the COVID-19 pandemic has provided the perfect real-world test for the usefulness of telehealth. It is an issue that the CDC (Center for Disease Control) focuses on, not just for getting through this challenge, but viewing this as a transitional opportunity for change, calling for healthcare systems to “adjust the way they triage, evaluate, and care for patients using methods that do not rely on in-person services.”
The CDC looks at the need to improve systems for more rapid response in a crisis, in order to screen patients quickly, gain quicker access to their records, sharing data in order to limit the spread of the virus to others, etc. This means coordinating with billing, triage, and making the best use of patient data that will be an ongoing part of the telehealth field.
As an example, we know that COVID-19 tends to cause the greatest risk to the elderly and those with compromised health, lung issues etc. If telehealth becomes a standard for routine monitoring of patient vitals, when an outbreak scenario does come along, that data can help medical teams automatically shift primary response towards people who are already in a shared database, which could indicate who might be at the highest risk. Getting to those patients early could mean getting ahead of the curve, which we’ve all learned is a crucial element in reducing fatalities.
One challenge that comes to mind, is that technology is a built-in comfort to those who have grown up with an internet their whole lives. But, the elderly still tend to struggle with today’s ‘gadgets’. There is a chance that those who wish to remain independent while taking advantage of the benefits of RPM may need increasingly simple solutions to help them translate their data to their caretakers. The technology and equipment used are straight forward, but we have to remain thoughtful to those who may still find the everyday TV remote a mysterious futuristic device.
At the end of the day, we have entered a new era towards the future in healthcare, and the potential benefits to patients, healthcare providers, and those middle-men who provide the software and staff to make this all possible are a huge leap forward.
As it is with all things, we have to also keep our eyes open to the changes and make sure the benefits always outweigh the downside. A little bit of convenience can always run the risk of a loss of privacy, from the ways that technology can peak into our private lives, to the open sharing of a database of all of these test results. With ease of shared data always comes the potential exposure of privacy. We can all remain hopeful that the end result will be shedding many headaches and inconvenient pauses in our lives in waiting rooms.
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