Jun 05, 2017

Physician Viewpoint: Acute Care Telemedicine - Catching Up to Modern Life

By Jacob Childers, MD

Like nearly all doctors, I have friends and family reach out with a text message or send a photo, asking if this cut needs stitches, or describing symptoms while inquiring if a sick niece or nephew should see a doctor.

I’m also accustomed to being on call and keeping a smartphone or laptop nearby. When there’s a buzz or ring, I respond.

In effect, I’ve been practicing acute care telemedicine for years. Like families who relied on house calls so many decades ago, many patients still feel they need medical guidance from a doctor immediately. And like consumers who use online banking and media services today, many patients want to connect from the comfort of home, work or travel.

Why are some doctors still reluctant to fully embrace acute care telemedicine?
They wonder if patients risk trading quality medical care for convenience. Is it safe for a doctor to “treat” a patient remotely and perhaps just that once, never examining the patient in person? You can’t take a throat culture, listen to a heartbeat, or feel for a swollen gland on a device screen.

Patients have questions, too. Will their insurance cover an urgent care telemedicine visit? Is shared data secure? Will internet connections work well? What’s the risk of miscommunication leading to misdiagnosis?

Such concerns are reflected in Texas, home to one of the strictest telemedicine regulatory environments. State lawmakers had been slow to change, for example, a requirement that telemedicine can’t start unless an in-person, face-to-face doctor’s visit occurs first.

But change is coming rapidly. This year, 90 percent of 133 large employers surveyed offer “telehealth” as a benefit. Last year, Kaiser Permanente’s CEO said the health network saw more patients online (52 percent) than in person.

Telemedicine isn’t so much revolutionary as evolutionary, as evidencedby the Texas Medical Association successfully working to get new telemedicine rules passed this year by the Legislature and sent to Gov. Greg Abbott. Quicker and more reliable internet connections, ubiquitous smart phones and evolving insurance standards are driving change. Why deter patients from seeking a physician’s guidance for common ailments or minor health issues – or leave them to seek help elsewhere (like online) that may be harmful?

As physicians, we know electronic medical records are proliferating and can be accessed almost anywhere, at any time. Camera phones and video can often provide the information a doctor needs to make an evidence-based medical decision to either treat the patient or refer the patient to their primary care doctor or a hospital ER. All this makes carefully practiced acute care telemedicine a safe option for physicians and patients.

Among doctors, three important, relevant issues surround telemedicine:

Compensation. In most states, including Texas, telemedicine payment models and reimbursements are inadequate or not in place. That is unsustainable financially for providers. It’s also ironic: making an acute care telemedicine visit may help keep patients from seeking more expensive points of care.

Return on investment. The necessary technology and staffing to start up and maintain a 24/7/365 telemedicine program poses significant cost. It’s out of reach for practices, clinics, hospitals and other medical concerns that lack enough patients to make telemedicine pencil out.

Trading quality for convenience? One-time consultations with doctors located elsewhere, clueless about patients’ histories and unaware of potential local circumstances (viruses “going around” local schools, allergies, weather, nearby hospitals and their capabilities) risks further fragmenting health care.

eMD Access, Austin Regional Clinic’s “localized” acute care telemedicine program, addresses the quality issue. We have local, accountable doctors, knowledgeable of local circumstances, responding to local patients around the clock and taking the time necessary to fully address patient concerns. They can access an ARC patient’s medical records, record pertinent information after a telemedicine visit – and alert a patient’s primary care provider to follow up, if necessary.

After 2 years of successfully providing the service to Austin Regional Clinic employees and 6 months of servicing members of local health plan Vista360health, we’re ready to make it available to anybody who has ever been seen at any ARC clinic.

Patients have busy lives. We get that; we’re busy, too. This makes acute care telemedicine a helpful and attractive option for minor health issues, and I expect it will grow more popular going forward.

Now it’s up to regulators, payers and providers to figure out how to make acute care telemedicine work financially and properly integrate into Texas’ health care system

Jacob Childers, MD, is a Board Certified Urgent Care physician at Austin Regional Clinic, an eMD Access provider and Medical Director of eMD Access.

Tags: Family Medicine, eMD Access, telemedicine, eVisit, Jacob Childers, MD, Physician Viewpoint