Forget house calls: What doctors can (and can’t) do remotely with telehealth products

When Ebola patient Dr. Richard Sacra was sent to the Biocontainment Patient Care Unit at the Nebraska Medical Center – one of only a few in the U.S. – the whole point was to physically distance him from as many people as possible. But for family members who flew to be near him in Nebraska, not to mention his caregivers who needed to check in on him regularly, quarantines are taxing both emotionally and in terms of the type of care able to be provided.

So the medical team turned to Vidyo, a video collaboration platform used in a variety of settings, but perhaps most notably by many telehealth providers, allowing caregivers and loved ones to interact with patients from a distance. Even though he was in biocontainment, he was not in total isolation.

“He’s in biocontainment, but his wife is communicating with him every day, all day long,” said Vidyo spokesperson Mari Clapp. “She was over video by his bedside. [She was] reading to him. That’s critical and meaningful. In addition, both nurses and doctors were able to communicate with him more frequently with less exposure.”

Ebola patient Dr. Richard Sacra speaks with his wife via Vidyo from the Biocontainment Unit. Photo provided by The Nebraska Medical Center via Vidyo.

Ebola patient Dr. Richard Sacra speaks with his wife via Vidyo from the Biocontainment Unit. Photo provided by The Nebraska Medical Center via Vidyo.

Platforms like Vidyo make up just one part of the burgeoning “remote” field of telehealth. While telehealth is historically an old-tech approach to delivering medicine long-distance and in a hurry – remember when people used to be able to pick up the phone and, gasp, ask their family doc a question – in its more technologically advanced state, replete with video, electronic medical records, and all sorts of medical accessories, it’s gone from a novel and not widely accepted concept 30 years ago to the next big thing in healthcare today.

Dr. Google

First, it’s clear that Americans are increasingly comfortable turning to the internet to gather health information (though whether the sources are reputable is another question entirely). Nearly three in four U.S. adults say they do this already, and one in three say they use the info they find to self diagnose, according to the Pew Research Center.

“Although little known by the public until recently, telemedicine has been in use for over 30 years,” Jonathan Linkous, CEO of the American Telehealth Association, said by email. “ATA has been around for the last 20-plus, allowing specialists to diagnose or monitor patients from a distance or rural residents gain access to far-away providers. Growth was slow at first, but has picked up significantly in the past few years. In fact, last year approximately 15 million people received telemedicine services in the United States.”

In August, the consulting firm Deloitte predicted that 75 million of the 600 million general practitioner visits in the US and Canada in 2014 would be e-visits. Further, even if just a third of office visits become e-visits, they could become a $50 to $60 billion market.

No wonder Google appears to be getting in the game with Google Helpouts. By linking its search engine directly to telehealth consultations during a “limited trial” that is currently free to use, the search engine giant is clearly trying to suss out market demand and viability.

Laws and regulations differ from state to state, as does acceptance from both within and without the medical field itself. But what type of care is and is not technologically possible to administer remotely?

The doctor is online

Veterans Affairs, which recently reported that nearly 700,000 vets are accessing at least one of its telehealth services in 2014, offers more than 44 clinical specialties via telehealth programs. As an example, one program at the Miami VA schedules close to 90 clinic connections every week for visits relating to dermatology, eye exams, podiatry, mental health and other clinical specialties.

ATA’s Linkous said that in addition to mental health services and the remote monitoring of chronic conditions, “New areas that are growing include more mainstream primary and urgent care, retail healthcare settings and mobile health applications.” When asked what sorts of care will simply never be possibly remotely, he replied: “Never is a strong word. With advancements in technology, we can’t rule anything out with ‘never.’ ”

Dr. Peter Antall. Source: Getty Images

Dr. Peter Antall. Source: Getty Images

Dr. Peter Antall, the president and CEO of Online Care Group, the country’s first online physician network that is used by telehealth service provider American Well, said that right now telehealth is “best-suited for dealing with minor acute problems – either illnesses or injuries.” He said telehealth doctors can also help “chime in” for patients having exacerbations of chronic illnesses – like an asthmatic who needs an inhaler refill. Sometimes a telehealth visit can also help people clarify whether they should or shouldn’t go to the ER – saving unnecessary visits (i.e. someone has a cold, not the flu) and prompting critical ones (one patient using American Well thought he had bronchitis and wanted antibiotics, but instead had a life-threatening pulmonary embolism).

Beyond acute and chronic care, general health questions are also commonly fielded remotely. Dr. Antall described a smoker looking for help stopping or someone seeking lifestyle changes after putting on 10 pounds. What telehealth should not do, he said, is “disintermediate care from one’s medical home, particularly their primary care.”

In the coming years, Antall and Linkous both point to better managing diabetes and mental health issues remotely, where access to care can be limited, expensive, and time-consuming for patients having to drive great distances on a regular basis.

Another change that’s bound to continue to push telehealth forward: Patient education. The more patients engage with healthcare providers online, the more comfortable they will become describing their symptoms, using accessories like stethoscopes, and understanding when a visit to a brick-and-mortar office is and is not necessary.

Connected devices and their impact on the healthcare system was a topic discussed at Structure Connect last week: check out the video of that session below:

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