In the just released issue of Telemedicine and e-Health, Doan and Merrell’s editorial addresses robotics in telemedicine. The editors write “Telemedicine, telehealth, and robotics are a few innovative approaches to alleviating the stress on an overburdened system. While technology continues its march forward, often unabated, the culture of medicine has not changed as rapidly. There are many individuals and health systems across the United States and the world that are reticent to change. Perhaps it is a lack of understanding or a fear of change or even a level of trust in the technology. Clearly a robot in a nursing facility that is driven by a remotely located physician who is in contact with the on-site nursing staff can add tremendous value. Robots have added value both in clinical settings and in the educational setting.”
The AMA is pleased to announce the formation of a CPT® Telehealth Services Workgroup, which will be chaired by members of the CPT Editorial Panel. The workgroup will be comprised of relevant medical specialties/organizations and industry stakeholders. The workgroup will recommend additions and changes to the CPT code set related to medical services utilizing telehealth technology. The charge of this ad-hoc workgroup is to:
- Recommend solutions for the reporting of current non-telehealth services when using remote telehealth technology (to include but not limited to E/M services). Considerations will include potential new codes, use of current codes without or with modifier, add-on code(s).
- Address the accuracy of current code set in describing the services provided when telehealth data is reviewed and analyzed, including potential code set revisions and/or education for:
- Appropriate code use (e.g., E/M versus data analysis codes);
- Potential code development to report analysis of transmitted data;
- Definition of data types whose interpretation will require differentiation and consideration of separate reporting of current E/M services/codes
- Potential new E/M services codes based on emerging new patterns for sites of service.
- Recommend whether any other telehealth service codes should be developed based upon services currently being provided.
- Develop new introductory language or modify existing introductory language to guide coding of telehealth services.
The workgroup will also help facilitate discussions with key stakeholders who may wish to bring forward telehealth services applications for consideration. According to the CPT Editorial Panel AdHoc Workgroup Organizational Structure and Processesguidance, all workgroup recommendations will be presented in a Code Change Application(s) for consideration by the CPT Editorial Panel. Participation in the Telehealth Services Workgroup does not preclude the submission of a separately developed code change application for consideration by the Editorial Panel.
In the Wall Street Journal Opinion page on August 3, 2015 , Dr. Richard Boxer who is chief telehealth officer of Well Via and former CMO for TelaDoc discusses the efficiency of getting a doctor on the phone within minutes, all courtesy of the utilization of telemedicine. He stresses a new found efficiency in a highly inefficient healthcare system. Emphasizing that over 100 million people are living in under served areas where major shortages of primary care physicians leave this population vulnerable, telemedicine helps to lessen the severity.
Economically, Boxer reports that 136 million ER visits could have been replaced by a $50 telemedicine consultation. Coupled with the anticipated 52,000 primary-care physician shortage by 2025 the crisis has already begun. Looking to train more physicians won’t do it. Advanced practice nurses helps but is not the solution. Anticipated health workers graduating from community colleges is a feel good thought without real power.
While no one is stating or hoping telemedicine will replace the live physician encounter, states and the federal government need to address how to engage and incorporate telemedicine into main stream medicine today, not tomorrow. How? Dramatic and commonsense inter-state licensure approval. Just as we have one drivers license good in all 50 states, with proper oversight why shouldn’t a California license be recognized in New York or any other state? After all, the European Union is light years ahead by recognizing other country medical licenses.
It is up to the public to jump on their legislatures to help move this along if they wish to avoid long waits or even worse, no access for their primary medical needs. Telemedicine is certainly a solution.
Lancet Psychiatry. 2015 Aug;2(8):693-701. doi: 10.1016/S2215-0366(15)00122-4. Epub 2015 Jul 16.
Many older adults with major depression, particularly veterans, do not have access to evidence-based psychotherapy. TelePsychotherapy could increase access to best-practice care for older adults facing barriers of mobility, stigma, and geographical isolation. We aimed to establish non-inferiority of behavioural activation therapy for major depression delivered via telemedicine to same-room care in largely male, older adult veterans.
In this randomised, controlled, open-label, non-inferiority trial, we recruited veterans (aged ≥58 years) meeting DSM-IV criteria for major depressive disorder from the Ralph H Johnson Veterans Affairs Medical Center and four associated community outpatient-based clinics in the USA.
- Between April 1, 2007, and July 31, 2011, we screened 780 patients,
- Treatment response according to GDS did not differ significantly between the telemedicine and same-room groups.
- Response on the Structured Clinical Interview for DSM-IV, clinician version, also did not differ significantly
- Results showed that no significant differences existed between treatment trajectories over time for BDI and GDS. The criteria for non-inferiority were met. We did not note any adverse events.
TelePsychotherapy for older adults with major depression is not inferior to same-room treatment.
This finding shows that evidence-based telepsychotherapy can be delivered, without modification, via home-based telemedicine, and that this method can be used to overcome barriers to care associated with distance from and difficulty with attendance at in-person sessions in older adults.
US Department of Veterans Affairs.
The failure to provide timely acute illness care can lead to adverse consequences or emergency department (ED) use. We evaluated the effect on ED use of a high-intensity telemedicine program that provides acute illness care for senior living community (SLC) residents.
MATERIAL AND METHODS:
- We performed a prospective cohort study over 3.5 years.
- Six SLCs cared for by a primary care geriatrics practice were intervention facilities, with the remaining 16 being controls.
- Consenting patients at intervention facilities could access telemedicine for acute illness care.
- Patients were provided patient-to-provider, real-time, or store-and-forward high-intensity telemedicine (i.e., technician-assisted with resources beyond simple videoconferencing) to diagnose and treat acute illnesses.
- The primary outcome was the rate of ED use.
- We enrolled 494 of 705 (70.1%) subjects/proxies in the intervention group;
- 1,058 subjects served as controls.
- Control and intervention subjects visited the ED 2,238 and 725 times, respectively, with 47.3% of control and 43.4% of intervention group visits resulting in discharge home.
- Among intervention subjects, ED use decreased at an annualized rate of 18% (rate ratio [RR]=0.82; 95% confidence interval [CI], 0.70-0.95), whereas in the control group there was no statistically significant change in ED use (RR=1.01; 95% CI, 0.95-1.07; p=0.009 for group-by-time interaction).
- Primary care use and mortality were not significantly different.
High-intensity telemedicine significantly reduced ED use among SLC residents without increasing other utilization or mortality. This alternative to traditional acute illness care can enhance access to acute illness care and should be integrated into population health programs.
COMMENT: A very nice introductory cohort study on a very pertinent topic. Hopefully to follow will be a prospective randomized study looking at both outcomes and financial data. Additionally, for those seen through telemedicine, following the ED admission course would be important.
by HIT Consultant Staff 07/15/2015
Approximately 75 percent of patients reported they either would not trust a diagnosis made via telemedicine, or would trust this method less than an in-doctor visit, according to a recent nationwide study conducted by TechnologyAdvice Research. The report reveals that although telemedicine initiatives may have a promising future to increase reliable access to basic and preventative care, patients remain dubious about this remote option and the quality of diagnosis made during virtual appointments. Nearly 65 percent of respondents said they would be somewhat or very unlikely to choose a virtual appointment known as a telehealth visit, while only 35.4 percent stated the opposite.
Telemedicine is a newer technology in the medical industry, with greater lack of familiarity, but data from the study shows that younger patients may be less skeptical. Only about 17 percent of 18-24 year old respondents, and 24 percent of 25-44 year olds, said they wouldn’t trust a virtual diagnosis. Also, 65 percent of respondents said they would be somewhat or much more likely to use a virtual appointment system if they had first seen the doctor in-person.
“If patients don’t trust the diagnoses made during telemedicine calls, they may ignore the advice given, fail to take preventative steps, or seek additional in-person appointments, which defeats the point of telemedicine,” said Cameron Graham, Managing Editor at TechnologyAdvice and the study’s author.
Increasing Telehealth Adoption
To increase acceptance of telemedicine and use of such services, healthcare providers and vendors need to focus on effectively explaining the advantages of these platforms. A combined 70 percent of respondents reported at least one of the following factors would make them more likely to use a virtual appointment: more convenient scheduling options, lower cost, less time spent in the waiting room, and ability to conduct virtual appointments at home.
The original data contained in the report comes from a nationwide internet survey of 504 U.S. adults (age 18 and over). The survey participants were surveyed about their preferences and feelings regarding telemedicine services. It is important to note the small size of the survey participants when reviewing this report and others.
Comment: The key portion of this story is the last paragraph. That tells all as it is a very small sample size. This statistically shallow survey is making headlines and certainly for those who deal with hospital patients would never suspect this as an issue.
At ATA 2015 (American Telemedicine Association), held in Los Angeles, a milestone was achieved as over 5,000 attendees from around the world stormed the LA Convention Center. The content of the symposium keeps getting better, ranging from lightening rounds to superb plenary sessions. What particularly struck me was that the keynote speakers, both physicians in different areas of medicine both understood and support telemedicine as an integral part of healthcare delivery. Dr. Sanjay Gupta, chief CNN medical correspondent, had previously done a story on telemedicine featuring Yulun Wang, CEO of InTouch Health. Dr. Patrick Soon-Shiong, an entrepreneur and brilliant visionary, has already embarked upon ways to treat cancer utilizing mobile health. The exhibit hall allowed one to roam a roomy exhibit hall to see new and established medical product and software companies display and explain their technology. Based upon the opinion of those in attendance, the ATA is striving toward increasing the content experience. Looking optimistically to another high level meeting in Minnesota for ATA 2016.