To be honest, I was skeptical about telemedicine. As a preceptor, I’ve spent most of my career training PA, NP, and DO students on the importance of physical exams. One of the first “pearls” I taught was to put your hand gently on someone’s shoulder as you auscultated their heart and lungs. When you are giving them bad news, always look them in the eye. Show the patient that they are not your “2:00″ or a “gallbladder in room 6″ but rather Mr. Jones, with a wife, two kids, and a dog named Patches.
Medicine is personal, right? Telemedicine seemed antithetical to my beliefs about connecting with patients.
Resistance Is Futile
Last year, I started a new job that required the use of telemedicine. I was resistant to embracing a technology that I thought would come between my patient and me. As part of training for my new position, I observed a telemedicine encounter between my colleague and a nurse at another site. It was this encounter that completely changed my view of telemedicine.
On the other side of the camera, the patient was fully engaged and excited to use the technology. The telesteth used was better than my everyday cardiology-grade stethoscope. An interactive screen allowed my colleague to guide the nurse to place the telesteth exactly where she needed to listen. The lung sounds were remarkably clear. The panoptic otoscope provided a bright, sharp image of the tympanic membrane and nasal turbinates. I could see mild erythema and cobblestoning in the posterior pharynx. The patient was able to see inside their own ear canal, too, making it much easier to explain findings and discuss treatment. When it comes to telemedicine, seeing and hearing is believing.
From that day on, my perspective was very different. After using this approach for more than a year now, I have discovered that the only disconnect when on this type of telemedicine encounter is the same as in any office setting — a human disconnect, not a technological one (e.g. I was having a hurried day, the patient was tired, etc.).
A Business Case for Telemedicine
In my current role managing a corporate health and wellness clinic, I perform preventive and acute care exams on-site or remotely via telemedicine to broaden our employees’ access to care. For businesses that are self-insured, this can mean tremendous savings for a company. Instead of an employee going to the ED after work for an ear infection, he or she can receive convenient, quality care for a fraction of the cost. This also helps minimize productivity loss.
Outside of a corporate setting, there is an increasing demand for care after traditional office hours, and many practices scramble to meet this need with overextended staff. Patients also want healthcare on demand. They want to be seen when they are sick, not three weeks later when there is an opening in their provider’s schedule. Telemedicine meets these needs and appeals to more tech-savvy patients.
Telemedicine also expands specialists’ reach and helps bring better care to rural health centers. With real-time and store-and-forward technologies, imaging/testing can be sent to remote specialists for consultation on neurologic evaluations, psychiatric care, and dermatology consultations, among other needs.
These benefits — patient convenience, expanded care, lower costs — are some of the driving factors in the projected 18–30 percent annual growth in telemedicine over the next few years, according to The Institute for HealthCare Consumerism.
Growing Pains
As with any new technology, telemedicine faces a number of growing pains, primarily in the form of state legislation. Many states have yet to create laws to address telemedicine, whereas other states have overreaching barriers to practice. These laws are changing so rapidly that even organizations that focus on telemedicine can’t keep up.
Three major areas of debate in state telemedicine legislation are:
- Establishing a provider-patient relationship. Is a face-to-face meeting required to establish this relationship? Does a provider need to be licensed in the same state as the patient?
- Defining telemedicine technology. Does telemedicine include email and voice-only interaction? Should it be a secure real-time, remote monitoring, or store-and-forward technology? Are mobile communication devices (mHealth) included? How do we protect patient privacy?
- Reimbursement. Should these encounters be reimbursed at the same rate as an office visit? Should they only be reimbursed in certain settings, such as in rural and underserved communities?
In addition to these issues, lack of license portability continues to create barriers to patient care in most states. Nurse practitioners and physicians now have compact licenses (just approved in the past year), but this is still in development for PAs. In addition, archaic laws that mandate “supervision ratios” for PAs and APRNs continue to unnecessarily burden medical practices and companies that wish to hire these providers for telemedicine positions.
Telemedicine Jobs
With the double-digit growth in the use of this technology, there are plenty of telemedicine jobs. If you are ready to pursue telemedicine, there are several important factors to consider:
- Do you already have a license in the state(s) where the company or medical practice operates?
- Will the company provide you with training?
- Are the costs of additional licenses, malpractice, etc. included?
- If you are a PA or APRN, you need to be aware of prescriptive rights in each state in which you treat patients.
Also, review the types of encounters you will be expected to evaluate. The American Telemedicine Association (ATA) offers a list of encounter types it feels are appropriate for telephone versus video interaction.
Looking Forward to Telemedicine
If you had told me 18 months ago that I would be excited to use my computer to interact with a patient in a different city, I would have laughed. How can I provide quality medical care if I can’t physically touch the patient?
After learning more about telemedicine and using this approach to treat patients successfully, I have seen the future of medicine. Telemedicine can be an effective and engaging approach to providing healthcare. I am ready to embrace the change. Are you?
If you have questions about finding telemedicine jobs, please comment below or tweet us @bartonlocums.
