Last week I was scheduled for a lab test to ascertain if my blood glucose readings were stabilized by diet and medication, however, I wasn’t sure if this test required a fasting protocol or a non-fasting one. Until recently, to determine which of these was required for an accurate test I would have had to call the doctor’s receptionist in the hopes of being connected to the nurse.  If this failed, I would have been forced to leave a message on their already overloaded answering machine and hope against hope that a live person would actually return my call.

However, this time I had a totally different experience thanks to Express Health, a new system implemented by our local hospital. Through this new service I was able to contact and receive a prompt reply, to my inquiry, directly from the Express Health website. In addition, once the lab tests are analyzed and sent to my doctor, an email will alert me that the report is available for my perusal. Though to some this may seem of only a minimal improvement or upgrade to our health services; I personally find it an innovative and a phenomenal upgrade to the archaic system that had been in place for decades.

However, while I am impressed with getting results quickly and painlessly, I can’t help but wonder if we are looking at the advent of a new horizon of what is being called Telemedicine and/or Telepsychiatry. If you haven’t yet heard of these new medical disciplines, they are technically a way for doctors to treat you from your home without your having to visit their office. As a result of the current economic climate these telemedicine and telepsychiatry e-Health sites make sense since they will eliminate expenses on the parts of both the doctor and the patient.

This is how the new e-Health proposals currently function and what may need to be accomplished before they are considered mainstream.

What is Telemedicine?

Telemedicine is the practice of treating a patient’s minor or routine ailments through a secure computer network. It allows for

  • The patient to visit their physician from the comfort of their homes or even from work.
  • Video conferencing that will enhance the experience by allowing face to face contact.
  • Follow-up examinations to be performed over video or, if necessary, for a physical office visit to be scheduled.

What are the benefits of Telemedicine?

  • You can receive treatment and healthcare provided to you, no matter where you are; be it in the middle of New York City or in the middle of the Sahara.
  • Many insurance companies, including Medicare, recognize the importance of  Telemedicine to keep medical costs under control.
  • Many insurance companies, including Medicare, are now reimbursing care via a virtual office visit.

The importance of this new virtual doctor’s office was obvious when in 2011 California’s, Governor Jerry Brown signed Assembly Bill #415 into law. The statute’s intent was to enhance Telemedicine, which California renamed  Telehealth, by outlining what Telehealth is and framing reimbursement requirements that would be needed to bill Medi-Cal. A quick outline of the bill follows:

AB 415 will :

  • Change the legal terminology of “telemedicine” with “telehealth;” and also update the definition of telehealth to reflect more of services in use today.
  • Make changes for the need of additional written patient consent and removes the Medi-Cal rule requiring documentation.
  • Eliminate previous restrictions on reimbursement of services provided via email or telephone and all restrictions on the physical location, such as doctors’ offices,
  • California hospitals will be allowed to use new federal rules to establish medical credentials of telehealth providers.

AB 415 does not:

  • Instead of replacing medical health care providers the bill will enhance doctor-patient relationships and will not change the practice of any licensed health care provider.
  • The new bill will not change existing nor future agreements between health plans and any provider.
  • Nothing in the new bill will remove or take away any of the decision making  that health plans, providers or insurers have with regards to controls and procedures of the new technology.

With this bill California seems to be at the forefront of a new age, and may well be setting the model for other states (Possibly even the Federal government) to emulate. Of course, an important consideration of this process, that is yet to be proven, is if it will work. In other words, will changing the reporting requirements and the services that can be reimbursed really reduce the  slew of red tape that is now required, thus creating an environment in which Telemedicine is in a better position to compete with the traditional doctor’s office visit.

Here are a few of the additional benefits of Telemedicine, Telehealth and Telepsychiatry:

  • Improved treatment and confidence in rural doctors who can consult with a specialist, in real time, while the patient is present.
  • After surgery: a patient can be observed while resting in their own bed at home; thus eliminating the need for an extended stay in an expensive hospital room.
  • Less cost for the patient and their families: Remember that families are unlikely to leave loved ones alone in a strange city and will thus incur expenses for motel rooms, dining out, and extra gasoline. This was brought home to us when my brother-in-law was hospitalized for heart problems and his family had to drive some 120 miles round trip or pay to stay in a motel.
  • Confidentiality: this is enhanced since no one else needs to know that you met with your primary doctor or even consulted a specialist.
  • These sites will allow patients access to classes on nutrition, diabetes education, oncology instructions, or any other medical led programs from the comfort of their chaise lounge.
  • These sites will also assist medical personnel by reducing the number of patients seeking treatment at ER rooms; be it because their doctor’s office is closed, they couldn’t take off work, or because they don’t currently have their own primary care physician.

In the realm of Telepsychiatry, one must realize that there are going to be some limitations that could hinder it from becoming a reliable means of treating those with mental illness issues. The limitations include the fact that even with one on one contact there are some mental issues that are too serious to be treated out of a hospital. Therefore, it seems to me that the primary use for Telepsychiatry may be limited to the treatment for anxiety and depression disorders. However, in these cases, the benefits for Telepsychiatry include not only ready access to your psychiatrist or psychologist, but extends to those with agoraphobia, claustrophobia, and certain anxiety and panic disorders that make it difficult for them to travel through congested areas.

Some of the challenges that Telepsychiatry may face are:

  • Some health plans do reimburse Telepsychiatry services or do so at a lower rate than what is provided for in-person treatment.
  • Medicare reimburses Telepsychiatry services only where there is a shortage of therapists in a given area.
  • There is also a concern that remote therapists may not be able to respond quickly in the event of a patient crisis.

Once these problems are addressed and dealt with, however, I believe that more doctors will get on-board and patients will be willing to accept a  remote diagnosis as an alternative to visiting their physician’s office. I, for one, would be quite happy to find a means of reducing health care costs and if  Telemedicine, Telehealth or Telepsychiatry services are the wave of the future you can sign me up for my surf board.

Comments welcome.

cc image via marsmet521