In Maryland, intensive care unit patients in 11 hospitals — 10 of them in sparsely populated rural areas — now have instant access to top specialists across the state through video cameras installed in their rooms.
In Oregon, stroke victims at some two dozen medical sites can be evaluated instantly and around the clock by neurologists.
In hospitals and medical centers across the country, telemedicine — the diagnosis and treatment of patients using telecommunications technology — is transforming the delivery of a growing portion of health care services. Just one example: Kaiser Permanente CEO Bernard Tyson recently announced that his health system is now seeing more patients online than in person.
Experts agree that the use of telemedicine is only going to grow.
“It’s starting to really catch on,” said Dr. Marc T. Zubrow, vice president of telemedicine for the University of Maryland Medical System. “I think this is the future. … In 10 years, there’s going to be a huge paradigm shift in a lot of the things we do in medicine — dramatic changes.”
Dr. Archit Bhatt, medical director for telestroke at Providence Health and Services in Oregon, said his system’s telestroke program is booming and now provides about 1,000 consultations a year. In the process, he said, it has given thousands of patients access to expert diagnoses and effective treatments they probably wouldn’t have gotten before — a key selling point of telemedicine.
The success has prompted Providence to explore other uses for telemedicine, such as telepsychiatry.
Bhatt conceded, however, that telemedicine has its limits.
“We have a long way to go for other non-stroke and non-neurological issues,” he said. “There are several barriers.”
That barriers remain for telemedicine is undisputed.
A study published in January 2015 by the American Hospital Association concluded that while telemedicine (sometimes called telehealth) is “increasingly is vital to our health care delivery system,” there are also “significant legal and regulatory challenges posed by telehealth technologies.”
Among those challenges, according to the AHA, are licensure (generally, physicians have to be licensed in the state where the patient lives, so treating patients across state lines is tricky), liability, privacy, security, and a “patchwork of reimbursement rules and rates.”
Zubrow mentioned one more impediment: Resistance from some physicians, most frequently, older physicians.
“We rarely run into patient or family resistance, but there’s a lot of physician resistance, for whatever reason,” he said. “It’s not traditional, not the Marcus Welby way of doing things.”
Even the most enthusiastic advocates say telemedicine does not work for some types of medicine.
“Obviously, there are some things you can’t do very well — some things where someone has to touch the patient, to see what’s going on has to be in the same room,” said Dr. Steve Ommen, medical director at Mayo Clinic’s Center for Connected Care.
Ommen said he expects the medical community to “re-examine” what needs to be done to advance telemedicine — and not just with video cameras.
He noted, for example, that devices already exist that allow someone to listen to a patient’s heart and lungs remotely, not to mention monitor blood pressure, weight, and other health factors. Those devices will be used more and more in the future, he said.
“Even just exchanging text messages, in a secure environment, can be helpful,” Ommen said.
To avoid “depersonalizing” medical care, Ommen said, physicians will have to figure out the proper balance between the convenience and advantages of telemedicine and the need for in-person visits and touch. “We don’t know all of that yet, but I think we’ll learn it organically,” he said.
As for telemedicine’s advantages, advocates say they are legion. The American Telemedicine Association lists a handful, including: improved access to expert health care, especially in less-populated areas; reduced or controlled costs due to increased efficiency, better management of chronic diseases, shared staffing, reduced travel times and shorter hospital stays; and equal or even better quality of care, especially in services such as mental health and intensive care.
Jonathan Linkous, CEO of the American Telemedicine Association, said telemedicine is growing faster than expected. In the past 24 months, he said in an email response to questions, the number of patients served has increased by about 30 percent.