Telemedicine Unbound: Applications for Remote Care Continue to Expand

By Melissa Moore
Monday, January 30, 2017

As more patients become interested in remote visits, some observers say telemedicine is lowering costs and improving care.

When parents in Arkansas receive a call from school informing them their child is ill, the call may come with a ready diagnosis and, if necessary, a prescription. That’s because recent legislation allows children to see a physician via teleconference in their school nurse’s office. Telepediatricians with Arkansas Children’s Hospital can diagnose rashes, colds, ear infections and other common ailments.

That is just one example of the growing availability of and investment in telemedicine. According to a survey from global management consulting firm Oliver Wyman, by late 2015, 57 percent of consumers were familiar with the concept of a health and wellness visit conducted remotely via phone, voice chat or video chat — up from 43 percent in 2013. Research from the National Business Group on Health found that 90 percent of employers will make telehealth services available in states where it is allowed, and it is expected that virtually all large employers will offer telehealth by 2020.

Patients’ willingness to receive care in new ways, such as telehealth, is no longer a matter of conjecture, says Graegar Smith, Principal in Oliver Wyman’s Health & Life Sciences Practice and lead author of the report.

“Consumers have spoken; the new front door is here,” Smith stated in a news release about the survey findings. “It’s up to healthcare providers, insurers and retailers to build it in a way that has meaning, impact and value.”

Improving Primary Care

The Oliver Wyman survey found patients desire virtual care for a wide range of primary care needs, with a quarter of patients willing to seek diet, nutrition, fitness and well-being advice via telemedicine.

The Clickwell Care model at Stanford Medicine was implemented as a way to reach the 20 percent of patients who had no contact with their primary care provider. A year after Stanford Medicine expanded hours at a conventional urgent care center and added virtual visit functionality and wellness coaching, approximately three-fifths of the clinic’s visits during that time period had taken place virtually rather than in person. Additionally, the cost of the virtual clinic was 30 percent lower than comparable in-person clinics — in part because of reduced staffing needs. Assessing Stanford’s initiative, Advisory Board, a best-practices firm, found patients in the virtual setting achieved weight loss goals 78 percent of the time and goals to reduce stress 93 percent of the time.

NewYork-Presbyterian Hospital also saw success with the NYP-Weill Cornell ED Telehealth Express Care Service. Within two months of launching the service, the average length of emergency room visits for patients with minor complaints dropped from four hours to 30 minutes, according to a late-2016 article in Healthcare IT News.

Telehealth shows promise for management of chronic conditions as well. A systemic review published in Telemedicine and e-Health found that patients with chronic heart failure fared better in a telehealth setting than under more conventional care. Patients who completed virtual visits had fewer episodes of worsening health and had general improvement in clinical, functional and quality-of-life status. Telemedicine reduced the rate of hospital readmissions, length of stay and emergency department visits.

Specialized Care for Underserved Populations

Primary care physicians picking up the phone to consult with specialists is nothing revolutionary. However, Richard Lawrence Merkel Jr., MD, PhD, Associate Professor of Psychiatry and Director of Outreach at the University of Virginia, notes that telehealth providers are now using a collaborative model of care in which the remote specialist is a virtual member of the local team. More than just a one-time consult, a collaborative model allows the specialist to provide ongoing education and support for primary care providers.

Dr. Merkel and the University of Virginia have been providing telepsychiatry services in rural Virginia for approximately a decade. He notes that in addition to providing support for often overwhelmed primary care physicians and nurse practitioners, telepsychiatry has multiple benefits for patients.

“Telepsychiatry is relatively easy to do and just as, if not more, effective than face to face when it comes to treating psychological and substance abuse problems,” Dr. Merkel says. “Morbidity and mortality rates come down significantly. In these rural areas, the stigma of seeking treatment for mental health is very high. When you go to see a counselor, people know quickly you have gone there. When a patient goes to a primary care or nurse practitioner office, no one knows why — it could be diabetes or a hundred other things. It’s easier for patients to feel more comfortable getting care.”

Training the Next Generation

For specialty clinics looking to bring mental health care to rural or other underserved areas, finding clinicians trained in providing those services via telemedicine can be a challenge. At the Texas A&M Telehealth Counseling Clinic, doctoral students in psychology provide counseling remotely to patients in the rural areas of the Brazos Valley region.

“All of health care, not just telehealth, is expected to use technology, but training programs are significantly lagging in training students,” says Carly E. McCord, PhD, licensed psychologist with the Center for Community Health Development at the Texas A&M School of Public Health and Director of Clinical Services at the Telehealth Counseling Clinic. “I strongly believe that the future generation of health professionals should have the knowledge and skills required to use telehealth.”

In addition to providing training for future psychologists, the Telehealth Counseling Clinic generates significant savings, McCord says. That’s because patients in rural areas with otherwise little access to mental health services do not need to rely on emergency care during a mental health crisis.