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Telemedicine Basically Healthy, with Some Complications

Carl Weinschenk

One of the feel-good stories (both literately and figuratively) of the modern telecom age is telemedicine. It’s a win all around: Patients in rural areas get better care and the dislocation of an elderly or sick person traveling to a hospital and staying away from home is reduced. Facilities free up space and manpower and lower costs.

That all sounds great. What kind of traction and reaction are these services receiving, however? The Advisory Broad Company has conducted a Virtual Visits Consumer Choice Survey to find out.

The results, according to the Healthcare Informatics Institute, should please advocates of telehealth. The survey found that 77 percent of consumers would use virtual access to health care, and 19 percent of respondents already have.

The survey of 5,000 people captured attitudes about 21 primary and secondary care scenarios. The top type of virtual visits – prescription questions or refills, pre- and some post-surgery meetings and others – were supported by more than 70 percent of respondents. A majority of respondents were open to virtual visits in all of the 21 categories.


The survey found that the top concern of patients was quality of the care (21 percent) and the likelihood that a diagnosis would be impossible and a physical visit would be necessary anyway (19 percent).

The biggest drag on use, the survey revealed, is physician resistance. Indeed, the reality of something as ambitious as telehealth is that some feathers will be ruffled. Today, mHealth Intelligence reported that legislators in New Jersey are battling over a provision in Assembly Bill 1464. The amendment stipulates that after a three-year grace period, physicians would be required to physically meet with new patients. The provision is leading to a loss of support for the bill, according to a lobbyist quoted in the story.

The issue points to the bigger point: Telehealth changes the doctor/patient relationship in ways that are significant -- and perhaps not liked by all:

The doctor-patient relationship is a tricky issue in telemedicine, with some physicians and physicians’ groups arguing that a doctor should meet in person with a new patient before switching to telehealth. The debate clogged efforts by the American Medical Association to draft ethical rules for telemedicine until last year, until the organization OK’d a document that’s favorable to telehealth.

The issue seems to be that there are good reasons for a personal meeting. But when do those good reasons become a shield for local providers protecting their turf?

HPPR posted a story that begins with a nice vignette of a telehealth consultation (a woman had symptoms that suggested a small stroke but will be okay). The Kansas House Health and Human Services Committee is considering a bill to encourage telehealth. It has powerful foes, however: Blue Cross and Blue Shield of Kansas and other insurers. They say that the approach makes it hard to price care accurately and may lead to higher premiums. Cases in which a physical follow-up is necessary may lead to two charges to the insurance company.

In the past, there have been liability questions as well. If, for instance, a patient is in Kansas and the telehealth firm with which she is dealing is in Nebraska, what laws are used if a legal issue emerges? Even more basically: Does a doctor in one state have the right to prescribe drugs in another?

Clearly, the promise of telehealth is profound. It is just as obvious, however, that lots of issues must be overcome.

Carl Weinschenk covers telecom for IT Business Edge. He writes about wireless technology, disaster recovery/business continuity, cellular services, the Internet of Things, machine-to-machine communications and other emerging technologies and platforms. He also covers net neutrality and related regulatory issues. Weinschenk has written about the phone companies, cable operators and related companies for decades and is senior editor of Broadband Technology Report. He can be reached at cweinsch@optonline.net and via twitter at @DailyMusicBrk.

 


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