The clinic's electronic intensive care unit, known as eICU, is one of the frontiers of telemedicine. Backed by Dr.
They zoom in remote video cameras to get detailed focus on individuals. They watch blood pressure numbers and respiration. They talk to patients. If they need to insert a breathing tube or reinflate a collapsed lung, they contact technicians at the hospitals where the patients are located and tell them what to do. They also listen to those technicians' feedback on how patients are progressing.
But even as they deliver intensive care in hospitals that could not otherwise provide it, government and private health insurance companies are not reimbursing them.
Telehealth is another name for telemedicine, but whichever term you choose,
That's why the lack of deadlines in "21st-century cures" legislation winding its way slowly through
To others the jury is still out.
Telemedicine for certain services is "equivalent to face-to-face treatment," said University of
New legislation that orders the
The House has not voted on that bill and the
Mayo will remain a financial powerhouse without extended
But to Mayo and other health care innovators across the country, telemedicine will play an increasingly major role in the future of effective and affordable health care. They think federal policies which recognize that fact make more sense than forcing care providers to overcome licensing restrictions as well as payment restrictions as they remotely treat ICU patients, remotely diagnose strokes, remotely direct the delivery of babies and remotely monitor patients in real time in their homes.
Twenty-seven states, including
As a result, hospitals outside the Mayo health system pay a subscription fee for Mayo's telestroke diagnosis, while the clinic picks up the tab for those within its health system.
Mayo began paying for the eICU in
From a care delivery perspective, the scope of eICU services around the country and the world is limited only by the existence of reliable, secure information technology networks, Brown said. Health care facilities in the
But as a practical matter, eICU's broader application lives and dies at the will of
"It takes a longer vision than what some people in the health care community have," Brown said. "It's kind of shortsighted what's happening now."
"Limited reimbursement continues to be a major barrier to the expansion of telehealth," the
Mayo and institutions around the country claim that
"This isn't just for people living in some rural outpost," said Mayo connected care director Dr.
Connected care extends beyond eICUs or "telestroke diagnosis" to such things as sharing electronic medical records, video consultations between doctors at different facilities and the use of more wearable devices by patients. It embraces a broad concept of prevention "so patients don't just come in when the wheels fall off," Ommen explained.
House leaders have not done that, according to the
Getting doctors licensed to practice telemedicine in several states is another sticking point. The
What people like Linkous and Ommen say they want is a nod to the future instead of the past.
Said Ommen: "To those of us involved in telemedicine, it is inevitable that we will practice this way."
'Carrying on as usual'
When she ran into complications delivering babies as a midwife in rural
Todd, 80, offers her observation as she walks around her
Todd welcomes the technology. She has not gotten a bill or a notice of insurance coverage yet, so she doesn't know what her share of the costs will be. Meanwhile, she hopes the data collected at her home will allow doctors to figure out why she's had a series of ministrokes.
Whether or not it does, the monitor has left her "quite confident that this is taking care of any problems that erupt."
"I've been carrying on as usual," she said. "I have two kids and five grandkids. I just had them over for dinner and had no problem at all."
This is what Dr.
At first, he focused his efforts in getting electrocardiograms read quickly for inpatients at Mayo.
"We have a turnaround time of less than 20 minutes," he said. "We have saved lives with that."
Now, technicians remotely track a number of other signs of physical health among the hospital's patients. But they are also extending that analysis beyond the institution's physical space to places like Todd's house.
The greatest challenge is not gathering information, Brady said. It is figuring out how to manage it.
"When I speak to physicians about home monitoring, they roll their eyes. We need to organize the avalanche of data that is available in a way they can use it."
As she looks at a graph of a remote patient's current heart activity, monitoring lab manager
Nearby, Brady considers this and other advances in remote information gathering and care delivery that he thinks can save lives while letting the health care system save money. Then, he thinks about the way those services are being paid for.
"The technology," he concludes, "is way ahead of anything in terms of reimbursement."
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