Telemedicine is Expected to Revolutionize Health Care

July 05--At Wegmans, you can talk to a doctor and receive a prescription through an iPad at the store's pharmacy. If that's not convenient enough, you can download the Doctor on Demand app and get an online consultation anywhere with a cellphone connection.

Meanwhile, a St. Luke's University Health Network endocrinologist in Center Valley is seeing diabetic patients at Miners Memorial Hospital in Coaldale via advanced video-conferencing. And burn specialists at Lehigh Valley Health Network's main campus in Salisbury Township use "exam cam" to assess the wounds of patients in hospitals in other states.

These are all examples of telemedicine or telehealth, catch-all terms for the use of telecommunications to diagnose, monitor and treat patients from afar.

Although telemedicine has been around for decades, its prevalence and popularity has suddenly exploded, fueled by a powerful combination of market forces and technological advances. The shift is expected to revolutionize the health care industry.

"It's a whole new world," said Joe Tracy, LVHN telehealth services vice president. "We remember the old-fashioned house call. This is the new way to do that."

More than half of U.S. hospitals now use some form of telemedicine, according to the American Telemedicine Association, an industry group in Washington, D.C. Among the diverse beneficiaries are 1 million Americans using remote cardiac monitors.

Harrisburg, however, is playing catch-up. Pennsylvania is not among the 24 states (and the District of Columbia) that require private insurers to cover telemedicine the same as in-person services. As a result, only some insurance companies reimburse telemedicine costs. Of those, some do so only for certain customers, or certain procedures.

State Rep. Mark Cohen, a Philadelphia Democrat, has introduced legislation that would simplify matters. His bill requires insurers to reimburse for telemedicine if it's medically appropriate and "is expected to result in lower health care costs." Cohen said the new rules could alleviate Pennsylvania's growing doctor shortage and provide better access to specialists.

He said he was inspired by the memory of his deceased father, who suffered from irritable bowel syndrome. Had affordable telemedicine been around a decade ago, his father might have been able to get his painful condition properly diagnosed and treated earlier, Cohen said.

"It seems to me it would be a useful option," he said. "And it's generally an inexpensive option."

The savings wouldn't come to individual patients as much as to the system, which would cut costs by providing more primary care, which would then reduce hospital stays.

Though Cohen's measure has stalled, telemedicine advocates are hopeful a bill of some sort will be passed before the legislative session ends in 2016.

"There's an all-out effort to move legislation," said Charles Moran, spokesman for the Pennsylvania Medical Society, which represents doctors. "This is an issue they will have to address sooner or later. You cannot stop advancements in technology."

Those advancements are clear on multiple fronts.

Using teleconferencing equipment, a patient can talk to a remote doctor on a computer monitor. A nurse at the patient's side assists the doctor by using an exam cam to focus on a particular part of the patient's body, or perhaps a scope to peer into the patient's nose or ears. The doctor can see the patient's face and high resolution images captured by the exam cam or scope.

It's a lot like Skype or FaceTime, online video conferencing programs available to anyone with a computer and a high-speed Internet connection. But the hospital's feed is encrypted to ensure patient privacy.

Sharon Kromer, a nurse at LVHN, said she used to work with infectious disease doctors who would sometimes diagnose patients over the phone, relying on an examining doctor's descriptions. The technique, while necessary under certain circumstances, seemed inadequate, she said.

Then, about five years ago, she saw her first telemedicine demo.

"I was like, 'Oh my gosh, this is so cool. This is what we have to do,' " she recalled.

Today, LVHN's infectious disease doctors use that technology to examine about 30 to 40 patients a month, dramatically reducing the amount of time they have to spend on the road shuttling between hospitals.

"Think about the cost savings in transportation alone," Tracy said.

For LVHN's behavioral health doctors, telemedicine has resulted in a 75 percent reduction in travel and a corresponding 75 percent increase in psychological evaluations, according to Tracy.

Another beneficiary is LVHN's burn center. Because it is one of the few top-accredited facilities of its kind north of Philadelphia, hospitals in New York and New Jersey rely on its expertise and, when necessary, transfer patients to it.

One of the first challenges for these hospitals is to figure out if patients should stay put or be transported -- often at great expense. Telemedicine allows the LVHN specialists to weigh in on the tough call. If they don't have immediate access to a computer, they can view images on their cellphones.

Since 2008, the burn center has responded to more then 5,000 cases virtually, about a third of which resulted in admission to the center, according to Tracy.

Another facet of telemedicine is remote monitoring.

Every night at LVHN's Advanced Intensive Care Unit on Lehigh Street in Allentown, a doctor and several nurses monitor computer screens linked to patients in the network's hospitals. This frees up the nurses in the intensive care units to spend more time attending to and interacting with patients.

Since the unit was established a decade ago, the mortality rate of intensive care unit patients has dropped 31 percent, Tracy said: "If a patient is heading in a bad direction, we're going to catch that real fast."

During the day, the unit turns its attention to chronically ill patients -- those with congestive heart failure or diabetes, for example -- who live at home. Staff can check their vital signs, which are relayed by electronic devices.

St. Luke's has a similar program administered by its Visiting Nurse Association.

"It makes the world a little smaller for our providers, and takes some of the travel and anxiety away from our patients," said Dr. Marc Portner, St. Luke's chief medical information officer.

"We've done a number of patient satisfaction surveys," he added. "They love [telemedicine], and they feel like it has made a difference in their health."

Even so, the technology isn't without drawbacks, the most notable being that it keeps a doctor from actually touching a patient and from observing certain cues that sometimes aid in diagnosing a condition. It also puts distance between a doctor and patient, making the experience more clinical and impersonal.

For hospitals, cost is a drawback. Because insurance coverage for telemedicine is so spotty, St. Luke's and LVHN -- the region's biggest health care providers -- end up providing some services without reimbursement.

"If we waited for legislation to pass, we'd never make progress in health care," Portner said.

Some insurance companies, apparently, have reached the same conclusion. Capital BlueCross, which has a major presence in the Lehigh Valley, plans to cover virtual doctor visits for its PPO (preferred provider organization) plans in 2016, though not for its HMO (health maintenance organization) plans.

"This is great for the mom with the sick child in the night, and you know it's not emergency-room serious," said Rebecca Winemiller, a senior product strategy consultant with Capital BlueCross.

An early leader in this growing market is Doctor on Demand, which Wegmans began testing this spring at several locations, including the one on Tilghman Street in Allentown.

Doctor on Demand, whose founders include TV psychologist Phillip "Dr. Phil" McGraw, is based in San Francisco. It uses more than 1,000 doctors -- mostly on a contractual basis -- in 47 states and Washington, D.C. The doctors communicate with patients via an app that can be downloaded onto cellphones, tablets and laptops. Consults cost $40 for 15 minutes. (At Wegmans, the first one is free.)

It won't be long -- perhaps a year -- before St. Luke's offers a similar service, Portner predicted.

"What we're trying to do," he said, "is keep our patients at home, where they want to be, and healthy."

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