The house call is back — with a high-tech spin.
In a bid to accommodate the aging population and the increasingly hectic lifestyles of their patients, physicians are embracing a broad spectrum of Web-based software solutions that are bringing healthcare services into the home.
From real time videoconferencing to secure online chats, telehealth is not only changing the way care gets delivered, but helping to improve medical outcomes by making care more accessible to patients who lack easy access, according to Ronald Dixon, a practicing general internist and director of the Center for Integration of Medicine and Innovative Technology, CIMIT, in Boston.
“We do a lot of chronic disease management in primary care, which is where telehealth is the most valuable to me,” Dixon said.
Patients with hypertension, diabetes, depression, coronary disease and other chronic illnesses, for example, can connect with doctors in his practice via a secure patient portal from their home or office computers and ask questions, or complete quick follow-up visits online — appointments they would otherwise be less likely to keep.
Virtual visits are also ideal for the growing number of elderly patients who are too frail to travel, those in rural locations, young mothers who can’t find or afford childcare, and busy professionals who have difficulty taking time off during the work week, which is fueling demand for remote patient monitoring.
Datamonitor, the London-based market research firm, estimates the market for telehealth services in the U.S. and Europe will grow from $3 billion in 2009 to nearly $8 billion by 2012.
A 2010 survey by Intel also found that 89 percent of health care decision makers believe telehealth will transform health care over the next 10 years.
Some two-thirds of health care professionals are currently using telehealth solutions, the survey found, with an 87 percent satisfaction rate. Among those not currently utilizing such technology, 50 percent plan to implement it within the next year.
One driver is internet software solutions allowing affordable and simpple digital dialogue to the consumer level.
That, coupled with reimbursement reform, is giving doctors good reason to learn the high tech ropes, says Roy Schoenberg, chief executive of American Well, a Boston-based telehealth company that provides Web-based software.
Many third party payers, he notes, including Medicare and private health insurance plans, are beginning to pay providers for online visits — typically at a lower rate than a traditional office visit. But it’s a vast improvement over no reimbursement at all.
At the same time, many payers are implementing pay-for-performance reimbursement models, in which physicians get rewarded for keeping patients in their practice healthy. That incentivizes doctors to use telehealth technology towards that goal.
“Physicians are beginning to take financial risk for their patients so they now have a greater incentive to remain in closer contact with their patients,” says Schoenberg. “If the patient does better from an outcome perspective, then the provider does better financially.”
Growing Demand for Medical Software
American Well sells its software primarily to health insurance carriers, which, in turn, allow in-network physicians to use the technology to “see” patients through videoconferencing, by phone or secure chat.
Offered in more than a dozen states, including New York, Texas, and Minnesota, the software enables doctors to review clinical information, prescribe medication and suggest follow-up care online for patients in the state where they are licensed. More complex visits are still performed in the office.
Due to growing demand from individual providers, however, American Well is also now selling its product to private practices, allowing doctors and specialists to set their own fees for online consultations.
For its part, CIMIT is also developing software that enables patients to connect not just with the first available doctor, but their own physician.
Dixon says all ten doctors in his practice are currently testing the software as part of the Virtual Practice Pilot program at Massachusetts General Hospital, which is studying the effectiveness of live office visits versus videoconferencing patient encounters.
“We’re trying to create a platform connected to patients’ actual doctors so it’s personalized doctor communication with a known entity,” says Dixon, noting the biggest challenge thus far is managing online workflow. “We’re used to having patients come into the physical office and check in, so now we’re creating virtual workflow and that all needs to be integrated with the patient’s electronic medical record.”
Biometrics: The Next Frontier
The next frontier for telemedicine, according to Schoenberg, is biometrics.
“We have the capability to bring care to patients, but we also want to make sure that that care is brought in at the right time — when it’s needed,” he says.
Earlier this year, American Well partnered with Seattle-based telehealth monitoring company Numera Health to let doctors review vitals alongside their patient’s medical history chart during online visits.
The data are captured and transmitted real time using at-home consumer devices such as blood pressure cuffs at home and glucose meters.
“This is a very big deal as we look ahead to what’s going to happen in healthcare in the next few years,” says Schoenberg. “If a patient is diabetic, their glucometer at home collects information on their blood sugar levels and that information flows transparently into our system and gets in front of the physician.”
As doctors continue to adopt telehealth services in their practices, patients (particularly the elderly and underserved) will benefit from better quality, more convenient care, says Yael Harris, director of the office of health IT and quality for the Health Resources and Services Administration.
Doctors, too, will be able to keep closer tabs on their patients, and get paid for doing it.
“Telehealth has the potential to transform the delivery of care in the United States,” says Harris, noting it will be “especially valuable as our nation experiences an increasingly aging population and a shortage of health professionals in rural and underserved areas to meet these increased needs.”