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Telehealth can be beneficial when used properly, say experts

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1995 (Published 26 March 2013) Cite this as: BMJ 2013;346:f1995
  1. Bob Roehr
  1. 1Washington, DC

Telehealth technology can help to make more efficient use of trained personnel, improve health outcomes, and bring financial savings if used properly, experts said in a congressional briefing in Washington, DC, on 21 March. That view contrasted with a study published in the BMJ the previous day, which found a particular use of telehealth not to be cost effective.1

Digital photos of skin conditions have been very useful for dermatology consultations, particularly in remote areas where specialists are rare, Mario Gutierrez, executive director of the Center for Connected Health Policy in Sacramento, California, told the briefing. “It is a way of avoiding unnecessary transportation costs and making more effective use of the specialists’ time.”

The University of New Mexico pioneered use of technology for distance consultations with specialists in cardiology, HIV, chronic pain, pulmonary disease, and rheumatology, he said, “and that is now being replicated around the country.”

The Center for Connected Health Policy has been designated the national center for telehealth policy. Its reports and an interactive “policy map” of laws, regulations, state Medicaid policies, and pending legislation­—“a one stop shop” for such information—will go live on 1 April at www.telehealthpolicy.us.

The fastest growing area is remote monitoring of patients. Gutierrez said that monitoring patients’ vital signs in their homes, often in combination with other services such as visiting nurse programs, “can avoid long term care costs and prevent complications from chronic disease.” It could allow frail elderly patients who lived alone to continue to stay in their homes, where they were most comfortable, and they would not have to give up their pets, which can be a great source of comfort.

In a cohort study that compared patients who used remote monitoring with matched participants who didn’t, the clinical results “were fabulous,” said Dan Cave, president of Nurtur Health, a wellness and disease management firm that makes extensive use of telehealth in urban and rural settings. A subsequent economic analysis showed that “we are seeing a very powerful return on investment for our clients who are using it.”

The technology is not appropriate for all patients, Cave said, using an example of a patient with high blood pressure who was otherwise healthy. “If their medical costs are very low, and they are not apt to go to the hospital any time soon, it may not make economic sense to deploy all of that technology,” he said.

“Technology is part of our lives,” Gutierrez said. “It is just another tool in the bag of the medical professional” that could be used well or poorly to provide high quality care. And, like any tool, to be effective it must be accepted and integrated into the overall delivery of the care.

Last year the Institute of Medicine conducted workshops and released a report on the role of telehealth in the evolving healthcare environment.2 A principal concern was that a lack of common standards across interventions made it difficult to evaluate programs rigorously, it said.

One barrier to the greater use of telehealth is the matter of reimbursement. Congressman Mike Thompson, who represents the Napa Valley of California, has introduced legislation that requires reimbursement for services to be the same whether they were delivered face to face or by telehealth.

Notes

Cite this as: BMJ 2013;346:f1995

References

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