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Telemedicine will be the norm as care shifts towards patients

By Jennifer Bresnick

- After nearly half a century advocating for the adoption of remote care, Dr. Jay Sanders, often dubbed the “Father of Telemedicine,” knows a thing or two about using technology to enhance the doctor-patient relationship.  As founder and former president of the American Telemedicine Association, Sanders has worked on numerous initiatives, including developing telehealth infrastructure in Georgia and consulting with NASA to keep astronauts healthy in space.

Telemedicine has a great deal of untapped potential, Sanders believes, not just as a way to connect patients with physicians, but also to revolutionize the way clinicians interact with the people they serve.  In this interview with EHRintelligence, Sanders discusses the emergence of telemedicine as an accepted and beneficial way to practice medicine despite the many barriers that still remain.

How are physicians embracing the idea of telehealth and remote monitoring?

It’s really the older age group, above 50, to whom this is totally new.  But for your younger physicians, this is just part of their everyday life.  So they’re not looking at this type of technology as really something new and different, whereas it can be a struggle for the older physicians because they’re just not used to taking care of patients this way.  Their tradition is that the exam room is wherever the physician is. For the consumer today and even for the younger physician today, the exam room’s really where the patient is.

And when you think about it, that’s not just an issue of convenience, it’s not just an issue of cost.  It’s really an issue of patients’ physiology, their actual medical care.  Taking the blood pressure of a patient in my office is ridiculous.  It’s entirely inaccurate. The best thing to do is to take the blood pressure of a patient when they’re at work or at home. What the present technology affords the physician is an ability to better evaluate their patient in the patient setting, not in the doctor setting.  And technology today, in effect, allows the physician almost to do a complete examination with communication technology.

Patients love it, too.  All of the evaluations since the 1990s have shown incredible receptivity on the part of the patient to the convenience, to the interaction.  They don’t feel that this is impersonal.  The first or the second most used consultation in telemedicine is for mental health care.  So it gives you an idea of the receptivity and the comfort that patients have with this type of technology.

Telemedicine is often seen primarily as a way to connect rural patients with physicians.  Is the industry moving past this limited goal?

The initial target in terms of rural America was the obvious one because of the geographic isolation.  But one of the things that we were very, very aware of was the fact that people in the inner city are socioeconomically isolated from this technology.  You need to realize that this technology wouldn’t have been so totally focused into rural areas for so many years, except for the fact that, for good or for bad, governmental funding was pushing access to care for those who were geographically isolated.

What we have come to learn, in the same way that we universally use our smartphones wherever we are, that this technology not only has a need, but a very clear practical application throughout the socioeconomic, geographic spectrum of our society.

And while a lot of my colleagues look at telemedicine as something very special and new and advanced, I have to be very candid with you and say the medical profession has been decades behind all the other service industries.  Think about it.  Healthcare delivery system is the largest service industry.  Yet the entertainment industry, the commerce industry, the banking industry, even the food industry figured out years ago how to bring their services to the consumer.

You don’t have to go to a movie house to see a movie anymore.  You don’t have to buy something in a store.  You can get it on Amazon.  You don’t have to go to the bank to do your banking.  Finally, my colleagues are figuring out, “Gee, we could do the same thing with healthcare.”  So whether you look at it as something new and different or whether you look at it and say, “What in the world is taking the medical profession so long?” really depends on your perspective.

How has the patchwork of state regulations and licensing rules prevented telemedicine from growing?

One of the things that slow things down has been the need for a physician to be licensed in the state in which the patient is physically residing at the time that they contact the physician.  If you are a patient who comes in with pneumonia, I wouldn’t treat your pneumonia differently in Massachusetts than I would in Virginia.  Why in the world do I have to have separate licenses?  We all we all take the National Board Examination.  We all get certified based upon a national examination.  There aren’t different types of medicine in one state versus another, yet we have this ridiculous outmoded rule or statute that you have to have individual licenses.

So what telemedicine has done is really shined a light, a very bright LED light, on these on old-fashioned regulations.   The other issue is payment regulations.  Many states say that an effective doctor-patient relationship can only occur if the doctor and patient are in the same room.  And many insurance companies have said, “Okay, unless an effective doctor-patient relationship occurs, we won’t reimburse for it.”  Well, that, as you know, I’m sure, has totally changed.  United Health Group, WellPoint, the Blues, Cigna, Aetna – they now all embrace telemedicine to some degree.

How do you see telemedicine expanding over the next few years?

I think, first of all, that the dramatic improvements in telecommunication and the rapid application of health apps to smartphones, will be universally accepted in the same way the Internet exploded, email exploded, Facebook exploded, et cetera.

I think what we’re also going to see a lot more wearable technology and monitoring sensors.  And I think that the yearly physical exam will be considered archaic.  Think about what happens when you get in your car and you turn on the ignition. That dashboard lights up and you instantly know everything you need to know about your car.  Soon with wearable sensors, we will know exactly what our status is at any point in time.  So I think the wearable sensor and its associated mobile technology will be universal.

I also think that the idea of the exam room as being where you live and work will be universally understood.  The technology will certainly be in the homes.  Many more people will be living in their homes as opposed to a nursing home as long as the physical construct of the home is such that they can live there.  Many times, it’s not an issue of being able to take care of a patient from a medical perspective.  It’s more about whether the configuration and structure of a home meets the needs of a patient who is now in a wheelchair, for example.  Oftentimes that’s why a home is no longer compatible for the patient, but I think we will soon adapt to the idea of designing homes that allow patients to stay in them for longer.



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