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BHCG Monitor: An Electronic Personal Health Record Primer

 

The Doctor's Not In?
Maybe It Doesn't Matter

How technology is changing the delivery of health care

In the February edition of the Monitor we wrote about the emerging primary care provider shortage: Primary Care - Challenges Ahead. We noted that, while most experts agree there is a looming shortage, the magnitude of that shortage is a point of debate. Some experts argue that current predictions are overestimating the looming primary care physician shortage because traditional doctor-to-population ratios fail to take into account how technological advances will allow fewer physicians to provide care to more patients. In this article we report on some of these new technologies and how they are changing the way health care is delivered.

The field of telemedicine – sometimes referred to as telehealth, e-health, e-visits, virtual visits, among other terms – developed more than 40 years ago as a way to deliver care to patients in rural areas. Its adoption, until recently, has been slow. That's changed in the past decade with the development of high-speed communications networks and the desire to slow the increases in health care costs. Starting slowly, but now seemingly picking up speed, technology is starting to change the way we receive health care services. Some relatively minor changes you may have already noticed. When you arrive at your doctor’s office, you may have to sign in on an electronic tablet rather than a clipboard. During your office visit, your doctor may be recording his or her notes on an electronic tablet or laptop rather than a piece of paper. Your test results may have been available to you online. And you may have scheduled your visit online rather than with a phone call.

Emerging ways to deliver care

These changes are rudimentary compared to some of the new ways health care is starting to be delivered. Telemedicine is transforming the delivery of primary care, giving consumers access to less expensive, round-the-clock care for routine problems – often from the comfort of their home or place of work. These include:

  • Conducting office visits using video conferencing technology, including Skype and FaceTime
  • Using text or instant messaging to conduct an office visit
  • Remote patient monitoring to allow a physician to take vital signs of a patient perhaps hundreds of miles away – using, for example, a blood pressure cuff, pulse oximeter and a glucometer

Another example: HealthPartners, an integrated health delivery system in the Minneapolis area, has developed a service, called Virtuwell, utilizing interactive diagnostic online questionnaires for about 40 different conditions with clear-cut treatment protocols. Nurse practitioners, available 24/7, review the questionnaires as well as uploaded photos from the patient to give advice, and, if necessary, send a prescription order to a pharmacy. The questionnaires are designed to automatically flag anything potentially serious requiring immediate medical attention. These e-visits cost patients $40 or less, compared with $100 or more for a trip to a doctor's office or to the emergency department.

Even doctors not offering e-visits are increasingly communicating with patients by secure e-mail through online patient portals or mobile phone apps that can access electronic health records, potentially saving the time and costs related to an office visit.

Survey Says…

Not surprisingly, several recent studies demonstrate that both providers and patients are beginning to embrace the changes in how health care can be delivered. In March of this year, Cisco announced the findings of a survey that studied the views of consumers and health care providers on the sharing of personal health data, participating in in-person medical consultation versus remote care and using technology to make recommendations on personal health. According to the survey:

  • Three quarters of consumers indicate they are comfortable with the idea of communicating with doctors using technology instead of seeing them in person.
  • Nearly half of the consumers surveyed and two-thirds of the providers would be comfortable sharing and receiving health information through social media channels.
  • More than 60 percent of consumers said they would be comfortable with the idea of being treated by a specialist using virtual technology.
  • Sixty-three percent of consumers are comfortable with having their health records securely available in the cloud.

According to 2012 data from an annual survey by the federal Centers for Disease Control and Prevention, 72 percent of office-based physicians used electronic medical record or electronic health record systems, up from 48 percent in 2009. The increased adoption of electronic health records by providers offers additional opportunities for physicians and patients to communicate in ways that heretofore did not exist.

Payers start to embrace the changes

The global telemedicine business is projected to almost triple to $27.3 billion in 2016, according to a recent report by BBC Research, a Wellesley, Mass., research firm. This is due, at least in part, to the fact that major insurers such as UnitedHealthcare, Humana, Aetna and Cigna are embracing it, as are large employers like General Electric and Delta Airlines. They see it as a way to make doctor “visits” less expensive and more easily available. OptumHealth, a division of UnitedHealthcare started NowClinic online care in 2010, offering web- and telephone-based medical services. It has since expanded to 22 states.

Some speed bumps

Some obstacles to an even more rapid expansion of telemedicine do exist. As reported recently in Kaiser Health News, some physicians and consumer groups are concerned. They quote Glen Stream, president of the American Academy of Family Physicians as saying, "Getting medical advice over a computer or telephone is appropriate only when patients already know their doctors. Even for a minor illness, I think people are going to be shortchanged.”

Carmen Balber, a spokeswoman for Consumer Watchdog in Santa Monica, Calif., in the same Kaiser Health News edition, stated her concern that lower co-payments and other incentives will spur consumers to see doctors or nurses online just to save money. "People will choose the more economical option, even if it is not the option they want," she said.

In addition to resistance from some physicians and consumer groups, regulatory issues may pose an even greater deterrent to the telemedicine trend. Many state medical boards make it difficult for physicians to practice telemedicine, especially across state lines, when the physician does not have a prior relationship with the patient. State medical boards want physicians practicing in their states to be licensed there so consumers have recourse if they are harmed.

Regardless of some reservations and resistance, telemedicine appears here to stay. While technology will never completely replace face-to-face patient-physician interaction, it seems certain to become a routine and accepted way to deliver health care in certain situations. Whether it also serves to lessen the predicted shortage in primary care providers remains to be seen, but it certainly holds promise to do so.

Bibliography

Cisco. (2013, March 4). Retrieved July 25, 2013, from Cisco: http://newsroom.cisco.com/release/1148539/Cisco-Study-Reveals-74-Percent-of-Consumers-Open-to-Virtual-Doctor-Visit

Galewitz, P. (2012, May 6). Kaiser Health News. Retrieved July 25, 2013, from Kaiser Health News: http://www.kaiserhealthnews.org/

Gardner, E. (2012, September 4). Is Your Doctor Out of the Office? Try an E-Visit. U.S. News & World Report .

Hall, D. D. (2013, March 7). FierceHealthIT. Retrieved July 25, 2013, from FierceHealthIT: http://www.fiercehealthit.com/

Miller, C. C. (2009, December 20). Virtual Vist Over the Web May Expand Access to Doctors. New York Times .

Williams, C. G. (2013, May 6). Virtual Health care Gaining Ground. USA Today .

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BHCG Monitor: Focus on Health Care Benefits - April 2012