December 17, 2017

Dr. Teresa Bartlett: Telemedicine Offers Virtual Patient Care

By Teresa Bartlett, MD, SVP Medical Quality, Sedgwick

Dr. Teresa BartlettTelemedicine is on the rise. It has been found to be a convenient, effective healthcare delivery mechanism capable of producing positive outcomes for patients. With the advancement of technology, increasing consumer demands, and projected shortage of physicians in some areas, telemedicine’s expanded use and increasing popularity can be expected to continue in the coming years.

This edition of WorkCompWire’s Leaders Speak series provides an overview of basic telemedicine concepts. In next week’s post, we will explore how telemedicine can be applied more specifically to workers’ compensation injuries and conditions. The bottom line is employers have an opportunity to prepare for this wave of change and capitalize upon telemedicine as an extended services offering to employees.

In exploring this option, it is important to understand what telemedicine is, how it works, the types of injuries and conditions for which it is best suited, and its projected uses in the future.

While telemedicine is sometimes perceived to be a relatively new concept, early forms were actually employed in hospitals in the 1950s. Initial applications focused on bringing healthcare services to patients in remote areas and serving patient populations where healthcare providers were in short supply. It also became a way for physicians to conduct medical consults and exchange expertise as well as a means of sharing medical records.

Today, technology is rapidly advancing, interconnectivity is expanding, and telemedicine components are becoming more affordable. Further, the telemedicine concept is becoming more readily accepted as increasing numbers of people use video chat applications in their everyday lives. As a result, videoconferencing between doctors and patients can be considered a relatively familiar option. It is among the more common forms of telemedicine and has been shown to streamline the care delivery process in a fast, convenient and effective manner.

Telemedicine is a part of the broader telehealth field. While the two terms are sometimes used interchangeably, telemedicine is considered a part of the larger telehealth arena.

Telehealth can include virtual education and informational offerings; clinical consultations through the sharing of electronic medical records, images, and notes; use of technology that enables a specialist to guide and direct another medical provider through a life-saving procedure at another location; and electronic patient monitoring. Telehealth also includes patient driven apps and online portals.

By way of contrast, telemedicine is more limited in scope. It generally refers to the virtual delivery of care to a patient by a physician or other healthcare provider.

While telemedicine is not appropriate for addressing extreme or severe medical situations, it can be an effective alternative for treating minor injuries and illnesses such as strains, sprains, and abrasions; types of common infections, colds, and flu; and rashes, insect bites, and skin inflammations. In many instances, telemedicine saves a patient the expense of travelling to a physician’s office as well as the time spent in the waiting room. It can be particularly effective in those instances where a medical recheck is needed prior to patient release and there is an existing relationship between the physician and patient.

The healthcare industry has found many uses for telemedicine in specialty areas. For example, radiology was an early adopter of telemedicine techniques. Telemedicine was used in small hospitals that did not employ full-time radiologists. A patient’s x-rays could be transmitted to another location for reading and facilitate more immediate and targeted treatment.

Psychiatry is another field that has benefitted from telemedicine. Technology is a way to expand access to behavioral health specialists. As an example, armed services personnel and veterans who suffer from post-traumatic stress disorder or depression can quickly access assistance relying on telemedicine techniques.

Dermatology is another specialty suited for telemedicine. A general practitioner can share images and photos of skin conditions and receive expert opinion in a fast and efficient way. Whether it is a rash, mole, or unusual inflammation, treatment can be initiated on a more immediate basis with the exchange of information and communication among providers.

The success achieved by these and many other specialists has opened the door to telemedicine being more commonly used to treat work-related injuries and conditions including initial injury diagnoses, rechecks and monitoring, as well as some physical therapy services. Like many treatment alternatives, telemedicine has its own distinct advantages and disadvantages.

One of telemedicine’s most notable advantages is fast, convenient care. In a properly structured program, a patient can receive a more immediate consult and professional opinion using telemedicine rather than traveling to a physician’s office. This is particularly true for extremely populous areas where traffic can be daunting and for employers that are located outside metropolitan areas and lack access to widespread healthcare systems, not to mention the convenience of immediate access for all appropriate referrals.

Second, telemedicine transcends many geographical boundaries. Treating physicians and specialists can consult with one another across state or even international boundaries to enhance patient care. For the patient, this means the opinion of a specialist can be obtained without the difficulty or cost associated with physical travel.

Third, telemedicine can streamline care and provide for more efficient delivery of services. A physician can see many patients and deliver appropriate care and advice while still ensuring a high quality health care experience. It can also help reduce unnecessary emergency room visits.

Fourth, some physicians and patients report higher satisfaction when using telemedicine. A well-structure program can offer active levels of engagement and increase feelings of empowerment among patients. This is particularly evident when a there is an existing relationship between the physician and patient.

Telemedicine has challenges as well. There is an initial investment cost to the provider or health system which is the cost to ensure the right technology is in place to provide a seamless telemedicine experience. The technology infrastructure is essential to protect the confidentiality of the doctor patient relationship and the medical information shared. It also assumes patients have access to a mobile device or computer and are comfortable using these platforms. In some instances, training and assistance may be needed to ensure the delivery of a high quality patient experience.

There will always be some patients who feel telemedicine is impersonal. These individuals prefer in-person discussions with their physicians. They lack confidence that an accurate diagnosis can be made remotely via a videoconference and are more comfortable in a physician’s office setting.

Despite all the technology safeguards some patients may be intimidated by this technology. Additionally, privacy concerns can arise. Patients may fear that their medical information will be compromised or disclosed using telemedicine technology.

There are telemedicine guidelines in place for physicians to use and adhere to in the virtual care practice. Telemedicine regulations vary by state along with licensing requirements for physicians. A number of legislative bills are being considered related to the practice of telemedicine across the country.

Telemedicine holds much promise as a healthcare delivery alternative and continues to gain momentum. According to Transparency Market Research, the global telemedicine industry is projected to be a $36.3 billion industry by 2020. This is up from a 2014 valuation of $14.3 billion by the same source.1 A report by EHR comparison group Software Advice found that 75% of surveyed patients expressed interest in telemedicine.2

Moreover, a 2014 telemedicine survey by Foley & Lardner LLP indicated that 90% of healthcare executives were interested in developing or implementing telemedicine alternatives. A reason cited was their belief that telemedicine would benefit the health of patients.3

Undoubtedly, telemedicine is here to stay. Next week, we will explore ways in which telemedicine can be safely and accurately applied to treat workers’ compensation injuries and conditions in a secure data environment.

About Teresa Bartlett, MD
Dr. Bartlett joined Sedgwick in January 2009 as senior vice president, medical quality. She began her business career by joining a large automotive manufacturer. She spent 20 years managing large self-insured, multistate workers’ compensation programs as well as the WSIB Canadian program. This involved PPO and IME network development and management and claim and litigation management. The short-term disability (STD) program that Dr. Bartlett managed was union negotiated. She developed an evidence-based medical substantiation process, which saved millions of dollars and reversed the escalating STD trend. The long-term disability program was ERISA-based and was also supported by the evidence-based medical substantiation process. In conjunction with these programs, Dr. Bartlett developed a benchmark fraud detection system, which included both provider and employee fraud for both the United States and Canada.

The scope of her expertise spans more than just occupational and non-occupational claims programs; Dr. Bartlett managed the occupational physicians within 32 manufacturing facilities. This involved a detailed understanding of safety and OSHA programs and required leadership to secure the necessary manufacturing support for the sophisticated return and retain at work process. This team won the Corporate Health Achievement Award from ACOEM in 2005 for the Development and Implementation of a Best Practice Clinical Model.

About Sedgwick
Sedgwick Claims Management Services, Inc., is a leading global provider of technology-enabled risk and benefits solutions. At Sedgwick, caring countsSM; the company takes care of people and organizations by delivering cost-effective claims, productivity, managed care, risk consulting and other services through the dedication and expertise of nearly 15,000 colleagues in some 275 offices located in the U.S., Canada, U.K. and Ireland. Sedgwick facilitates financial and personal health and helps customers and consumers navigate complexity by designing and implementing customized programs based on proven practices and advanced technology that exceed expectations. Sedgwick’s majority shareholder is KKR; Stone Point Capital LLC, La Caisse de dépôt et placement du Québec (CDPQ) and other management investors are minority shareholders. For more, see www.sedgwick.com.

Sources
1 Sudip, S. “Global Telemedicine Market to be Worth US $36.3 bn by 2020,” Transparency Market Research, November 4, 2015, www.transparencymarketresearch.com
2 Wike, Katie “75% of Patients ‘Express Interest’ in Using Telemedicine,” Health IT Outcomes, February 11, 2015, www.healthitoutcomes.com
3 Wike, Katie, “90% of Executives Pursuing Telemedicine,” Health IT Outcomes, November 14, 2014, www.healthitoutcomes.com

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