By Kathy Farrell, MD, FAAP
Telemedicine is a complex, dynamic, and growing venue to help care for patients. Healthcare professionals have different questions and concerns about how Telemedicine may fit in private practice.
Telemedicine is a billable, cost effective interactive service.
There are several platforms that offer patients the opportunity for a video non facilitated DTC (Direct to Consumer) encounter.
Some DTC companies advertise with the swipe of a credit card for $40, 24/7 non facilitated video coverage via a Smartphone to see a board certified physician. Most consumers do not recognize the difference in training between family practice physicians and pediatricians.
Consumers are driving the convenience of this service as it can be performed anywhere and often used in home, school, and kiosks in grocery stores. Some health systems are utilizing this application to direct minor illnesses away from the ER and when needed back to the medical home. It is essential DTC providers preserve continuity by integrating with the medical home.
The convenience of Telemedicine can be a threat to primary care office visits, and is important to understand the difference between a facilitated and non-facilitated visit.
Just as Urgent Care Walk-In Clinics have eroded continuity, we must ensure quality care is not jeopardized for convenience, such as prescribing medication without a full exam.
Meaningful uses of telemedicine include the ability to offer immediate expertise to the bedside anywhere via a facilitated visit. Facilitated visits allow for a complete exam using platforms and USB medical devices (stethoscope, otoscope and exam camera) with video, audio transmission. This rapidly advancing technology rivals traditional otoscopes with the ability to show the patient and family the tympanic membrane on the screen. Facilitated visits are superior to non facilitated to examine patients remotely via high definition cameras, USB port stethoscope, otoscope, and exam camera medical devices. Some outreach programs utilize other health providers at the remote site to palpate lymph nodes, liver, spleen, joints, and facilitate audio, video, USB otoscope, exam camera, and stethoscope. Facilitated Telemedicine visits often decrease travel burden for patients and providers saving time and money.
Telemedicine can help deliver the right kind of care needed.
A new AAP-endorsed document provides guidance for clinicians, administrators and policymakers on safe and effective pediatric Telehealth practices. A link to Operating Procedures for Pediatric Telehealth is published in the August issue of Pediatrics. This document provides the broadly applicable framework without clinical guidance of how to implement Telehealth. Access the document athttp://bit.ly/2sM31at.
Key issues addressed:
- The Patient Centered Medical Home is essential link for specialist communication and appropriate patient follow-up.
- Need for parent or legal guardian presence during encounter.
- Telemedicine needs to be done in HIPPA encrypted format to ensure adequate privacy and confidentiality.
- The technology has to be user friendly and work consistently in a secure network.
- Appropriate examination and testing are imperative prior to prescribing antibiotics.
- One of the most common legislative policy changes at the state level is deciphering parity in payment for services in person vs. services via Telemedicine. Currently there are over 200 Telehealth related bills introduced in over 44 states.
Telemedicine is novel, exciting and an innovative way to care for patients. The key driver must be keeping the medical home intact, and arranging close follow-up for better continuity and care.
Private practices needs to find novel ways to integrate and simplify workflow via Telemedicine to compete in this consumer driven industry. Pediatricians need to remain vigilant about preserving quality, continuity, and close follow-up in the medical home. To remain relevant providers need to be stay up to date on technological advances, and educate caregiver consumers quality can go hand and hand with convenience.
