HumanIT Blog

Strategies for Providing Better Care through Telemedicine

April 30, 2019

Written By: By Bruce Hensel, MD, FACEP, Cloudbreak Chief Medical Officer; Former Medical Correspondent, NBC; Full Professor of Medicine, UCLA


In my 27 years as a health, science, and medical correspondent for NBC, I received an average of more than 500 “pitches” and questions per week. The pitches—mainly from medical organizations or their marketers—were mostly about touted tests, treatments, or “cures.” The questions came from viewers, readers, and listeners, and often asked about some of these vaunted methodologies and how to choose among them.

There is no doubt that there are more choices now than ever before. That should mean medical care is less expensive, better, and more accessible. We all know the opposite is often true. It is more difficult to choose, more expensive and, in some cases, more dangerous. Yet we are living longer and better than ever before. It is clear that, properly chosen (which is why I had a long career explaining the choices), these options can improve and lengthen life.

But many factors influence the ability of these to have the proper effect, such as:

  • The use of the internet for what we call Cyberchondria—searching for answers and solutions that may be misleading because the sources are sponsored and have agendas
  • Around 23% of Americans live in rural areas and say access to quality doctors and hospitals is a major problem1
  • About 21% of Americans speak a language other than English at home2

Those are three reasons I chose to join Cloudbreak Health a few years after doing a story on its use for interpretive services at Sloan Kettering Memorial in New York. It simply struck me that video interpretation and telehealth could help overcome two of the most severe impediments to good health care: distance and language. Yet since that time, the two modalities have been challenged by restrictions due to cost and other obstacles.

Dr. Bruce Hensel
Dr. Hensel reporting on Martti and its use in a hospital environment. (Original story licensed by NBC.)

In 1996, four years after I first did a story on telehealth, the Institute of Medicine (IOM) defined telemedicine as “the use of electronic information and communications technologies to provide and support health care when distance separates participants.”3

Currently, the exploding trend of medical cost absolutely demands we increase value to sustain revenue and improve lives. Yet many companies resist spending the time and money on these modalities, fearful that the cost would make their bottom lines bottom out. In many cases they look at overall cost without considering whether quality of care or length and number of visits were affected using these modalities. Many studies suggest that when these aspects are considered, cost decreases and patient and provider satisfaction increase.

The telehealth interventions that are most likely to achieve these goals will be those that ensure quality as outlined by the IOM in its landmark report, Crossing the Quality Chasm—namely, health care that is safe, effective, patient-centered, timely, efficient, and equitable. 4 As the IOM noted, “health care is undoubtedly one of the most, if not the most, complex sectors of the economy. Sizable capital investments and multi-year commitments to building systems will be needed.”

Studies have outlined some critical moves that can help organizations best take advantage of these modalities, including:

  1. Adjusting to patients’ understanding and needs
  2. Providing help, resistance, and training to improve the use of these modalities
  3. Changing how we look at revenue streams
  4. Changing the provider-client interaction
  5. Addressing privacy, security, and space considerations
    All of which are not only crucial to the patient but also to the provider who has little time and needs the space and opportunity to use these innovations.
  6. Focusing on prevention and detection as well as treatment
    The use of these modalities in pre-hospital settings, offices, clinics, companies, and, believe it or not, retail outlets.

Revenue and excellence of care don’t always go hand in hand in traditional settings. The provider is pressed for time and income. The patient/client is fearful and not as informed as he or she would like to be or need to be. Traditionally that equates to visits that are too short and unfocused. Preparation, video interpretation, and telehealth can address all those issues. And while it may seem costly when looked at in bulk, when shorter and fewer visits and improved outcomes are factored in, it is often cost effective and can deliver significant savings.

Deciding when to use video interpretation and other telehealth strategies, and when not to use them can be crucial to this formula. They should not be used just because they seem progressive and new. When chosen and used properly they can:

  • Improve flow
  • Reduce readmissions
  • Improve outcomes
  • Increase revenue
  • Improve data collection (thus providing better future care as well as itemizations that prove the modalities’ usefulness and cost-effectiveness)
  • Improve patient and provider satisfaction

More study is needed to know what is best for our systems overall, but in the meantime, each health system should choose based on the evidence within their organization. Some questions to guide those decisions:

  • How large is your non-English speaking population?
  • What percentage of visits is with patients who live in distant areas or have work or other responsibilities that make in-person visits difficult?
  • Where and how do you set up time, space, and training for those who will use these services?
  • Does the telehealth organization you choose provide assistance in each of these areas?

These modalities should deliver care that—after evaluation of the client and patient population—considers patient needs, is consistent in quality, and helps reduce inequalities in care.

We all know remote monitoring can prevent and treat problems early. Properly used it can also reduce waste of equipment, redirect personnel, and dramatically reduce costs of transportation and energy while helping patients and providers make better use of their time.

REFERENCES
  1. https://www.pewresearch.org/fact-tank/2018/12/12/how-far-americans-live-from-the-closest-hospital-differs-by-community-type/
  2. https://www2.census.gov/library/publications/2013/acs/acs-22/acs-22.pdf
  3. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.1021#B1
  4. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.1021#B4