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HEART Insight:
doi: 10.1097/01.HEARTI.0000390856.62559.67
Features: Scanning The Horizon/Online Bonus

Extending Medicine's Reach

Lewis, Darcy

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Abstract

New Ideas To Improve, Streamline Healthcare Delivery

The combination of millions more Americans having access to health care under the newly enacted healthcare reform law, an aging population and a widespread physician shortage potentially may further strain the U.S. healthcare system. The solution: Creative thinking, more technological advancements and a willingness to see the doctor-patient relationship with fresh eyes.

For instance, does a doctor have to actually be in the same room as a patient in order for their interaction to be considered an “office visit,” or can they be thousands of miles apart? Technology makes it possible, but if a patient's insurance company does not cover the remote consultation, neither the doctor nor the patient will be willing or able to use the technology.

Here, a snapshot of new technologies that promise to lower the cost of healthcare while improving its quality, and the pros and cons of each.

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SOLUTION: MOBILE MEDICINE

How It Works: A doctor in another location uses his cell phone to diagnose a patient based on receiving high-quality cell-phone photos from the bedside doctor.

Pros:

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▪ Specialist doesn't need dedicated videoconferencing equipment.

▪ Can make a diagnosis anywhere with cellular coverage.

▪ No insurance hassle: carriers cover the expert consultation, regardless of whether the expert relies on a cell phone.

Cons:

▪ Some rural locations have poor or nonexistent cell phone coverage.

▪ Cell phone camera must be able to take a clear photo that can be magnified.

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SOLUTION: TELEMEDICINE

How It Works: A specialist in another location uses videoconferencing equipment to diagnose patients in tandem with the bedside physician.

Pros:

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▪ May be the only way rural facilities can respond appropriately in cases of suspected stroke and other time-sensitive emergencies.

▪ Equalizes access - now rural patients receive the same care as patients in large cities.

▪ Useful for many medical specialties, including cardiology, intensive care, psychiatry, dermatology and more.

▪ Private insurers reimburse for telemedicine services at the same rate as if doctors were at the patient's bedside.

Cons:

▪ Getting a telemedicine program off the ground can be expensive because of the cost of videoconferencing equipment, which can run $40,000-$60,000 for two telemedicine units. In addition, staff and telecommunications costs can easily equal that of the equipment.

▪ Medicare does not reimburse for a telemedicine consult unless the patient is located in a rural area.

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SOLUTION: E-CONSULTS

How It Works: Patients view E-mail as part of their daily routines and are weary of playing phone tag with their doctor and his staff. It's much quicker and simpler to fire off a quick E-mail with a follow-up question forgotten at the office visit, or to check on routine lab results.

Pros:

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▪ Patients love E-mail because it is more efficient for both them and the doctor.

▪ Some doctors appreciate the convenience - they can answer patient questions when their schedule permits.

▪ Could free up the doctor's time to see more patients instead of returning patient calls.

Cons:

▪ Only appropriate for routine matters-doctors worry that patients might E-mail during an emergency instead of seeking immediate help.

▪ Doctors fear being inundated with E-mail from hundreds of patients.

▪ Commonly used E-mail programs may not meet the federal government's HIPAA privacy requirements.

▪ May not be covered by insurance, which penalizes the doctor unfairly.

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SOLUTION: SHARED MEDICAL APPOINTMENTS

How It Works: Medical practices set-up a group appointment for patients who have the same medical condition for follow-up patient education. Each person receives a private exam, guided group discussion and the chance to learn from other patients.

Pros:

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▪ Frees up doctor to concentrate on patient exams and education, not paperwork.

▪ Patients learn from each other and feel less isolated.

▪ Patients have the option of private appointments as well.

▪ Less time in the waiting room - appointments start promptly because the doctor is less over-extended.

▪ Insurance pays for each patient individually, which incentivizes the doctor to provide his or her services more efficiently.

Cons:

▪ Resource-intensive for the doctor, who must hire additional staff members.

▪ Appointments last 90 minutes - which may be a challenge for patients to fit into their day, though they can leave whenever they need to.

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SOLUTION: SECOND OPINION E-CONSULTS

How It Works: Patients send their medical records and test results to a specialist located in another part of the country for a second opinion. For example, Cleveland Clinic physicians will review your case, answer your questions and provide a comprehensive report to be shared with your doctor for $565 ($745 if you also need a pathology review).

Pros:

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▪ Patients obtain a high-quality second opinion quickly and easily.

▪ Patients make an informed decision about whether to travel to the specialist.

Cons:

▪ Insurance does not cover this service.

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SOLUTION: PERSONAL HEALTH RECORD

How It Works: Patients log on to a secure Website to record personal health data. For example, the American Heart Association's free cardiovascular wellness center, Heart360™, lets you record your blood pressure, cholesterol and glucose readings; track your weight and physical activity; and update the list of medications you take. You can even create reports to print or E-mail to your doctor.

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Pro:

▪ Easy, secure and free or inexpensive.

▪ Visible record of your progress provides motivation.

Cons:

▪ Your record is only as good as the data you enter.

▪ You must remember to update your file.

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SOLUTION: MOBILE PHONE APPS

How It Works: Online services store your medical information like a personal health record, but you can track your condition using a smart phone instead of having to be at a computer.

Pros:

▪ In the future, mobile devices may act as personal healthcare hubs.

▪ May include alarms if readings veer outside approved range or you forget to enter data.

Cons:

▪ Consumer smart phone apps are currently incompatible with hospitals' electronic medical records systems.

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SOLUTION: TEXT MESSAGING REMINDERS

How It Works: Healthcare providers are experimenting with text reminders to see whether they help patients comply with doctor's orders on taking medication, wearing sunscreen or getting regular exercise.

Pros:

▪ Inexpensive and discreet

▪ Uses a widely accepted technology.

Cons:

▪ Not always effective. A recent study in Obstetrics & Gynecology found that women who received daily text reminders to take their birth control pills missed just as many pills as women who didn't get the reminders. Additional research is necessary to determine whether text reminders will help patients remember to take other types of meds, such as those to manage high blood pressure.

© 2010 American Heart Association, Inc.

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