Convenient Care and Telemedicine

Policy Reports | Health

No. 305
Wednesday, November 28, 2007
by Devon M. Herrick

Executive Summary

Telemedicine — the use of information technology for diagnosis, treatment and monitoring of patients' conditions — brings a new dimension to 21st century health care. Entrepreneurs are using the Internet, improvements in computer software and the advent of high-speed telecommunications networks in innovative ways to make medical care more accessible and convenient to patients, to raise quality and to reduce costs.

Patients, physicians and other medical providers all must deal with a wide range of problems in the traditional health care system.  For example:

Problem:  Doctors are hard to see.  As many as one-in-three people have trouble seeing their primary care physician, and nearly one-in-four have problems taking time from work to see a doctor.

Problem:  Patients have trouble contacting physicians by telephone or e-mail. Although lawyers and other professionals routinely consult with their clients by telephone and by e-mail, very few doctors will consult by telephone and less than one-in-four communicates with patients electronically.

Problem:  There are too few doctors in rural areas.   Compared to metropolitan areas, there are fewer physicians serving rural patients and patients must travel farther for office visits.

Problem:  Patients overuse emergency rooms.  Because their primary care physicians are inaccessible by telephone or after hours, many patients turn to hospital emergency rooms.  More than one-half of all ER visits are for nonemergency health problems.

Problem:  Patients have difficulty getting information during office visits.  More than one-third of physicians do not have the time to deliver enough information to their patients during office visits, and 60 percent of patients later say they forgot to ask questions during their visits.

Problem:  Fragmented care.  Because most patients see a number of physicians over time, care is often fragmented and physicians often must treat patients with inadequate information.

Problem:  The chronically ill are not well served.  More than 125 million Americans have chronic medical conditions, yet most are not receiving appropriate care, in part because monitoring is complex and expensive.
Telemedicine has the potential for restructuring medical care in ways that can solve many of these problems, while reducing costs and improving the quality of care.

Solution:  Nontraditional physician practices.  To avoid the time and expense of traditional office visits, medical entrepreneurs are creating innovative services for patients.  These include practices that are staffed by physicians who are available after regular office hours, are easier to reach and are able to order tests, initiate therapies or treatments and prescribe drugs.

Solution:  Pay doctors for e-mail and telephone consultations.  Entrepreneurial providers are creating services outside the third-party payment system that allow patients to pay directly for access to physicians or nurses by telephone or e-mail.  In some cases, insurers are reimbursing for e-mail and telephone consultations in addition to office visits.

Solution:  Empower rural consumers to direct spending on their own health care.  If Medicare and Medicaid allowed beneficiaries to control some of the dollars spent on their health care, entrepreneurial providers would offer services that are not now available.  For example, retail medical clinics staffed by nurse practitioners is one possibility; consultations by phone with medical specialists is another.

Solution:  Physician advisory services can substitute for emergency room care.    In many cases merely speaking to a doctor by phone avoids an unnecessary ER visit.  Medical entrepreneurs are setting up 24-hour consultation services across the country to which individuals can subscribe, and an increasing number of insurers cover the cost of such services.

Solution:  Internet-based medical information.  Patients no longer have to rely on their doctor for answers to every question.  Medical information has become available outside doctors' offices through thousands of health-related Web sites on the Internet. According to a recent poll, more than 80 percent of Americans with Internet access — about 113 million adults — have searched online for health information.

Solution:  Electronic medical records.  The use of electronic medical records (EMRs) — containing a patient's medical history, test results and prescription information — has the potential to improve quality and reduce medical errors  while allowing for better coordination of patient care among different providers.

Solution:  Remote chronic disease management. Programs to manage chronic medical conditions are beginning to use remote monitoring.  These involve training patients to collect and transmit data on their condition and allowing them to receive physician feedback.  Research has shown such monitoring not only can improve patients' adherence to protocols, it also can often be outsourced to low-cost, qualified medical providers in developing countries.

Obstacles.  The obstacles to achieving the full potential of telemedicine include the way in which Americans pay for health care, the medical culture in which physicians practice and government regulation of medical practices.  For instance:

  • Because patients pay directly for only 13 cents of each dollar spent on health care, providers have little incentive to create innovative patient-pleasing services unless third parties (private insurers, employers and government) pay for them.
  • The medical culture generally, and medical societies in particular, have tended to oppose expanding patient services beyond traditional face-to-face office consultations and treatment in traditional settings (clinics and hospitals).
  • State laws and regulations that prevent physicians licensed in one state from practicing in other states also keep doctors from providing medical care across state lines — such as writing a prescription or providing follow-up consultations remotely to patients who have returned home to another state.

Overcoming the Obstacles.  These barriers must be lowered to realize the full benefits of telemedicine.  If patients control more of their health care dollars, entrepreneurs will design innovative services to meet their needs.  If medical entrepreneurs are allowed to employ physicians in other states and overseas, they can reduce the cost of services.  If outdated state regulations restricting the practice of medicine are reformed, the quality of care can be improved.

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