Sometimes, technology moves faster than our willingness to accept it. Such was the story with personal computers and cell phones. What once seemed like novelties or expensive playthings are now indispensable.
The same can be said for telemedicine. If I were to pinpoint the most significant trend in the industry as we move into a new year, it would have to be the rapidly growing acceptance of telemedicine by providers and patients alike. Here are three reasons we can expect to see telemedicine in more hospitals in 2017.
1. Growing general acceptance.
Eight years ago, when our company began offering telemedicine services to our partner hospitals, the most common response from hospital executives and medical staff was, “You’re crazy.” A few years later, it was, “We think it will work, but we’re just not ready for it.” Today, it’s a different story. What we hear most often is, “When can you start, and how can you help us with this, this, and this?”
Why the change? I see three factors in play. First is the ongoing physician shortage, particularly the lopsided distribution between rural and urban communities. It’s not news to anyone that rural communities are struggling to find primary physicians, let alone specialists like cardiologists, neurologists, and others.
Second is the growing unwillingness of physicians to be on call at night. “Work-life balance” is something previous generations of physicians didn’t think much about; working on call was simply a fact of life, and one of the things you accepted when you took the Hippocratic Oath. But times have changed. Night coverage is one of the biggest struggles hospitals face today—rural and urban—and telemedicine is helping solve the problem.
Third is the growing cultural comfort level with two-way audio/video interaction. With applications like Skype and FaceTime, videoconferencing has permeated many aspects of our personal and professional lives. It’s no longer the futuristic concept we used to see played out on TV shows like “The Jetsons.” It’s real—as much a part of our lives as online banking and GPS—and nowhere near as out of place as it once seemed in our homes and in healthcare. In most cases, we find, it’s a welcome addition.
2. Expansion in the areas of telemedicine use.
The fields of psychiatry and stroke evaluation were the early adopters of telemedicine, but now we see its acceptance across a much broader spectrum of specialties—nephrology, cardiology, critical care, pediatrics, to name just a few. The technology enables remote consultation and evaluation in a wide range of fields. The list will keep growing, especially as our population ages and our supply of physicians continues to shrink.
We are also seeing the expansion of telemedicine across a broader range of hospitals than we ever expected when we first started offering telemedicine services in 2008. At that time, the need for telemedicine to close staffing gaps in rural critical access hospitals was obvious—the first market we penetrated. But today, it has earned a place in larger metropolitan facilities, as well. Not only is it used to smooth the admission process in busy Emergency Departments (EDs), but it also plays an important role in night cross-coverage calls. With telemedicine providing care to patients on the floor who need it, ED physicians and nocturnists can focus on admissions and avoid being called away. Night work is one of the major sources of burnout for physicians today, and telemedicine eases the stress.
Another trend: Just this year, we have seen interest from LTACHs—long-term acute care hospitals—in our telemedicine services. LTACHs are typically 50-60-bed facilities located in larger metropolitan areas or suburbs. Sometimes they are standalone facilities; sometimes they are part of an acute care hospital. They specialize in treatment of patients with serious medical conditions that require care on an ongoing basis. LTACH patients typically require more care than they can receive in a rehabilitation center, skilled nursing facility, or at home.
With a substantial number of LTACH patients on ventilators or dialysis, there is often a need for specialist consultation—cardiologists, nephrologists, and others. Telemedicine can fill a need here, as well as providing night coverage so the existing team of hospitalists can keep their daytime work schedules. This is a new market that we’re excited about serving—and another indication of how telemedicine is permeating virtually every aspect of hospital care.
3. Increasing interest by physicians to perform telemedicine.
We see a growing interest in physicians who want to perform telemedicine as a way to bolster their income from regular practice, or who want to make telemedicine their only practice. In fact, we have waiting lists of physicians who want to join our telemedicine teams. Is there any other area of medicine today where the supply of physicians exceeds the demand?
Physicians see telemedicine as a way to have greater control over their work schedule than what the traditional hospitalist model offers. It is novel, creative, “next-generation”. And it attracts people whose top priority is location. We currently have a telemedicine physician who lives in Israel and practices remotely in American hospitals. In fact, the director of our telemedicine program lives in Paris. The options are unlimited. You can practice in a rural hospital even if you prefer big-city life, and vice versa. Telemedicine is also a good option if your prime objective is work-life balance. You can work at home and still practice the profession you love. We will see more physicians pursue this career direction in 2017.
After innovation, the culture plays catch-up
Technological innovation typically raises a host of questions as the culture works to accept it. In the realm of telemedicine, there are some related to legal and payer issues. Seventeen states are now part of an interstate compact that makes it easier for physicians to be licensed in multiple states, helping expand their reach to areas where they are needed. There is also ongoing—albeit slow—movement to increase payer reimbursement for telemedicine services. The American Telemedicine Association deserves credit for its diligent work on this issue, although uniform payment for telemedicine services is still a long way off.
One thing is clear, however, as the new year approaches. Telemedicine is here to stay.