The voice of telemedicine: John Hopkins

The voice of telemedicine blog series is an opportunity for telemedicine practitioners to share their experiences with telemedicine. Today's guest blogger is Dr. John Hopkins:

First and foremost thanks for the opportunity to allow me to participate and share my experiences on the blog. Telehealth utilization is critically needed in healthcare today and creating opportunities to communicate its value is imperative to drive legislative change.

Currently I am faculty at Thomas Jefferson University in Philadelphia and work primarily in the telehealth department. I am part of the clinical staff that supports the on-demand service provided through JeffConnect. The service is open to the public in certain states and provides a great resource to the community for low acuity issues.

What is your background? Specialty? How long have you been practicing? Where is your primary location? I am a residency trained Emergency Physician and certified through the American Board of Emergency Medicine. For the past 8 years I have practiced in many different practice settings both in the US and internationally. Through my experiences, I developed an interest in telehealth deployment as an avenue to increase both quality and access to healthcare for everyone.

How long have you been practicing telemedicine? I have been practicing telehealth for less than a year, but have done an extensive amount of market and policy research on the subject for the past 3 years.

What motivated you to start practicing telemedicine? Several different factors developed my interest in telehealth. Early in my career as an attending physician in the emergency department I became increasingly frustrated with patients who would come to the ED for low acuity issues when we were concomitantly struggling to handle the volume of sick folks who needed our immediate attention. To be fair in general they were frustrated with us because they waited 3 hours to be seen. Appreciating the frustration from both points of view I began looking at other ways to provide care through available technologies to decrease unnecessary ED and urgent care visits.

After several years of practicing at a tertiary care center I took a position traveling in the mid-south to work in a more rural arena to understand the underserved landscape. This is when my interest really began to blossom. Underserved areas have a hard time recruiting and retaining qualified clinicians mainly due to geography and as a result the access and quality of care suffers tremendously. It became apparent to me that telehealth could help fill this void and have a positive impact on care delivery. This prompted me to create a mechanism that was able to redistribute health care resources, which in turn led me to start Convenient Care Solutions, LLC. We provide turnkey telehealth solutions from design and implementation to cost efficient telehealth staffing solutions.

Additionally, I see it as an avenue to retain physicians who are nearing the end of their career and find it physically demanding to keeping pace with the current medical system. Telehealth has the potential to allow physicians to continue to practice in a less physically stressful environment and may help promote longevity in our profession as opposed to a high rate of burnout. We are looming on a provider shortage and need to be creative in our ways to retain highly skilled clinicians and refocus some of our efforts on their health and wellbeing.

How has telemedicine changed your practice? I wouldn’t say it’s changed my practice significantly but it has reignited my passion for medicine. There is a lot of opportunity to be creative and not succumb to the traditional medical dogma and behaviors that currently exist in the medical profession. Being able to really think outside the traditional medical box and apply new ideas is refreshing.

How do your patients like meeting with you by telemedicine? Regardless of the current limitations of telehealth patients love the service and are excited about the interaction. The convenience is unmatched. I think there will be a tectonic shift in utilization in the near future and patients will be expecting providers to have the capability to deliver care via this modality.

Do you have any insightful, interesting, funny, or notable experiences using telemedicine? Telehealth forces you to be creative in your diagnosis and treatment of patients. Utilizing tools such as a patient’s significant other or parent during diagnosis and treatment is challenging but also rewarding.

I had a 2 year old present because he hurt his arm. The child was wrestling with mom while she was trying to put on his shirt. Afterwards he wouldn’t use his right arm from his wrist down. Through further history and mom assisted physical exam I was able to diagnose nursemaids elbow. This is a common condition that occurs in children after a forceful tug on the arm causes a subluxation of the radial head. The diagnosis is commonly made through history and physical. The treatment is a reduction that takes seconds to complete. I walked mom through the treatment and within minutes the child was back to using his arm again without issue. They didn’t have to leave their house. How cool is that?

What challenges have experienced practicing telemedicine? How did you overcome them? As with any new technology there are always challenges. One significant issue is the inability to seamlessly capture vital signs and perform a remote physical exam through a high definition interface and peripheral medical equipment (i.e. stethoscope, otoscope, etc.). As the saying goes “vital signs are vital” and not having them available limits a clinicians diagnostic capabilities. Additionally the picture clarity of the images transmitted through the majority of cellular networks is poor which again can limit your scope of practice. As the modalities of delivery improve and wearable devices capturing pertinent biometric data become more readily available, some of these challenges will be overcome.

Currently the state medical boards require clinicians to be licensed in the state in which the patient is located regardless of your status of licensure in another state. If a physician wants to provide care in a state they have to obtain an individual license in every state they want to provide treatment. This is a huge financial and time-consuming effort. The state boards need to come up with a more efficient manner in which licenses are granted and increase reciprocity for telehealth services.

In addition, the federal legislators need to lift geographic limitations pertaining to patient presentation sites and instead focus on the quality of the physician-patient interaction. As it stands now Medicare will not reimburse a physician for a telehealth encounter in a patient’s home, even if a visiting nurse facilitates the interaction through a high definition interface with mobile peripherals. In an age when we are focused on caring in place and reducing re-admissions we can do better. Today’s regulatory environment makes it very challenging to design and implement sustainable telehealth programs despite all the progress that is being made with telemedicine parity laws.

What advice would you give to other healthcare providers interested in starting telemedicine? Keep an open mind and embrace the change. There is a learning curve. I’ll have to admit even with being a big advocate for telehealth utilization I felt a bit uncomfortable during my first patient encounter. Though afterwards, I was even more convinced that we are heading in the right direction. Telehealth will open doors for a large number of clinicians and patients.

Dylan Turner

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