TELEMEDICINE- the Future of the US Health Care System
Wei Wu, RN, BSN
University of San Diego
Health Care Informatics
With the development of technology during the last several decades, people are getting used to receiving health care services by using technology. It is now possible for people to use devices to consult with health care specialists through video chat. Nurses can monitor patients with chronic diseases by receiving the update data from devices sitting in patients’ houses. Parents can send pictures of their kids through patient online portals to get advice from pediatricians. These ways to receive health care services through technology are parts of “Telemedicine.” (we can also call it “telehealth”) What is “telemedicine?” Telemedicine is using cutting-edge technological advancements to change people’s lives dramatically. According to the National Telehealth Policy Resource Center, “Telehealth is a collection of means or methods for enhancing health care, public health and health education delivery and support using telecommunications technologies”.[^1] Telehealth does not indicate a specific device or technology; it is a collection of various types of ways to deliver virtual medical services, educate patients and promote population health.[^1] Many hospitals in the United States have adopted telemedicine, while many states have set several restrictions on virtual visits. State restrictions prohibit the adoption of telehealth in these states, which consequently prevents people living in those areas from getting full benefits from telehealth.
There are several shortcomings in the US health care system, and the most challenging problems include limited access to care, unsatisfied quality of care, and high cost of health care. Telemedicine is like the light at the end of the tunnel and is likely to help people fix some of the problems in our health care system. Thanks to telemedicine, people can easily access remote health care service and “remote hospitals can provide emergency and intensive care services”.[^2] Using telehealth can help people be diagnosed and treated earlier and improve outcomes of diseases.[^2] Home monitor devices are significant for chronic patients through their reduction of high-cost hospital visits and stays.[^2] Telemedicine is a revolution, which can radically change the way people seek and receive health care. No one can deny its far-reaching influence on our health care system.
There are a bunch of studies that approve the effects of telemedicine on health outcomes, improvement in different kinds of patients and in various settings. A clinical study among sixteen primary care clinics in an integrated health system in Minneapolis-St Paul, Minnesota, showed that “home blood pressure telemonitoring with pharmacist management resulted in large improvements in blood pressure control and substantial decreases in blood pressure during twelve months”.[^3] In addition, patients receiving telemonitoring interventions had better adherence to medication and had stricter controlled sodium intake than patients with normal care.[^3] Even more beneficial, thanks to telemonitoring, follow-up patients expressed more satisfaction and felt safe at home.[^3]
Another study in England checked the effects of telemedicine on blood sugar control among patients with type 2 diabetes.[^4] In order to understand the effects of telehealth, the researchers compared standard care with telehealth care, in which a class of technologies was added into standard support and treatment.[^4] They used telehealth device to do remote monitor of patients’ blood sugar level.[^4] The sample of this study included 513 patients with type 2 diabetes.[^4] The final results indicated that telehealth resulted in better blood sugar control than traditional standard care over twelve-month period.[^4]
In addition to this study on type 2 diabetes patients, a longitudinal study conducted in Taiwan involved patients with Chronic Cardiovascular Disease.5 Researchers compared 576 patients who joined a telehealth program with 1178 control patients who received standard care.[^5] The results demonstrated that “there were 53 (9.3%) deaths in the telehealth group and 136 (11.54%) deaths in the control group”.[^5] From this study, we can tell that patients with chronic cardiovascular disease who receive telehealth care had lower mortality than patients treated with only standard care.[^5]
Telemedicine not only helps improve the quality of health care, but also works effectively in decreasing health expenditure. According to one recent Smart Rural Community (SRC) white paper, the benefits of rural telehealth can be divided into two classifications: nonquantifiable and quantifiable.[^6] There are several categories of savings within quantifiable benefits, including transportation cost savings ($5,718 per medical facility, annually), lost wages savings ($3,431 per medical facility, annually), hospital cost savings ($20,841 per medical facility, annually), and increased revenues to local labs (from $9,204 to $39,882 per type of procedure, per medical facility, annually) and pharmacies (from $2,319 to $6,239 per medical facility annually, depending on the specific drug prescribed).[^6]
Another randomized controlled trial study, which happened in Australia, had a total of 120 participants.[^7] In order to compare the costs of a home telehealth-based cardiac rehabilitation programme to the costs of a standard hospital-based programme, researchers randomized these 120 patients with chronic cardiovascular disease into two groups.[^7] Half of the patients were designated to the telehealth group. They received “a mobile phone, Wellness Diary and a Wellness web portal, with daily text messaging”.[^7] The other sixty patients in the control group just “received the standard six-week hospital-based outpatient cardiac rehabilitation programme, including gym sessions”.[^7] The study concluded that patients treated by telehealth had similar clinical outcomes; however, “the telehealth intervention could be delivered for $1633 per patient”, compared to $1845 for its in-person counterpart. Moreover, patients’ travel costs for the telehealth group were much less than those of the control group patients, who receiving face- to-face rehabilitation ($80 vs $400)[^7]. From this study, obvious advantages of telehealth cardiac rehabilitation were indicated on cost savings.
From all these studies mentioned above, we can see that telehealth has the potential to improve the US health care system. Besides improving clinical outcomes and saving in health care costs, telehealth also provides more opportunities to access health care services for people living in rural areas, and reduces the time people wait to visit specialists in urban areas. The report of the assessment of routine telepsychiatry service in Alberta has shown that the use of this technology has reduced clients’ wait time to get an appointment dramatically.[^8]
So far, these studies have demonstrated that patients have benefited from telemedicine. However, there are other studies that show that hospitals and health care providers can also benefit from telemedicine. After studying the adoption of telehealth among 2,891 US hospitals, researchers drew a conclusion that “telehealth is perceived as a way to increase patients’ access to care and to give hospitals a competitive advantage”.[^9] Utilization of technological communication can also expand physicians’ client base, and it even allow physicians to get in touch with clients from other states.
As a registered nurse and a student pursuing a master’s degree in health care informatics, my future role is to promote “the understanding, integration, and application of information technology in health care settings”.[^10] Everyone knows that technology plays an important role in many industries. Technology utilization in the health care industry is still in its infancy, but various professionals working in health care system have the same final goal. This goal is to help patients obtain satisfied health outcomes and reduce the costs of health services by providing patient-centered care.
But what are current restrictions to telemedicine adoption? Twenty states, which is nearly half of the country, don’t require private insurance companies to cover telehealth service and they even set up various artificial barriers and restrictions to prevent their Medicaid from reforming their telemedicine policies[^11]. Telemedicine is one of the ways which have the potential to improve the US health system by providing more access for receiving health care services, helping obtain better outcomes and dramatically decreasing the cost of health care. If its adoption can get improvements, restrictions or artificial barriers can be eliminate, we can fix shortcomings of the whole health system. In conclusion, it is essential to ensure people get full benefits from telehealth and telemedicine. Otherwise, there will be a burden to public health, to this country, and to everyone who lives in this country.
1 .The National Telehealth Policy Resource Center. (2017). What is telehealth? Retrieved from http://www.cchpca.org/what-is-telehealth
2 .California Telehealth Resource Center. (2017). Why are Telemedicine and Telehealth So Important in Our Healthcare System? Retrieved from http://www.caltrc.org/telehealth/why-are-telemedicine-and-telehealth-so-important-in- our-healthcare-system/
3.Margolis, K. L., Asche, S. E., Bergdall, A. R., Dehmer, S. P., Groen, S. E., Kadrmas, H. M., ...& O’Connor, P. J. (2013). Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. Jama, 310(1), 46-56.
4.Steventon, A., Bardsley, M., Doll, H., Tuckey, E., & Newman, S. P. (2014). Effect of telehealth on glycaemic control: analysis of patients with type 2 diabetes in the Whole Systems Demonstrator cluster randomised trial. BMC health services research, 14(1), 334.
5.Hung, C. S., Yu, J. Y., Lin, Y. H., Chen, Y. H., Huang, C. C., Lee, J. K., ... & Chen, M. F. (2016). Mortality Benefit of a Fourth-Generation Synchronous Telehealth Program for the Management of Chronic Cardiovascular Disease: A Longitudinal Study. Journal of medical Internet research, 18(5).
6.Schadelbauer, R. (2017). Anticipating Economic Returns of Rural Telehealth. Retrieved from http://www.frs.org/images/AnticipatingEconomicReturnsOfRuralTelehealth.pdf
7.Whittaker, F., & Wade, V. (2014). The costs and benefits of technology-enabled, home-based cardiac rehabilitation measured in a randomised controlled trial. Journal of telemedicine and telecare, 20(7), 419-422.
8.Alberta Heritage Foundation for Medical Research, & Simpson, J. (1999). An assessment of routine telepsychiatry services. Alberta Heritage Foundation for Medical Research.
9.Adler-Milstein, J., Kvedar, J., & Bates, D. W. (2014). Telehealth among US hospitals: several factors, including state reimbursement and licensure policies, influence adoption. Health Affairs, 33(2), 207-215.
10.Healthcare Information and Management Systems Society (HIMSS). (2017). What is Clinical Informatics? Retrieved from http://www.himss.org/library/clinical-informatics/what-is
11.Thomas, L., & Capistrant, G. (50). State Telemedicine Gaps Analysis Coverage & Reimbursement. American Telemedicine Association, February 2017.
You can connect with Wei Wu on LinkedIn.