Tag: jama

Getting health care — whatever happens with the health care bill — is no longer just a matter of getting to the doctor. Issues of comfort, efficiency and cost control increasingly point to the use of telemedicine, which is coming, ready or not. And one recent report suggested the medical profession isn’t ready. Pauline Chen, M.D. , writing recently in the New York Times, cited resistance by doctors and nurses alike to what some consider long-distance health care.

Telemedicine has the potential to improve quality of care by allowing clinicians in one “control center” to monitor, consult and even care for and perform procedures on patients in multiple locations. A rural primary care practitioner who sees a patient with a rare skin lesion, for example, can get expert consultation from a dermatologist at a center hundreds of miles away. A hospital unable to staff its intensive care unit with a single critical care specialist can have several experts monitoring their patients remotely 24 hours a day.

But despite its promise, telemedicine has failed to take hold in the same way that other, newer, technologies have. Not because of technical challenges, expense or insufficient need. On the contrary, the most daunting obstacle to date has been a deeply entrenched resistance on the part of providers.

Tech industry writer/elder care advocate Laurie Orlov thinks those concerns are a thing of the past. Since data was gathered for the study Dr. Chen cited, Orlov points out in her Aging in Place Technology blog, doctors, patients and technology have come a long way. “Forget the JAMA study”, Orlov says, “here come the virtual visits.”

Medical practices, hospitals, clinics are well aware of a much-changed world and consumer health care costs that can be breathtaking. American Well’s virtual visit platform use is growing, as are other virtual platforms discussed in our 2009 Calibrated Care report. They have read about transformation of self-care and virtual visits in Denmark. Given the geographic distribution of people — and the distance required to get to doctors in some states and rural areas, given the availability of technology that was barely known or completely unknown in 2006, these are going to happen, reimbursement has begun, criteria for the use has emerged, and the JAMA study (and its much-syndicated press coverage) is already irrelevant.

On a technologically lower level is the use of PC programs long in place for Kaiser patients. They haven’t asked for a testimonial, but here’s one, with enthusiasm. The e-mail your doctor program allows doctor-patient communication at the convenience of each (my primary care doc, oncologist and other specialists almost all answer queries within 24 hours or less); test results are posted immediately and can be viewed via charts or graphs to show how you’re doing; drug information or other Q&A’s are immediately accessible through personal accounts. All of the above save time, money and patient angst.

Doctors in cyberspace could be good medicine indeed for U.S. health care.