Telehealth and Telemedicine seem to be everywhere in conversation lately; I haven’t met anyone without an opinion whether that it’s great and could be a panacea for all our ills in EM or will cheapen and cause destruction to the quality of our care. As I work almost primarily with this care modality, I don’t believe it is either. It’s a tool like numerous others we use to take care of our patients.
I got into Telehealth almost by accident; I had quit a stressful and busy full-time community job and was working per diem as a break before looking for another position. I stumbled upon an article about a new startup and decided to apply. It turned out I knew some of the leadership and a year later I was a full-time physician and eventually assistant medical director. From there, I moved onto an academic center with an enterprise wide program (how I got there is a funny story, ask me in person one day) and have been there since.
There are some misconceptions and questions I commonly hear and I wanted to address some of them since telehealth is not just coming, it is here.
What is it?
Telehealth is defined as remote video based medical encounters for acute illness or management of chronic diseases over a mode of technology whether or not there is a prior relationship. It has been around for decades and initially included audio consults but the standard is becoming video based encounters. It has gained more traction in the last few years due to improved communication, cultural shifts in using technology, and the need for improved access and decreasing costs in healthcare.
Telehealth or Telemedicine?
Generally, these terms have been used interchangeably, however, telehealth is broader and includes not only acute illness consult but is inclusive of other use cases. For this reason, I use the term telehealth in this post (though you will find my other writings also using telemedicine).
What is it used for?
It can be used for:
- Provider and patient visit whether an acute care, management of chronic illness, surgical follow-up or remote ED triage
- Provider to provider for remote consults, improving efficiency of transfer or doing a visit that can avoid transfer altogether
In Emergency Medicine, it’s mostly utilized between provider and patient with institutions running a direct to consumer acute care model, seeing low acuity patients in the ED or using it for remote triage to place orders and improve ED throughput.
What are the benefits?
The benefits, like in all healthcare interventions, are to increase efficiency and improve quality of healthcare. It’s helpful to think of it in the terms laid out by the National Quality Forum’s framework for assessing Telehealth quality. They include:
- Access to care: including access to information
- Experience: both patient and provider experience using Telehealth services
- Effectiveness: of operations, clinical, technology and system
- Financial impact/Costs: individually as well as to the system and society overall
This framework helps to assess the program you are developing, a program you’re working at or research on telehealth effectiveness.
How do I learn how to do it?
Telehealth isn’t really a new branch of medicine; it’s a care delivery modality. If you are comfortable with your in-person clinical practice, you can do telehealth.
I’ll address issues of patient safety and physical exam in future posts, but suffice it to say, it’s possible and just takes creativity.
How do I get involved?
It’s likely eventually you will be as it’s becoming more ubiquitous. Aside from that, many physicians choose to work part-time with one of the direct to consumer companies to get experience or as a change from their normal clinical shifts. I recently saw an ad for telehealth physician headhunters so looks like there are opportunities out there.
If interested, I recommend joining any of the interest groups at both SAEM and ACEP to be part of the conversation. We’re still a small crew and new interest and blood is always welcome.
I’ve enjoyed being part of this ride and continuing to learn how to better care for our patients in ways we didn’t learn about in medical school or our training. Luckily, EM physicians are trained to embrace new ideas and are the perfect advocates for it as we move forward in our changing healthcare environment.