Improving Health with Telemedicine
The Institute of Health Improvement developed the Triple Aim Initiative that describes an approach to optimizing health system performance: Better care for individuals, better health for populations and lower per capita costs.
In most rural areas, healthcare is limited to primary care because specialists tend to congregate in urban areas to broaden their patient pool. Since 2010, 71 rural critical access hospitals have closed, and another 673 are vulnerable to shutting down across 42 states. Meanwhile, small communities find it difficult to attract enough primary care providers to serve their populations. Programs that offer college loan forgiveness to young doctors who practice for a period of time in rural communities have had only limited success in keeping them once the loans are repaid.
Better health relates to the outcomes of healthcare interactions. Where the availability of healthcare is limited or non-existent, people forego yearly checkups and often delay being seen in a timely manner by distant specialists until a problem or condition reaches a more serious stage, narrowing the chances for positive outcomes. According to the Centers for Disease Control and Prevention, regular health exams and tests can help find problems before they start.
The U.S. healthcare system is the most costly in the world, accounting for 17% of the gross domestic product. By 2020, that percentage is expected to grow to nearly 20%, meaning that one of every five dollars spent will go towards healthcare.
A Solution: Clinical Telemedicine
Clinical Telemedicine operates on the premise that if the patient finds it difficult to travel to a physician then technology can bring the doctor to the patient. Unlike Direct to Consumer Telehealth services, clinical telemedicine provides the remote clinician with the data and evidence needed to make a differential diagnosis. The patient is in a clinic, hospital or doctors office, while the distant healthcare provider can be anywhere, connecting via WiFi, 3G/4G, or broadband. At the patient end, the same medical devices involved in an in-person examination are used to collect the vital signs, auscultations, medical images, as well as ECG/EKG and ultrasound studies.
Patients appreciate the convenience of a virtual visit, especially when an in-person appointment would mean a lengthy trip of several hours, if transportation were available. Such trips require planning ahead and may result in patient no-shows due to unanticipated problems the day of the appointment. Many practices experience a five- to seven-percent no-show rate on average. The ability to offer a clinical telemedicine appointment can help reduce the practice no-show rate, and it may help with patient flow and billable time.
Regular visits provide clinical preventive care in primary care practices. The costs of modifying primary care by adding a telemedicine system can be offset with appropriate care in a timely manner.
-  IHI Triple Aim Initiative. http://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx viewed on 1/12/2017.
-  The Rural Hospital Closure Crisis: 15 Key Findings and Trends. Ayla Ellison, Beckers Hospital Review, February 11, 2016. http://www.beckershospitalreview.com/finance/the-rural-hospital-closure-crisis-15-key-findings-and-trends.html viewed on 1/6/2017
-  Centers for Disease Control and Prevention, Regular Check-Ups Are Important. https://www.cdc.gov/family/checkup/ viewed on 1/6/2017
-  Dielman, J.,PhD, Baral,R.,PhD, et al. US Spending on Personal Health Care and Public Health, 1996-2013, JAMA, 2016;316(24):2627-2646 http://jamanetwork.com/journals/jama/fullarticle/2594716 viewed on 1/6/207
-  5 Ways Telemedicine Can Improve Your Practice Revenue, Teresa Iafolla. Southwest Telehealth Resource Center http://southwesttrc.org/blog/2016/5-ways-telemedicine-can-improve-your-practice-revenue viewe on 1/12/2017.
-  Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis, Hogg,W., et al. 2005. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079830/ viewed on 1/12/2017.