Vir­tual vis­its to the doc­tor be­com­ing more com­mon

Ex­panded in­sur­ance, tech im­prove­ments help push telemedicine for­ward

Baltimore Sun - - FRONT PAGE - By An­drea K. McDaniels

Aided by his wife, Pe­ter Schon wrapped a gray cuff around his up­per fore­arm to take his blood pres­sure. Within sec­onds, thanks to wire­less tech­nol­ogy, his read­ing popped up on a com­puter screen in his home near where he sat in a brown leather re­cliner.

A cou­ple of min­utes later, the phone rang. On the other end was a reg­is­tered nurse from a home care agency who had got­ten a mes­sage that Schon’s blood pres­sure was el­e­vated. She wanted to make sure the Bal­ti­more re­tiree was feel­ing OK and to de­ter­mine whether she needed to in­ter­vene be­fore his high blood pres­sure turned into a se­ri­ous health prob­lem.

Schon, 80, suf­fers from a va­ri­ety of ill­nesses that keep him home­bound, but telemedicine en­ables nurses to mon­i­tor him vir­tu­ally. The tech­nol­ogy-driven re­mote mon­i­tor­ing and treat­ment has him — as he put it — liv­ing in to­mor­row­land.

He could be right. In just a few years, telemedicine went from a promis­ing but lit­tle-used form of health care, thought to be use­ful mostly in ru­ral ar­eas with few doc­tors, to one that is grow­ing rapidly as tech­nol­ogy im­proves, in­sur­ance cov­er­age ex­pands and pres­sure grows to keep peo­ple out of hos­pi­tals.

Last year, more than 15 mil­lion Ameri-

cans re­ceived some kind of vir­tual med­i­cal care, ac­cord­ing to the Amer­i­can Telemedicine As­so­ci­a­tion. The trade group ex­pects the num­ber to jump by 30 per­cent this year. Nearly three-quar­ters of large com­pa­nies will of­fer telemedicine doc­tor vis­its as part of their health pack­ages this year, an in­crease from 48 per­cent last year.

In a nod to the large role telemedicine soon may play in health care, Johns Hop­kins Medicine cre­ated the first ad­min­is­tra­tive po­si­tion and of­fice ded­i­cated to the prac­tice this sum­mer. Among the tasks of the new of­fice is de­vel­op­ing poli­cies and guide­lines around the use of telemedicine.

“I think the fu­ture mar­ket for telemedicine — the po­ten­tial is in­cred­i­ble,” said Dr. In­grid Zim­mer-Galler, ex­ec­u­tive clin­i­cal di­rec­tor of JHM Telemedicine. “The mar­ket is ex­plod­ing. Things you would think you can’t pos­si­bly do from home are ab­so­lutely go­ing to be­come a re­al­ity in com­ing years.”

Doc­tors and nurses across the state are us­ing high-res­o­lu­tion cam­eras, smart­phones and desk­top com­put­ers to di­ag­nose, treat and mon­i­tor pa­tients.

They pro­mote it as a way to bet­ter care for pa­tients like Schon who can’t eas­ily get to the doc­tor and say it can help de­crease emer­gency room vis­its. They also have found that many pa­tients like not hav­ing to drive to the doc­tor’s of­fice.

State health of­fi­cials see telemedicine as key to new re­im­burse­ment mod­els that em­pha­size fewer hospi­tal vis­its and more pre­ven­tive care.

“Tele­health has the po­ten­tial to in­crease ac­cess to care, im­prove pa­tient out­comes and gen­er­ate cost sav­ings,” said Ben St­ef­fen, ex­ec­u­tive di­rec­tor of the Mary­land Health Care Com­mis­sion. “Ex­panded ac­cess to tele­health will be an es­sen­tial el­e­ment of the new pri­mary care mod­els now be­ing de­vel­oped in Mary­land.”

But some wrin­kles still need to be worked out for it to be­come more wide­spread. Not all doc­tors and pa­tients are ready to em­brace re­mote treat­ment. And while pri­vate in­sur­ance and Med­i­caid cover telemedicine, doc­tors say the re­im­burse­ment process can be te­dious and hard to prove.

“It is very chal­leng­ing. You have to do it in a spe­cial way and meet cer­tain cri­te­ria,” said Dr. Marc T. Zubrow, vice pres­i­dent of telemedicine at the Univer­sity of Mary­land Med­i­cal Sys­tem. “The com­pa­nies make you jump through so many hoops.”

CareFirst BlueCross BlueShield, the state’s largest in­surer, said it cov­ers telemedicine if it is a face-to-face con­sul­ta­tion and in­cludes both video and voice ser­vices. In the last year, the in­surer cre­ated Video Visit, where pa­tients can see a doc­tor if their pri­mary care physi­cian is un­avail­able or A de­tail of the Lorien At Home pro­gram used by pa­tients in their homes. The com­puter link en­ables pa­tients like Bal­ti­more re­tiree Pe­ter Schon to re­main in vir­tual con­tact with their health care providers. they need treat­ment for com­mon con­di­tions or rou­tine fol­low-up care. CareFirst also has given out $4.2 mil­lion to var­i­ous providers to in­vest in telemedicine.

UMMS brought in Zubrow in 2012 to launch a telemedicine pro­gram for in­ten­sive-care units. Un­der the pro­gram, UMMS doc­tors can eval­u­ate pa­tients at 11 other re­gional hos­pi­tals via video cam­era as needed. The ser­vices have been help­ful to smaller hos­pi­tals that don’t have doc­tors on staff 24 hours a day.

“What­ever the nurs­ing and med­i­cal staff can see, we have the com­puter ca­pa­bil­ity to see at the same time,” Zubrow said. “It’s as if we’re at the bed­side.”

UMMS has other tele­health ini­tia­tives and more in the works. For in­stance, physi­cians can eval­u­ate pa­tients who show up at smaller emer­gency rooms around the state to de­ter­mine if they need to be flown to Bal­ti­more for vas­cu­lar surgery.

Johns Hop­kins is us­ing telemedicine in its own emer­gency rooms to ex­am­ine pa­tients with less ur­gent needs, so they won’t tie up per­son­nel in­volved in more ur­gent cases or have to wait long for care. Un­der the pro­gram, a re­mote doc­tor works with an on-site nurse to as­sess pa­tients at spe­cial­ized carts with a video mon­i­tor, stetho­scope, oto­scope and high-res­o­lu­tion cam­era.

In six months, the pro­gram has proved so suc­cess­ful in re­duc­ing wait times that Hop­kins plans to ex­pand it to other hos­pi­tals in its sys­tem, Zim­mer-Galler said. It plans to bring telemedicine to other ar­eas of the hospi­tal in the next year, she added.

Physi­cians also are start­ing to use telemedicine in their of­fices. MedChi, the med­i­cal so­ci­ety that rep­re­sents many of the state’s doc­tors, held a ses­sion on the prac­tice in Oc­to­ber.

Dr. Michael Ran­dolph, a Bal­ti­more pri­mary care physi­cian, be­gan in­cor­po­rat­ing telemedicine into his prac­tice a few months ago and has seen 10 to 12 pa­tients re­motely. Ran­dolph said it can be more con­ve­nient for his pa­tients who may not have enough time for an of­fice visit. He also said it is easy for him to squeeze in con­sul­ta­tions be­tween of­fice vis­its.

But Ran­dolph said doc­tors still have to worry about li­a­bil­ity is­sues and for now he prefers to use telemedicine for pa­tients with whom he al­ready has re­la­tion­ships.

“Some­times peo­ple are sick and you want to see them,” he said. “I tell them, ‘You look bad. You need to come in here.’ ”

Schon, the re­tiree, started get­ting telemedicine ser­vices two months ago through a pro­gram run by Gilchrist Ser­vices. The health care com­pany known for its hospice ser­vices runs a pro­gram for the el­derly with ei­ther de­bil­i­tat­ing or ter­mi­nal ill­nesses. They used a grant from the Mary­land Health Care Com­mis­sion and co­or­di­nate care with Lorien At Home, which em­ployed the nurse who con­tacted Schon. The Gilchrist pro­gram has en­rolled 15 pa­tients, in­clud­ing Schon, since it started in Au­gust.

El­li­cott City-based Lorien Health Sys­tems also works with Univer­sity of Mary­land Up­per Ch­e­sa­peake Health to pro­vide telemedicine ser­vices for pa­tients at Lorien’s three fa­cil­i­ties in Har­ford County. Each of the skilled nurs­ing fa­cil­i­ties has a telemedicine room used to ex­am­ine pa­tients whose con­di­tion changes sud­denly. Doc­tors for Up­per Ch­e­sa­peake ex­am­ine the pa­tient via video in hopes they don’t have to come to the emer­gency room.

Tra­cie L. Sch­woyer-Mor­gan, lead nurse prac­ti­tioner for Gilchrist’s pal­lia­tive pro­gram, said the pro­gram’s goal is to bet­ter mon­i­tor the health of pa­tients

“The idea that we can phys­i­cally see them with­out be­ing there gives them some re­as­sur­ance and com­fort,” she said.

Schon’s wife, Julie Schon, 72, said the ser­vice gives her peace of mind.

“I can go to the store and know if some­thing hap­pens, there is some­body mon­i­tor­ing him,” she said.


Pe­ter Schon par­tic­i­pates in a Lorien At Home telemedicine pro­gram from his Bal­ti­more home with the help of his wife, Julie, right, and Tracy Car­roll, left, di­rec­tor of the pro­gram. The ser­vice en­ables him to re­main in vir­tual con­tact with his health care­givers.


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