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Teleradiology and Telemedicine in Medical Practice

by Will Irwin, MBA


Have you thought about using teleradiology and telemedicine to extend the reach of your practice and to improve patient care, access, loyalty, and satisfaction?

Consider offering teleradiology to your patients at home. Mobile radiological technologists travel across western New York State (NYS) in specially equipped vehicles every day performing x-ray, ultrasound, echocardiogram, EKG, Ankle Brachial Index (ABI) testing for patients who are too frail to travel. Recent technological advances have dramatically increased the quality of these mobile services, most of which are now equivalent in diagnostic quality to the tests done in the emergency department (ED) or hospital. These services are available 24/7/365. Some mobile providers guarantee that, if you order a STAT exam, their technologist will arrive at your patient’s home as soon as two hours from the time of your order and that you will receive a report of findings from a radiologist within an hour after the exam. Many mobile services offer HIPAA-compliant software systems, which allow you to view images and reports online from anywhere via your smartphone, tablet, laptop or PC. For older adults Medicare and other commercial insurance will usually pay for teleradiology services, when in the physician’s judgment it is unsafe for the patient to travel outside the home. The range of disease categories where diagnosis can be accelerated through teleradiology is large: pneumonia, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD – emphysema), various cancers, life threatening blood clots, arterial occlusions, dysfunctional heart valves, low ejection fraction, etc.

Advances in technology have also encouraged innovative mobile providers to offer a high-intensity, bedside telemedicine (HIBT) visits in the home. These encounters mimic a patient visit to the physician’s office/ This service is different from telemonitoring, where the patient reports to a call center via the Internet metrics, such as weight, blood pressure, etc.. It is also different from on-demand, “Doc-in-a-box” telemedicine, where the patient independently initiates a live consultation with a remote physician via his smartphone. The HIBT visit allows a physician to send a trained technologist to the patient’s residence with the tools necessary to enable a clinician’s bedside assessment. The typical patient for this service is frail, physically unable to reliably self-report his/her medical condition, may lack transportation to his physician’s office,  and/or is unwilling or unable to keep follow-up appointments. The tools can include:

  1. A web-based platform which allows the service to be done via a smartphone, tablet, laptop, and PC.
  2. An online, physician-designed protocol guiding (a) the collection of patient history, (b)  the identification of the chief complaint, (c) the examination of the patient, and (d) the review of the medication list
  3. A HIPAA-compliant teleconferencing software to give the on-call clinician the option of conducting a remote interview of the patient with the assistance of the on-site technologist.
  4. Vitals: BP, O2, temperature, pulse
  5. Recording stethoscope
  6. Scale
  7. Otoscope and HD still and video cameras for assessing ear infections, sore throats, skin disorders, non-healing wounds, edema, gait, limb mobility, etc.

The technologist conducts the patient encounter using his tools to gather the physician-specified clinical data and uploads the information to a secure web-based platform for use by either the physician or his on-call clinician for assessment. The clinician can evaluate the data and then at his/her option initiate a secure tele-conference with the remote patient with the active assistance of the mobile technologist at the bedside. Based on this evaluation, the physician then can propose a plan of care to keep the patient at home, or, if necessary, send the patient to the ED. This intensive, bedside telemedicine model described above has been tested in a multi-year study at the University of Rochester Medical Center. The results of that study have been reported in two peer-reviewed articles: 1) High-Intensity Telemedicine-Enhanced Acute Care of Elder Adults: an Innovative Healthcare Delivery Modeli (2013); and 20 High-Intensity Telemedicine Decreases Emergency Department Use for Ambulatory Care Sensitive Conditions by Older Adult Senior Living Community Residentsii (2015). The 2013 study concludes that “high intensity telemedicine services for acute illnesses are feasible and acceptable and can provide definitive care without the requiring ED or urgent care use3 and reports high levels of satisfaction with the high-intensity telemedicine model itself by both providers and patients.4 The 2015 study concluded for those patients receiving a “high-intensity telemedicine” services “ED use for ACSCs decreased at an annual rate of 34%.” The acronym “ACSCs” stands for “Ambulatory Care Sensitive Conditions,” such as bacterial pneumonia, bronchitis, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes, gastroenteritis, hypertension, hypoglycemia, severe ear, nose & throat infections, and urinary infections.

If you are concerned about a lack of qualified clinicians in your practice to evaluate to HIBT visits, particularly on night and weekends, you should know that some mobile providers of HIBT services have contracts with on-call, reputable physicians and nurses to supplement your internal staff by performing HIBT evaluations on behalf of your practice including providing the necessary documentation for care coordination.

If you do consider using a mobile provider of bedside telemedicine, you should carefully review with your attorney the telemedicine service agreement to insure that it includes appropriate protections for your practice, such as an adequate informed consent agreement for your patient, appropriate notice of privacy practices, HIPAA-compliant, secure storage of patient health information, an effective process for continuity of care, and payment arrangements acceptable to your practice.

In conclusion, with appropriate precautions the use of teleradiology and high-intensity bedside telemedicine offers your practice the opportunity to extend its reach, accelerate patient care, and improve patient access, loyalty, and satisfaction.

 

References:

i. Journal of American Geriatrics Society (JAGS) 61:2000-2007, 2013

ii. Journal of the Society for Post-Acute and Long-Term Care Medicine (AMDA) 15-8610 2015

iii. Journal of American Geriatrics Society (JAGS) 61:2000-2007, 2013, page 2000

iv. Journal of American Geriatrics Society (JAGS) 61:2000-2007, 2013, page 2005

v. Journal of the Society for Post-Acute and Long-Term Care Medicine (AMDA) 15-8610 2015, page 1

Published in the Monroe County Medical Society’s Nov/Dec 2015 issue of The Bulletin.  Page 20.