Telemedicine: New technologies, new normal
The use of telecommunication and information technologies to provide clinical care from far distances makes it possible to dream of a world where country borders, weather conditions, and lack of mobility or transportation will not dictate which patients have access to potentially life-saving services.
A physician based in Denmark may soon examine a patient in rural Arkansas through videotelephone, eliminating the need for the physical presence of health professionals and broadening access. A pharmacist in the Netherlands can approve patient orders for a hospital in Texas (yes, this is already happening). Can this result in better patient outcomes and lower costs?
Constructs of telemedicine
Telemedicine is based on three main distinctions: store-and-forward, remote monitoring, and real-time interactive services.
Store-and-forward, or asynchronous, telemedicine can be equated to shared electronic health records that are safely transmitted between different members of the health care team as needed. With major transitions to electronic health records in physician practices and health centers already under way across the country, this exchange of patient information is quickly becoming a well-accepted and “normal” way to provide health care.
Remote monitoring telemedicine (distant or hub site) involves one or more health professionals who use technological devices to continuously monitor a patient from a distance.
A recent study in JAMA1 described the impact of using a home blood pressure monitoring device connected to a cloud in the treatment of patients with uncontrolled hypertension. Real-time data were transmitted to a pharmacist remotely, who would provide feedback to patients based on their blood pressure readings. Patients using the telemonitoring device were 90% more likely to have controlled blood pressure at the 6- and 12-month intervals, and these results persisted even after the 12-month mark. Although the intervention was expensive (averaging $1,350/patient), it has the potential to be cost-effective in the long run, bringing better control and preventing expensive hospitalizations and billions of dollars in direct medical expenses.
Real-time interactive services provide patient interaction with health care providers in actual time, using either online video technology, online communication, or phone calls. Generally, both audio and video components are essential to qualify as a real-time interactive service eligible for reimbursement from payers such as Medicaid. Using such technology to provide patient consults may be cost-effective as face-to-face office visits prove to be more expensive and eventually may be a fading trade.
Future of telemedicine
Pharmacy has a role in the future of telemedicine. Medication therapy management, patient counseling, prior authorizations and refill authorizations, as well as the actual checking and dispensing of prescription medications, can all be done remotely by a pharmacist. These services can be more convenient for patients, especially in areas where pharmacy access is limited.
Daniel Kraft, a physician, scientist, and inventor, hinted as much in a recent TED talk on the future of medicine. The use of robotics and communication technology may be used on an advanced scale well beyond what we currently imagine. Specialized surgeons may soon become available without patients needing to travel further than their local hospitals. In addition to delving into new, innovative technologies, we can also get creative in leveraging the use of existing technology.
Margolis KL, Asche SE, Bergdall AR, et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA. 2013;310(1):46–56.