The Challenges and Opportunities of Telemedicine

I was at Brookings this morning for a discussion on "Consumer-Driven Medicine" (A curious euphemism for what I would call "patient-driven medicine"-- isn't it a disturbing reduction to think of patients as simply "consumers" of medical services? But I digress...). Specifically, telemedicine (or mHealth, or whatever you want to call it) in America was the subject of the day.

There was unanimous agreement that telemedicine has the potential to help improve healthcare outcomes without raising costs (and possibly lowering them). Further, as I was saying on Tuesday, the technology is basically already here, and AT&T, a presenter on the panel, has been developing technologies that would network all our mHealth devices. So why can't you track your blood sugar and check your medical records on your Blackberry?  A few key themes emerged:

  • TelemedicineThe biggest obstacle for telemedicine is that insurance doesn't cover it. Part of the problem here is that when the CBO costs out implementation of telemedicine infrastructure, they don't account for cost savings. True, a big upfront investment is required, but telemedicine is all about cost savings. It saves trips to the doctor.  It saves the valuable time of doctors.  Through preventive care and monitoring of chronic disease, people can avoid getting sick-- and that's a massive cost saver. So the CBO issue prevents Medicare and Medicaid from leading in telemedicine, and given a comfortable status quo, private insurers are unlikely to make the initial investment, either.
  • Rural areas stand to gain the most from telemedicine. One of the presenters was Dr. Karen Rheuban, a self-described "country doctor" (and also head of the American Telemedicine Association). Like in any developing country, rural America faces challenges of resource scarcity. Doctors are few, hospitals are far-between, and high-quality specialty care is virtually nonexistent. Dr. Rheuban talked about one initiative in Virginia that brought a mobile mammogram machine into rural communities.  The images were reviewed by doctors in Richmond, and results returned the same day.
  • Patients love telemedicine. Doctors are a little wary. The panelists concurred that after their first experience with remote monitoring or consultation, patients are enthusiastically ready to make it their norm. Doctors, while they know it has potential, and know it's where events are leading, tend to be more dubious. This was interestingly reflected by the audience at the event; in question after question, doctors seemed very wary of telemedicine, and of yielding much control to either data-crunching software or to patients themselves. Change is hard, but this is a case in which progress could lead to doctors having more of their rarest resource: time.

In sum, good event from Brookings on a crucial subject (and one, I'd say, that should have a bigger role in our current healthcare debate).