Telemedicine is leading a revolution in connecting people to better health care
America is facing a health-care conundrum. While the Affordable Care Act is expanding coverage for millions, no one is sure how these additional patients will impact the system. How do we find medical homes for the newly insured? Will there be enough physicians? Can hospitals handle the extra load?
Part of the solution may come from the burgeoning field of connected health, which includes telehealth, networked devices, smart phone apps and electronic health records. The same technologies that power business teleconferences can also enhance communication between physicians and patients.
"If we are going to use our current provider work force to care for patients already being treated, plus the millions of new folks who will be seeking care as a result of health-care reform, we will have to expand our tool set beyond the office visit," says Joseph Kvedar, who directs the Center for Connected Health in Boston." Connected health is a big part of the solution."
For more than two decades, UC Davis has been a leader in telehealth, enhancing patient care and bringing specialist expertise to underserved areas. In fact, UC Davis’ advanced telemedicine program expands access to more than 30 specialties, including dermatology, psychiatry, orthopaedics and endocrinology.
But that’s only the beginning. Telehealth is proving instrumental in educating clinicians and health-care students to embrace technology-enabled care, as well as helping researchers conduct clinical and population health studies.
As the Affordable Care Act rolls out, connected health will become even more integrated into the nation’s medical fabric. UC Davis is already there.
Physicians at UC Davis began practicing telemedicine in 1992, when family physician Thomas Nesbitt established a telefetal-monitoring project.
"I saw firsthand how the lack of specialists at a small community hospital could reduce care. Telemedicine was a great solution," says Nesbitt who, as associate vice chancellor for strategic technologies and alliances, oversees UC Davis’ application of technology-enabled care and education.
The fetal monitoring project, and other programs Nesbitt spearheaded, evolved into the Center for Health and Technology (CHT), which uses advanced approaches to improve patient care, education and research. Despite Nesbitt’s visionary application more than two decades ago, the technology needed to catch up.
"Early on, you had to spend $50,000 or $60,000 dollars for a teleconferencing system," says Aaron Bair, the center’s medical director. "That was for just one machine, and naturally you needed at least two to talk to anyone. Now you can do pretty much everything on an iPad with a secure connection."
Equally important, patients and physicians had to accept the technology to make it effective. With the rise of Skype, FaceTime and other web-based video applications, people have grown accustomed to videoconferencing. Now, it’s a small leap for a patient to go from chatting with grandchildren to consulting with a physician. The benefits can be enormous.
"If you’re living an hour or two outside an urban center, your access to specialists drops off considerably," says Bair. "A lot of people need an endocrinologist or an infectious disease specialist. Breaking down these disparities is a real target for telemedicine."
Improving care statewide
"Telemedicine is all about reducing geographic disparities. It's about getting the right expertise to the right people at the right time."
Enhancing access to specialists is one of telemedicine’s fundamental strengths. A new UC Davis program – called Pediatric Emergency Assistance to Newborns Using Telehealth or PEANUT – is a great example.
Funded by the U.S. Department of Health and Human Services Office for the Advancement of Telehealth, PEANUT provides rural clinicians 24/7 access to pediatric specialists in the most commonly needed subspecialties to treat respiratory distress, pneumonia, hypoglycemia, sepsis and other conditions.
"Telemedicine is all about reducing geographic disparities," says Nesbitt. "It’s about getting the right expertise to the right people at the right time."
Another UC Davis program, HEALTH-COP – Healthy Eating Active Living TeleHealth Community of Practice – creates a virtual learning network to support clinicians addressing family obesity. A recent study confirmed the program’s virtual training has helped physicians provide better care and counseling.
The list of telemedicine applications is lengthy. The UC Davis Comprehensive Cancer Center uses the technology to conduct virtual tumor boards with its cancer center network. The sessions bring together a range of medical disciplines to address how to improve care for cancer patients.
The technology has also been instrumental in conducting research. For example, telemedicine allows clinicians to check in with clinical trial patients who are too sick to leave the house.
"There have to be follow-up visits," says Hien Nguyen, medical director of the health system’s electronic medical records."Patients who are sick with the flu don’t want to come in. With telemedicine, mobile nurses can visit patients, and they don’t have to go anywhere."
Spreading the word
Enhanced education is another way connected health is improving care. UC Davis’ telehealth education programs teach the benefits of telehealth to health-care providers setting up their own programs.
A recent two-day lecture and hands-on class drew participants from Iowa, Kansas, Minnesota, Michigan, Colorado and Ohio, but participants come from all over the world. The class explains the ins and outs of telehealth, including equipment types, billing arrangements, public policy and even how to overcome technical difficulties.
"Our technicians run participants through troubleshooting scenarios," says Bair. "Sometimes it’s good to break the machine, so to speak, and have the technical team demonstrate how to fix it."
To make these interventions as realistic as possible, the program utilizes high-tech training labs, mock exam rooms and consultation suites for hands-on experiences. Nearly 2,000 people from 800 organizations have taken the courses.
The national picture
UC Davis’ early adoption of telehealth has paid dividends for patients, clinicians and researchers. That expertise is now having a profound impact on the national discussion, as health systems look for successful programs to emulate.
"UC Davis boasts the pre-eminent connected health program in California and is one of a handful of successful programs in the U.S.," says Kvedar. "The Center for Health and Technology is recognized for its innovation in technology-enabled care, education and research. This is great for patients because it gives them the tools to manage their health, rather than having to schedule time, travel, parking and waiting."
As successful as connected health has been at UC Davis, there are incredible opportunities to do more. As new technologies, such as wireless devices, make their way into common practice, these approaches could reduce unnecessary hospitalizations and improve quality of life for millions of patients.
"The potential is enormous," says Bair, UC Davis’ CHT medical director.