Welcome back to Population Health(ier), a recurring series featuring athenahealth and The Atlantic’s best storytelling on America’s population health revolution. To catch up on our series, you can find last week’s story here. Today, we explore how telemedicine has benefitted a rural hospital in Maine and the patients in its care.
In 2008, after a child suffered a bad burn to his body, his family sought immediate medical assistance in Maine. But due to the lack of burn specialists in the state, standard practice would have required the child be flown to a specialty hospital in Boston. A situation like this, which in another area of the country might have meant a quick drive to the hospital, would lead to expenses like aerial evacuation and an extended hospital stay, and those factors—in addition to the medical treatment itself—can quickly and easily amount to tens of thousands of dollars. This doesn’t even account for the intangible trauma caused by the entire ordeal and suffered by the family.
In this particular instance, the child and his family, while awaiting the aircraft, were in put in touch via teleconference with Dr. Rafaela Grossman. Through a camera, Dr. Grossman determined that the airlift to Boston was unnecessary and that the child did not even require immediate hospitalization. “I’ll see you in my office on Monday,” Dr. Grossman said to the patient. “Here is what you do with the wounds.”
Situations such as these are cornerstones for telemedicine, an intersection of technology and treatment that connects doctors to patients via forms of live audiovisual communication. Telemedicine intervenes at critical moments of long-distance care and supports cost efficiency and positive outcomes for providers that aren’t always able to perform in-person consultations.
Dr. Grossman and the rest of the trauma team at the Eastern Maine Medical Center (EMMC) became pioneers in the field of telemedicine purely out of necessity. Tucked into the corner of the country, EMMC serves one of the most rural regions in Maine, sprawling across roughly 26,000 square miles of northern Maine and providing care for fewer than half a million people. The hospital’s staff of 450 physicians needed a way to reach out to their vastly dispersed patient base. Telemedicine—with only a two-percent medical error rate, as opposed to the phone consultation’s 11.8 percent rate—seemed like the best fit.
But while the hospital’s use of telemedicine may have been borne from necessity, this isn’t to negate its benefits—even when stacked against standard forms of consultation. A 2009 study by Dr. Grossman and the EMMC found that telemedicine consultations led to greater cost savings and better care than even in-person visits. Because a doctor can see a patient more quickly by videoconference—and more reliably schedule multiple patients back to back— providers can complete simple check-ins efficiently, allowing them to reserve face-to-face interactions for patients who need closer attention.
Not only does this reduce costs for both patients and providers, it also cuts down on unnecessary commuting, which is notable for rural populations. If only 15 to 20 percent of patient visits require physical interaction during a consultation, telemedicine allows these patients to be seen quickly and succinctly, without asking anyone to drive great distances or worry about inclement weather.
Due to its sparse population, Maine has been an early leader in the field since the mid-1990s, the number of hospitals utilizing telemedicine continually growing. Alongside this physical expansion, telemedicine is poised to continue embracing and encompassing more technologies, particularly those that already exist. By moving away from expensive and specialized equipment and increasingly leveraging off-the-shelf products like smartphones that both patients and providers already use, telemedicine has the capacity to save more money and be more readily integrated into care.
As the use of telemedicine swells, it is bound to come into contact with the greyer, more antiquated areas of legislation—and with that comes a number of challenges. Added security measures must be implemented on programs for telemedicine to ensure that patients have the same privacy when they use e-paperwork and video-conferencing as they do when they come for an in-person visit. This year, Skype for Business announced a service that is HIPAA-compliant—just one of many steps that have been and will be taken to enhance the confidentiality of medical information shared over the Internet.
But the EMMC is confident that these roadblocks will not prevent telemedicine, already valued as a $30 million industry, from continuing to evolve and involve itself into the landscape of the healthcare industry. “We are near the point where it is no longer going to be called telemedicine—it’s going to be medicine with better phones,” says Dr. Grossman. “We are not doing anything terribly different. We just had to overcome the mystique of doing it over cameras.”
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