Health Law

INTERNET MEDICINE: PART V ?TELEMEDICINE AND THE VIRTUAL DOCTOR VISIT.

By Greg Piche'

According to Dr. Roy Schoenberg, M.D., founder of the telemedicine company, American Well, Inc., the Obama administration?s stimulus plan for investment in local community broad band digital capability has far more potential to impact the development of 21st century medicine than the electronic medical records subsidies. Witness the recent announcement of an agreement between a new, high end, but remote real estate development near Bozeman Montana, Ameya Preserve, and SwiftMD for SwiftMD (see www.swiftMD.com )  to become the sole telemedicine supplier to the 300 family subdivision, currently under construction.. The homes are scheduled to be wired with all the technical components for the online subscription telehealth service. 

Until recently telemedicine has been largely restricted to remote physician consultations, teleradiology, virtual classrooms for medical students, teleimaging of medical records and real time surgical monitoring. Although telemedicine has been around in one form or another since the fifties its primary focus has been the delivery of specialized services to remote and medically underserved populations.  It now appears to be coming into its own as a core ?disruptive technology,? that is a technological advance that disrupts the way services have traditionally been delivered.  It is now starting to compete with the traditional delivery models of physician services by providing access quickly and inexpensively.

Blue Cross and Blue Shield of North Carolina recently reported that the cost of a telehealth consult was on average about $55.00 as compared with the average cost of an office visit ($140.00) an urgent care visit ($196.00) or an emergency room visit ($1024). Quick, same day access to a physician while eliminating the inconvenience of long office waits and travel has its attractions.  There is off course a fair amount of pushback coming from the AMA, medical societies and medical licensing boards.  Many stress that there can be no substitute for the physician examination of the patient by a doctor. Others counter that a lot of consulting is currently performed on the phone by partners and other providers who have never met the patient before.

Dallas based TeleDoc. ( www.teledoc.com. ) has been a pioneer in telemedicine services and has adopted strict rules of engagement with its members that clarifies that its services are to complement and not substitute for the care provided by a patient?s primary care physician. Its prescription drug policy limits its on-line prescriptions to non-controlled medication such as antibiotics and antihistamines and other drugs unlikely to lead to abuse. TeleDoc markets its services through insurance companies and third party administrators for private plans.

Dr. Schoenberg?s company, American Well, Inc. also started out conservatively in a different manner. It too markets through the health plans, but it has to date focused its attention on smaller, more isolated markets such as Hawaii. where the advantages of telehealth access is more obvious and immediate. American Well, Inc. is now expanding stateside with a new agreement to provide services through Blue Cross and Blue Shield of Minnesota. These telehealth companies create a digital log of their services and patient communications which are transferred digitally to a patients electronic medical record file for access by the patient or the patient?s primary care physician. They are in effect redistributing medical services through direct access.  Although resistance to telemedicine?s expansion into traditional clinical healthcare will likely to continue to meet resistance, doctors would be well advised to take a hard look at the threats and benefits of ?disruptive technology.?  Wait until the real promise of the Iphone technology begins to surface.  The ?Borg? will see you now.

Full post as published by Healthcare Law Blog on May 11, 2009 (boomark / email).