View From The Hill
Telemedicine Technology
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EXPANDING HEALTH CARE ACCESS AND OPTIONS.
Technology has provided most of us with easy and user-friendly access to innovative and critical services. We now have PDAs, cell phones, online bill payment, Global Positioning Systems (GPS), DVRs… the list goes on and on.
The military is at the forefront of developing many of these technological advances. Online bill payment wouldn’t be possible without the Internet, which the military played a critical role in developing. GPS and radar were also innovations born of military necessity but are now widely used in commercial applications.
From Florence Nightingale’s pioneering work during the Crimean War to the discovery of the mosquitoes carrying yellow fever, the military has also been at the forefront of numerous medical innovations. The Department of Defense is leading the way again with the development and implementation of telemedicine services for members of the military located in remote places and far from needed specialists. Advances in telemedicine now make it possible for a dermatologist in the U.S. to treat a patient in Iraq.
Telemedicine technology provides a two-way, interactive, audio-video connection, usually over telephone lines. It consists of three types of systems: live and interactive consultations with health care providers, the storing and forwarding of photographs and other vital information, and chronic disease management.
The U.S. military is harnessing all three types of telemedicine systems to provide patient-centered, cost-efficient and real-time care to service members.
Psychologists use telemedicine to provide live, interactive consultations for service members serving in Iraq through secure networks and e-mail.
Additionally, in 2004, the U.S. Army Medical Department approved the use of the e-mail system for telemedicine consultations for service members serving in Iraq, Kuwait and Afghanistan, specifically for dermatology consultation. An e-mail is sent to an on-duty clinical specialist who will respond within 24 hours for routine requests and six hours for urgent requests. This allows a specialist located in the U.S. to manage complex medical cases in conflict areas and reduce airlift medical evacuations and lost duty time.
Telemedicine also provides cost-effective care. As of January 2006, teledermatology consultations resulted in more than 50 avoided airlift medical evacuations, saving $1 million. Cost savings have also been realized in the telecardiology program at Brooke Army Medical Center in San Antonio, Texas.
The Brooke Army Medical Center has done over 6,000 telecardiac echocardiograms from outlying Army medical clinics in Oklahoma, Missouri and Louisiana, for a cost savings of $2.5 million.
Just as the military has realized the cost savings of reduced medical evacuations and immediate access to specialists, civilian health care providers are realizing the cost savings of reduced emergency room visits and early intervention.
Unfortunately, the potential for significant cost savings from the use of telemedicine has not yet been realized in the Medicare system.
It’s time that Congress expands the use and access to telemedicine technologies for Medicare beneficiaries. The military has proven that telemedicine can be used to reach patients in remote locations and reduce costs.
Unfortunately, Medicare, which provides health care to seniors and people with disabilities, lags behind the military in technological advances. Telemedicine is a powerful tool that could provide Medicare beneficiaries with the option to receive medical care in their homes. It also reduces incidents of emergency care, allows providers to reach out to patients living in rural areas and provides better management of chronic conditions like diabetes, congestive heart failure, hypertension and chronic obstructive pulmonary disease.
As co-chair of the Bipartisan Disabilities Caucus, I am committed to developing legislation that recognizes the right of people with disabilities to live with dignity and appropriate support in their own homes, fully participate in their communities and make their own decisions about their lives.
Adults with disabilities and seniors should be able to live in their own homes as independently as possible for as long as possible. People want to live in supportive communities that encourage independence and a high quality of life. Access to health services is a critical component of making livable communities work.
To support the movement to create a consumer-directed community-support system, the government needs to remove barriers to technology [and] adopt proven solutions for Medicare beneficiaries.
Telemedicine has proven extremely effective in providing timely, high-quality care in the military. It offers immediate access to the patient, access to patients in remote areas and earlier intervention at the first signs and symptoms of disease. Just as the military has shown the way in advancing technology in so many areas, the military experience with telemedicine should pave the way for Medicare beneficiaries.
That’s why I introduced H.R. 3588, the Medicare Home Health Telehealth Access Act. This important legislation would allow home health agencies to receive Medicare reimbursement for telemedicine visits. It would also create a demonstration project with incentives when patients’ outcomes, such as reduced hospitalizations and lower costs, are improved by using home telemedicine.
Not only does telemedicine make health care more accessible, but it also saves valuable health care dollars by addressing medical needs before they require emergency care.
Americans with disabilities are more than twice as likely to postpone needed health care because of cost concerns. Delaying treatment, however, can drive up costs as patients end up going to the emergency room for treatment. While a trip to the emergency room is less expensive than an airlift medical evacuation, these costs add up quickly.
Telemedicine offers immediate access to health care and helps intervene before a patient requires emergency treatment.
The example of Mrs. Olson provides an excellent illustration of the kind of patient-centered and cost-effective medical care that can be utilized to provide chronic disease management through telemedicine.
Mrs. Olson suffers from congestive heart failure and diabetes and was hospitalized six times in one year due to her congestive heart failure.
After consulting with her physician, Mrs. Olson began receiving telemedicine visits twice a week. During her telemedicine visits, her lungs were checked for fluid buildup, her vitals signs were checked, her glucose levels were checked and adjustments were made to her treatment.
As a result of the telemedicine visits, Mrs. Olson became more aware of her diet and adhered to it more closely. A foot injury was monitored and managed without an office visit, and she had no hospitalizations for six months!
During this time of staffing shortages and increasing travel costs—whether to a patient’s home or the doctor’s office— home telemedicine offers a cost-effective way of providing needed care and monitoring.
That’s why it only makes sense that Medicare reimburse for telemedicine.
Not only has the military led the way in realizing the full potential of telemedicine, but the military is now on the verge of full implementation of electronic health records. At nearly 60 percent implementation, the Department of Defense is on the cutting edge of patient-centered, real-time medical care. Electronic health records are available to health care providers around the clock and around the world.
Electronic health records are key to seamless delivery of health care services. All of a patient’s information will be stored in one location, so when a patient moves from diagnosis to treatment to recovery, there will be no interruption or overlap in the delivery of care.
Telemedicine coupled with electronic health records will ensure that health care is delivered in a timely, cost-effective and patient-centered manner. I am pleased that the military is leading the way on full implementation of telemedicine technology and electronic health records. This will truly be a model for Medicare and other health systems to follow.
It’s time to bring the technology developed and efficiently utilized by the military to the rest of our health care system. It’s time to tear down barriers to telemedicine technology and bring health care fully into the 21st Century. ♦