hot topic | TELEMEDICINE
The Doctor Will
Email You Now Technology Is Rapidly Changing Health Care, but Problems Persist by Jennifer Ginn
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JULY / AUG 2013
16
We license by place, not practice. I think a cultural change needs to take place in the doctor-patient relationship. … If we talk about telehealth, really we’re talking about the application of technology, but the practice of medicine has not changed in either case.” —Former Wyoming Gov. Jim Geringer
Former Wyoming Gov. Jim Geringer has a favorite response to people who say having an appointment with a doctor by webcam is different than going to a doctor’s office. “If anybody tells you telemedicine is different than the practice of medicine, they don’t know what either one is,” he said. Telemedicine is when medical professionals use technology—whether email, telephone or webcam—to provide care for patients. It has been around since the late 1950s, when psychiatrists provided therapy to patients by phone. “It’s not reached its full potential yet, but the expansion of telemedicine has practically skyrocketed the past couple of years,” said Jonathan Linkous, CEO of the American Telemedicine Association, a nonprofit group that promotes improvement in health care delivery through technology. “About a year ago, somewhere around 10 million Americans benefitted somehow from telemedicine.” “This year, we estimate somewhere between 80,000 and 100,000 Americans will have shown up in emergency rooms with a stroke and that stroke will be assessed and treated using teleneurology. So we’re talking about applications that are really making a difference in people’s lives.”
Telemental Health
Access to medical care is an issue Dr. Sara Gibson, a psychiatrist and medical director of telemedicine for the Northern Arizona Regional Behavioral Health Authority, knows well. The publicly funded agency oversees mental health care for 700,000 residents living in the northern half of Arizona. Distance, Gibson said, is a tremendous obstacle in the 62,000 square miles the agency covers. “When I first started doing this, we were looking at one of two options,” she said. “(We could) either bring in sort of a circuit psychiatrist who would travel to the area like for one week a month and see everybody during that week, then move on to other places. “The other option we were thinking about was putting everybody on a bus and driving them in to see a psychiatrist. Again, it wouldn’t be as frequent as it needs to be. There weren’t any great options.” Telemedicine has provided services to patients who otherwise wouldn’t be getting help. Nancy Rowe, director of the authority’s telemedicine program, said providers use 36-inch televisions so patients see their psychiatrist life-size. “It’s a pretty immersive experience,” she said. “What the patients report is a huge degree of comfort,” Gibson said. “The comment comes up over and over again, ‘I feel like I’m in the same room with you.’ There’s a little bit of anxiety initially, so we try to have somebody sitting with them on the other end. “There are even some people who feel more comfortable using this technology than an in-person evaluation. They feel like they can open up more and are a little safer from being flooded by the intensity of being in the same room with somebody.”
Telepharmacy
Twelve years ago, the North Dakota Board of Pharmacy did a survey of community pharmacies in the state and discovered something disturbing. “They discovered … 26 small, rural communities in the state had lost their local pharmacies (and) another dozen
