Monday April 17, 2017

Telemedicine Trends Upward in Health Care Sector

SUNY Oswego focuses on biomedical and health informatics
By Lou Sorendo

    The best is yet to come.

    With modern technology advancing at a whirlwind pace, it’s no wonder it is dramatically impacting the world of health care.

    Dr. Isabelle Bichindaritz is an associate professor and director of biomedical informatics
 at SUNY Oswego
’s Computer Science Department
. She said demand for telemedicine is increasing in the Central New York region as it is across the nation.

    Bichindaritz, who has been at SUNY Oswego since 2012, said biomedical informatics deals with applications of information and technology to the medical and health fields with the intent to improve health outcomes.

    SUNY Oswego offers a course in digital health that emphasizes the importance of continuity of care, Bichindaritz said. The course focuses on telemedicine, mobile health and sensor-based systems.

    Now there is a movement beyond telemedicine,” she noted. “It’s moving toward an ‘anytime, anywhere continuous’ form of personalized care. This is preventive care that is personalized and moving toward virtualized care."

    The digital health course also examines how information related to the health of a patient is constantly monitored and supported by alerts that prompt medical intervention and the stabilization of the patient.

    he course is part of SUNY Oswego’s new master’s program in biomedical and health informatics.

    For regions such as the North Country and many rural areas like Oswego County, there is a strong demand for telemedicine because of a lack of specialists. “Patients who have diseases that require specialist intervention can be treated and seen at a local hospital or doctor’s office, and at the same time videoconference with a specialist,” she said. “The best experts may not be available locally, but they will be through distance consultation.”

    Bichindaritz has joined organizations such as Oswego Health and the Rural Health Network in Oswego County to encourage the development of health technology.
    There are many applications of telemedicine, including AIDS, HIV-HPV, X-ray interpretation, psychiatry, neurology, pediatrics, dentistry, nutrition, diabetes, and virtual case management.

    She was part of an entourage that recently visited Finger Lakes Community Health, which has successfully implemented telemedicine in rural areas.

    Another strong area in telemedicine is home health care,
    Bichindaritz said. Aging baby boomers and elderly throughout Central New York oftentimes want to stay home, but at the same time many suffer from medical conditions such as diabetes and heart disease that require constant supervision.

    Meanwhile, the North Country Telemedicine Collaborative has applied for grants through the U.S. Department of Agriculture to use telemedicine in rural areas. One target group is uninsured migrant workers, who don’t see doctors on a regular basis. Grant funds would enable health care professionals to access migrant workers and use distance consultation when a physician is needed.

    She said there are several key factors that will influence the continued growth of telemedicine and telehealth. Telemedicine refers specifically to remote clinical services. Telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.

    She said synchronous telemedicine involves a videoconference where a patient connects from a distance to a physician in real time. “This requires fiber optic connectors and having high-speed Internet, so there are infrastructure requirements,” she said. “You don’t have that available everywhere,” but it is becoming more prevalent.

    Another key factor is funding.

    “Those who do telemedicine need to have special equipment, depending on the type of telemedicine is it,” said
    Bichindaritz, noting that digital data is produced by wireless cameras and monitors. For example, audioscopes and stethoscopes can be connected to a camera to enable a doctor to see into a patient’s ears or listen to a heartbeat.

    Bichindaritz noted a cart being used by Finger Lakes Community Health featuring such equipment costs $40,000. “So this type of real-time consultation might be expensive, and that’s why grants are applied for,” she said.

    After setting up a telemedicine network, a team needs to be created of physicians and specialists who have time available to devote to a given patient base.

    Finger Lakes Community Health works with hospitals in Rochester and Syracuse, where the density of physicians in particular specialties is greater.
    Bichindaritz said it is challenging to find available physicians who have time to do telemedicine.

    She said the physician shortage nationwide stems from strict standards in medical school admission. “We don’t train enough physicians, and this of course is going to have repercussions,” said Bichindaritz, noting expertise is necessary in order to develop a telemedicine team that can use the infrastructure that offers access to all specialties.

    Reimbursement is another limitation, she said.

    “Even if you find a physician who wants to do telemedicine consultation, you need to make sure they are going to be reimbursed by insurance,” she said.
    She said the American Telemedicine Association is lobbying to allow more telemedicine to be reimbursed by insurance.

    “The association has created a cost benefit analysis explaining that telemedicine can save money,” she said.

    She said according to Finger Lakes Community Health, savings comes in the form of reduced travel expenses, particularly when it involves negating an ambulance ride.

    Bichindaritz said telemedicine also allows patients to get timely appointments that they respect more.

    “It’s much easier if it only takes a patient an hour instead of a whole day,” said Bichindaritz, noting by respecting appointments, there is less funding lost per appointment.

    She noted patients like to have services in their own communities, and telemedicine also prevents complications. For example, access to a dietitian would be beneficial to a diabetic, she noted.

    “There are a lot of areas where there is a case to be made,” she said.

    Bichindaritz noted it is important to look at what others have done, reproduce successful models and then spread to models to communities. While more private insurers are paying for telehealth services, Bichindaritz said there are some highly specialized areas of telemedicine — such as psychiatry, dermatology and interpretation — where doctors have to make a case to insurers for coverage.

    She said it is important to have staff on board who can deal with insurance companies while organizing and dispatching an entire team to care for a patient. This care management specialist will be responsible for connecting local physicians and health care agencies with the distance health care community as well as insurance companies.