In just the past three months telemedicine has grown exponentially. It has entered the main stream of medicine. Several hospital chains are using Teladoc. Some providers are concerned about remote diagnosis. Telehealth will meet specific guidelines for it's use. In rural areas where providers are not available, it could make the difference between life and death. In instances where patients present in an emergency department with vascular emergencies, stroke in particular there is a very narrow time window for treatment with drugs that prevent clots or dissolve them.
In some situations such as academic medical centers the appropriate physicians are in hospital. However in most community hospital settings they are not. The video demonstrates availability of a neurologist in less than 6 minutes. A nurse or emergency department physician can conduct a physical examination while the consultant observes. If indicated the treatment can begin immediately. A history is already available or can be obtained in real time. Time is then available for the neurologisit or other specialist to arrive and see the patient face-to-face. Telehealth will never replace a physician visit, only augment his arrival at the scene.
Hospital and emergency department studies reveal that only a few patients are now treated within the recommended time frame. The time difference can mean the difference between successful treatment or serious disability and even death.
The most significant barrier is that each state has it's own medical board, and it will require changes in physician regulations by 50 different state medical boards. It will also require Medicare and private insurers to cover this as a eligible charge. While Medicare and private insurers have expressed concern about additonal costs during an era of cost containment in the long run hospitalizations, and periods of rehabilitation as well as a decrease in permanent disability would offset the initial cost. A 48-72 hour hospitalization is significantly less that a 7-10 admission.
Physicians must insist that their medical boards allow this to proceed without sanctioning physicians and/or hospitals for providing this needed service for patients. State medical societies, and appropriate specialty societies also need to weight in with this as a standard of care. The evidence is already present.
1: Zerna C, von Kummer R, Gerber J, Engellandt K, Abramyuk A, Wojciechowski C,