CiscoBy Mary Ann Azevedo
The U.S. healthcare industry has come a long way in recent decades in using telecommunication services to improve patient care.
Twenty years ago, the University of Texas Medical Branch at Galveston began using 600-pound videoconferencing equipment to connect patients and doctors. Today the institution’s videoconferencing equipment has been reduced to a system that can sit on a desktop and weighs 15 to 20 pounds.
Sick or injured people in remote areas such as the South Pole and on cruise ships can get evaluated by specialists thanks to advancements in technology.
More doctors are adopting electronic health records to manage patient care, and more patients have access to those records via Internet-based systems.
The U.S. healthcare industry increased its spending on telecommunications services in the past four years by about 20 percent – from about $7 billion in 2008 to $8.3 in 2011 – at about half the rate that is projected for the next six years, according to Mountain Lakes, N.J.-based Insight Research Corp.
And those numbers are projected to go even higher. The U.S. healthcare industry will boost its spending on telecommunications services by 9.7 percent a year – from $9.1 billion in 2012 to a projected $14.4 billion in 2017, according to a recent report from Insight Research Corp
A number of factors will drive the increased spending including continued growth in the healthcare industry as a whole, patients’ increased use of mobile devices and health organizations scrambling to meet federal guidelines that will make them eligible for financial incentives while avoiding penalties.
On top of that, an aging population and healthcare worker shortages are pushing the industry to find alternative approaches to current treatment practices.  The report claims that much of the high costs in the current health care system are related to the proximity of patient and provider, as well as to the “archaic administrative systems used to manage records and exchange information.”
“Healthcare providers are avid consumers of telecommunications services and new technology,” said Fran Caulfield, research director for Insight Research Corp. “ The combination of increased demand for wireless and broadband access, massive  data storage demands, and the conversion to electronic health records (EHRs) and procedures is straining existing healthcare networks.”
The Health Information Technology for Economic and Clinical Health Act, a part of the American Reinvestment and Recovery Act of 2009, says hospitals that can demonstrate “meaningful use” of electronic health records will receive money from the Centers for Medicare and Medicaid Services. Those that don’t will face a reduction in Medicare patient reimbursement rates.
“It’s clear that the larger organizations are converting to electronic health records sooner and they are doing it more expensively,” Caulfield said.
Not surprisingly, the biggest obstacle for health organization is cost. The conversion process is expensive even in the face of potential incentives, notes Jan Emerson-Shea, spokeswoman for the California Hospital Association.
“While you may be able to get reimbursed for some of the money, you still have to lay out cash up front,” Emerson-Shea notes.
Still, she believes that at least in California, hospitals across the state are “absolutely moving toward implementation of electronic medical records.”
“Some organizations are further ahead than others,” said Emerson-Shea, agreeing with Caulfield that those that are ahead are typically the larger, integrated systems.
One such organization is the Palo Alto Medical Foundation (PAMF). Dr. Albert Chan, who serves as PAMF’s Chief Medical Information Officer, is proud that the medical foundation was an early adopter of electronic medical records.
With more than 45 locations and 1,100 physicians in the San Francisco Bay Area, PAMF went live with electronic health records in 1999. Two years later, the organization saw its first patient go live on its online service, which today is called “My Health Online.” Today, about 73 percent of adult PAMF patients use My Health Online, both via the web and on mobile devices, to view their health information, schedule appointments, and communicate with their doctors and other PAMF staff.
A new appointment scheduling feature went live in late December 2011. Between January and July 2012, PAMF saw about 65,000 appointments with primary care physicians directly scheduled online.
“The system gives patients access to the majority of their health information in an electronic chart as well as access to test results as allowed by state law, including lab work, blood tests and any radiology tests,” Chan said.
The system’s most popular features are giving patients the ability to send a secure message or email to their doctors, and to see their test results, he added.
To Chan, the system has made patient experiences more “robust.”
“Now there’s a much better discussion about details of results and what they might be concerned about,” he said. “It creates trust, and a sense of transparency, in my opinion.”
Even in messages back and forth to doctors, Chan says, “a lot of care is being delivered.”
“It’s simply more efficient when patients don’t have to leave work,” he said. “They can email their questions on their time. So in a sense, care is delivered virtually.”
The concept of remote treatment is not new to other institutions, such as the University of Texas  Medical Branch (UTMB) at Galveston.
In 1992, the school won a contract to provide health care for the Texas Department of Criminal Justice. Oliver Black, manager of UTMB’s information services video operations, said it quickly became apparent that it was “terribly expensive” to transport inmates from more rural parts of the state to Galveston for care.
The university implemented a video conferencing system in an attempt to save the state money in transportation costs.  The move proved to be a success and since then, video conferencing technology has come a long way.
“Before the entire teleconferencing system was the size of a refrigerator and weighed about 600 pounds,” Black said. “Now the system has been reduced to a 20-inch monitor with a microphone that weighs 15 to 25 pounds.”
That success has led to more work for UTMB. In 2003, the school got a contract to provide telemedicine and consulting services for the South Pole stations of the National Science Foundation. With only one doctor, usually an emergency room physician, it’s not uncommon for that doctor to get backup consultations with specialist such as a psychiatrist or a cardiologist.
In one case in 2010, an NSF worker had suffered from a mild heart condition and was able to receive consultation from a general physician, a cardiologist and an ultrasound technician via video. UTMB also does work on cruise ships. Say someone falls while in the middle of the Atlantic Ocean. They can get a radiological exam on the boat that is sent via a private network to a UTMB radiologist, who gives a report and sends it back to the ship. The patient in turn is handed a CD or DVD with their digitally encrypted images and a report from a UTMB physician.
Looking ahead, Caulfield believes everything that is happening related to telemedicine is just the beginning.
“We’re seeing more home health care monitoring and wireless applications coming on the market,” he said. “This will allow health care providers to keep better track of patients’ status while not under their direct care.”
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