the patient gets peace of mind in knowing it’s appropriate to go in, and the virtual clinic doctor can alert their bricks-and-mortar counterparts. “At least it’s streamlined,” he says.
New diagnostic tools such as the Steth IO smartphone stethoscope from Seattle-based StratoScientific or the Oto HOME otoscope from San Francisco-based CellScope could help with better telemedicine diagnosis. Other wearable devices and technologies such as the Health app from Apple also hold promise, Scott says.
The University of Washington has some 40 years of experience with telemedicine, helping it provide care and training across a five-state area comprised of Washington, Wyoming, Alaska, Montana, and Idaho. Scott says in the 1970s, UW doctors used NASA satellites to communicate in remote areas of Alaska, for example. More recently, programs such as Project ECHO (Extension for Community Healthcare Outcomes) have linked doctors around the region to discuss best practices for treating specific diseases such as Hepatitis C, HIV, and multiple sclerosis, as well as conditions like chronic pain. The UW also has strong initiatives in telepsychiatry and teledermatology, Scott says.
He says cheaper, more accessible technology is one thing pushing telemedicine in general toward a “tipping point.”
“A lot of that is driven by the average person having a smartphone,” Scott says.
Patients are enthusiastic about telemedicine for its convenience. Employers, too, are encouraging employees to use virtual clinic services to quickly get a diagnosis—Is it the flu? Should I go home to avoid infecting coworkers?—without leaving work.
Another big driver is payment reform. As reimbursement models shift from pay-for-service to pay-for-performance, healthcare organizations are increasingly focused on things like reducing hospital readmissions for heart disease patients.
An earlier UW pilot project provided 30 heart failure patients with a device that measured their blood pressure, pulse, cardiac electrical activity, and weight. The data was transmitted back to healthcare providers via a 3G mobile network. “We could see all the patients who are out of range on those metrics,” Scott says.
If a patient showed signs of heart failure, doctors could suggest changes in medication or other interventions. “We did a 90-day pilot with these 30 patients who were in and out of the hospital a lot before this, and then we only had one patient come in to the hospital, and it was because they choked on a hot dog. It wasn’t because of heart failure,” he says. “Other hospital systems have used this on a much larger scale for their heart failure patients, and it has shown dramatic reductions in hospitalizations and also [improvements in] survival.”
Healthcare providers are forming accountable care organizations (ACOs), in which providers team up to improve care quality and reduce costs of treating Medicare patients, yielding savings that the organization would share. UW Medicine launched its Accountable Care Network last year, applying a similar concept for private employers and signing up Boeing as an initial customer.
Scott says the UW is looking at how a virtual clinic can be used in an ACO setting. “That’s where things can really get exciting,” he says. “How do you coordinate care better? How do you have better, more convenient access?”
The UW Medicine Virtual Clinic is currently unavailable to Medicare patients thanks to what Scott calls outdated rules set at the federal level. Meanwhile, a bill pending in the Washington Legislature would recognize telemedicine for coverage by Medicaid and commercial insurance plans in the state.
