(HealthTech Wire / Interview) - Ahead of the first HIMSS European Telemedicine Conference, which will take place in Edinburgh on 29-30 October 2013, HealthTech Wire spoke to Dr Michael Weiner, Director, Healthcare Strategic Services, IBM, about the role telemedicine can play in helping solve healthcare challenges across the globe.

What are the main drivers for using telemedicine?

Aging populations, rising rates of chronic diseases, increasing cost of care and a decreasing provider base are major drivers of healthcare systems transformation. For years, many healthcare professionals saw telemedicine as the answer to those problems. The only thing holding it back was the incentive model, which a decade ago did not support the use of technology. Today, payment models are evolving to support it. This is as simple as going from a volume-based system to a value-based one; from transactions to holistic health outcomes that improve population health. Measures like readmission rates for congestive heart failure patients and emergency room visits from asthmatic patients are now a factor in reimbursement. Value is quality over cost and the goal is to drive down the cost of care. It requires a coordinated care delivery system, with everyone in the care system performing efficiently and utilising modern technologies to support them.

What is the main role for technology?

The main role is to increase efficiency and effectiveness of healthcare. One niche for technology is a telemedicine visit. Seeing a patient at home for a follow-up appointment with a telemedicine visit means a patient doesn't have to leave the house or work and then drive to an appointment, find parking, etc. Where specialties don't exist locally, it means patients can get care quickly and efficiently delivered by telemedicine instead of travelling long distances. Technology can also help health systems and providers manage long-term conditions that are known to be the greatest cost drivers. With congestive heart failure, for example, there is such a cost to the community and the system, for the patient and the family. It is often a preventable condition with the right coordinated care model. Technology can help better connect the patient at home with the physician's office to better coordinate and manage these high-risk patients. Sometimes it's as simple as a good Internet connection. The city of New York and the local cable provider worked with visiting nurses to deliver monitors and cameras to patients in their homes. With broadband they are able to have a more realistic dialogue with their patients by being able to have both verbal and non-verbal communications through telemedicine. The Veteran's Administration piloted low cost technology using devices in the home that took low bandwidth, making it possible for veterans around the country to check in with their care providers.

How has the mobile phone changed care?

Studies have shown that when smartphones are used by chronic disease patients they have better outcomes because you can set up automatic systems that remind patients to take their medication, daily weight and lung function. The phone can act as a hub for the devices in the home to collect data and send it to a central hub. So instead of one nurse, care coordinator, doctor, only being able to see 20-40 patients per day, you now have a team that can see hundreds a day because the data is available to enable that. Then you can also model the data for the patient, for example see that their weight is starting to creep up, and perform preventive intervention to avoid readmission.

How can telemedicine benefit physician-to-physician engagement?

Physician-to-physician engagement is where we started this journey, whether it's a phone call to a fellow clinician asking for a consultation, or a remote area doctor needing a specialist consultation on a patient. We set up a process where you send an email to a central system where it was picked up by the appropriate physician that was on call. We found that many of these physician-to-physician consultations, by telephone or more recently video, helped get timely, effective care to patients and ultimately prevent the need for higher-level acute care. Telemedicine enables physicians to consult more from their office and gives them more time to take care of those patients that can only be taken care of face-to-face.

Dr Weiner, thank you very much for the interview. (HTW)
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