From the Editor
By Michael McBride
Not long ago, doctors made house calls. How nice it must have been to be treated by one's doctor in one's own bed, with family about and chicken soup on the boil. No lying in tiled hallways, clinging to cold metal tables waiting on overworked ED staff. Physicians had time to bond with patients and build relationships. Could that era come again? Possibly.
From hospital portals to robotic surgery to rural telehealth to telehomecare to remote monitoring, the industry seems poised at the edge of a new era in expanded caregiving that promises to not only give us back the luxury of house calls, but also to save U.S. healthcare from almost certain collapse under the weight of the impending Boomer onslaught.
Studies clearly show that most ED overcrowding comes from non-emergency patients, increasing cost. Were those patients able to receive quality care at home, that double whammy would diminish. In fact, simply managing the most common geriatric diseases in a home setting would significantly reduce the pressure on the healthcare system, not to mention thousands of ED patients presenting each year with common ailments. Technology is no panacea, but the possibilities are too great to ignore, and the results of ignorance too grave.
Representatives have repeatedly introduced legislation designed to expand telemedicine's role, with developmental grants being awarded as far back as the late 80s. And yet, like regular flights to the moon, the industry can't get off the ground. But there is hope.
Currently before the House and Senate are two bills (H.R. 5765 and S. 631) that, if passed, would "amend title XVIII of the Social Security Act to provide for coverage of remote patient management services for chronic healthcare conditions under the Medicare Program." Once Medicare reimburses doctors for disease management, other conditions would surely follow, opening the door for healthcare organizations to improve patient care and increase the bottom line through telemedicine.
Clinics would open in rural areas, where before, none existed. Elderly could receive treatment in their recliners, with electronically prescribed medications delivered by courier. Specialized medical call-centers, similar to remote home security, could monitor hundreds of patients with chronic conditions, alerting physicians and family members when necessary.
Imagine a time when we could place a hand on a telehealth device that reads temperature, pulse and draws blood. It then transmits the results to a healthcare provider's clinical information system, which identifies the patient and compares the readouts against previously recorded baseline readings. If necessary, the system alerts the patient's physician, assumes a claim will be filed and simultaneously contacts the payer's system, which validates the claim and provides remittance advice. The hospital's system then makes contact with the patient and brings a clinician online for consult or treatment. All this happens in seconds, not days or weeks. It's like OnStar for the sick.
This can happen, it should happen, and it will happen if enough hospital organizations support it with their purchasing and voting decisions. Then, perhaps, we can all stay home instead of flooding EDs.