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Telemedicine is ‘Catching On’ Among Physicians

Aug 21, 2019 07:00AM ● By MED Magazine

According to a national analysis conducted by Doximity , a little over 15% of physicians reported having telemedicine skills in 2016. Last year, the figure had grown to nearly 1 in 4. MED spoke with Josh Crabtree, MD, Senior VP of Clinic Operations at Sanford Health, to find out where Sanford physicians stand on their comfort level with consulting and caring via telemedicine.

JC: I think it’s important in this conversation to define a telemedicine interaction. This can be a provider-to-provider consultation, which we have had in place in rural emergency rooms for many years. The rural ER has a complex patient they need to transfer and they’d like some assistance. They can get on the telemed line with the ER doctor in Sioux Falls or Fargo. That is a big improvement in quality and timeliness of moving patients. 

Or it could be a clinician interaction in an outpatient setting. Sometimes that is via video, but it can also be as simple as a message inside of the electronic medical record. eVisits and video chats are what many patients think of when they think of telemedicine. 

Another use is remote patient monitoring. This can include wearable devices like an Apple watch or a continuous glucometer or heartrate monitor or even a Bluetooth connected device in the home that can provide real time reporting of data. It may not even be a face-to-face or even a phone call interaction. As we look for ways to provide better care at a lower cost, we are finding more and more potential for this. 

MED: Are Sanford providers as a group getting more comfortable with telemedicine?

JC: Yes. Although statistics can be manipulated, I do think that 15 to 25% increase in interest is probably pretty accurate. We are definitely seeing that interest. As recently as five years ago, there was resistance on the part of both patients and doctors. People wondered, how can a patient really be taken care of if there is not that face-to-face interaction? But providers are getting more comfortable with the idea of taking care of patients virtually.

MED: What do you think has made the difference?

JC: One thing is that more patients are looking for alternative ways to access providers. I think they are seeing that there are some conditions that lend themselves to being taken care of remotely. A run-of-the-mill cold or respiratory infection, fevers in kids, rashes, etc. are very appropriate to at least start the care for that condition through a telemedicine approach. 

MED: What are other examples of situations where telemedicine might be ideal and others where it wouldn’t?

JC: Radiology is another example. X-rays are easy to transfer and share digitally. It is very easy to have someone in Sioux Falls or Fargo take a look at an X-ray and offer their input without ever having to leave their reading room.

Another example...I know an ENT in North Dakota who put in a lot of ear tubes for children with recurrent infections. These kids usually have to do a 2-week postoperative follow-up. Some patients end up having to take off work and drive 200 miles to see this doctor and have a recheck that takes all of three minutes. We are starting to use some of the newer technologies to look at those ear tubes in their local clinic. Their ENT surgeon can actually view the tube remotely and confirm that it is where it needs to be. Then the child can be back at school and the parents back at work in 45 minutes or so.

Another win for telemedicine is just exposure. If we are in flu season and I don’t want to expose myself to the germs in a waiting room full of coughing people, I could use telemedicine capabilities whether its video visit or even just a chat visit to consult with the doctor. And vice versa. If I’m sick, others don’t have to be exposed to my germs. 

On the other hand, if you sprain your ankle, it is hard for me to examine you remotely. There will always be some specialties that lend themselves to efficient, good quality use of telemedicine and others that don’t. 

MED: How much of Sanford’s footprint has telemedicine capabilities now? 

JC: Nearly all of our regional facilities, including all of the critical access hospitals and most clinics, have some form of telemed capability where they can connect with a specialty physicians or an ER within our larger health systems. We lump that under OneConect. We can access our tertiary care centers so that we can have clinicians talking to each other. When it comes to patient to clinician/interactions, we have video visit capabilities for just about all patients who want to have that. The uptake has been variable depending on the patient and the physician.

We are starting to see some slow uptick with the use of Tyto Care. It has not been a rapid adoptions of that technology, but it is getting to be more and more. These are all for acute care and we run that through our acute care centers. So it’s available 24-7 through our acute care facilities. 

MED: Is there a different an adoption by location?

JC: Actually, a study done in 2018 on commercially insured populations found that there is faster adoption of telemedicine technology in urban areas that in rural areas. Eighty-three percent of people using telemedicine were in urban areas versus rural areas. At Sanford, we have seen 900 percent growth in the use of telemedicine in the rural areas. But the numbers remain small.

MED: What do you see as the future of telemedicine in our area?

JC: Telemedicine is never going to replace a face-to-face connection between a patient and physician. In some cases, the doc actually has to lay hands on the patient. But we have to understand that telemedicine is going to have to be a tool in our toolboxes in order to meet the desires and expectations of our patients. 

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