Role and Rules for Telemedicine

A recent editorial in the British Columbia Medical Journal:

Does Telemedicine Need Stricter Rules for Engagement?
BCMJ, Vol. 56, No. 2, March 2014   

Willem R. Vroom, MD

Until recently, with very few exceptions, MSP fee compensation for a patient service was contingent on a face-to-face patient visit, regardless of whether the visit was an efficient use of time for the patient or physician. Times have evolved and MSP (Medical Service Plan) will now compensate physicians for limited patient services delivered by telephone. In addition, it is possible to receive MSP compensation for virtual visits via telemedicine.

Telemedicine goes a step beyond the telephone—it is a combination of telecommunication and information technology, in varying degrees of sophistication, which allows for real-time voice and visual communication between the parties involved. At its most straightforward it involves contact through a service such as Skype or FaceTime, which should be compliant with the CMPA’s legal advice and the College’s standards regarding privacy and security. A more sophisticated type of real-time telemedicine captures vital signs and oxygen saturation and uses instruments such as otoscopes, ophthalmoscopes, and electrocardiography monitors. Some of these instruments provide a magnified image with clarity that is better than in real life. Telemedicine technology may one day be able to transmit tactile response, making the virtual visit almost indistinguishable from a face-to-face visit; however, only the real-life visit will convey the personal interaction so valuable as a therapeutic tool and in the creation of a good physician-patient relationship.

The biggest challenges facing telemedicine today are not the gaps in technology but how telemedicine is applied. If telemedicine is allowed to flourish as a new form of medicine rather than as a tool that a physician chooses to optimize patient encounters, the risk is that it will become an industry in itself and lead to tele-walk-in clinics and prescription-refilling services. And depending on how remunerative it is, it could potentially draw physicians away from clinic or hospital-based work. Should we not learn from the example of walk-in clinics eroding the traditional primary care home?

In some circumstances telemedicine can provide a valuable medical service to communities with scarce physician resources, despite its diagnostic and treatment limitations. However, the question remains: How should telemedicine evolve in urban settings and how should it be funded? In my opinion, it is up to the primary care physician to determine how best to provide care in specific circumstances, be it face-to-face, by telephone, by telemedicine, or by e-mail. Telemedicine has tremendous potential value in enhancing comprehensive longitudinal care and should not result in more fragmented care. The implementation of this technology deserves a sophisticated utilization strategy. As for public funding, would it not be best for physician remuneration to be based on comprehensive patient care rather than on the modality used to service patients?

View PDF of article here

Honorary degree for Aran doctor and lifeboat medical officer

Dr Marion Broderick, general practitioner for the Aran Islands, was conferred yesterday with the Honorary Degree of Master of Health Sciences at NUI Galway

By currach, lifeboat and helicopter, Aran island doctor Marion Broderick has saved as many lives at sea as on land over the past 32 years.

The general practitioner’s “solo” role as “first port in the storm” and advocate for her community was recognised yesterday by NUI Galway (NUIG), which conferred her with a masters degree in health science.

Dr Broderick, who has also served as medical officer to the RNLI lifeboat, epitomises the best definition of “optimal” general practice, Prof Andrew W Murphy said in his citation at the conferring yesterday.

That definition, articulated by world authority Barbara Starfield in the Lancet journal, involves providing “first contact, continuous, comprehensive and co-ordinated care” to people “undifferentiated by gender, disease or organ system”, Prof Murphy said.

“In a world reduced to statements of 140 characters, the concept of simply being there over an extended period of time seems revolutionary,” Prof Murphy said.

“It can also appear that doctors are expected to know more and more, about less and less, making comprehensive care an unrealisable fairytale,” he said, while co-ordination is “generally overlooked and always underestimated”.

Dr Broderick was one of the first in Ireland to use tele-healthcare and “near patient” testing, he said, and she was “intrinsic” to the development on the island of Arás Ronán, a 12-bed nursing home.

Rural practice is universally recognised as being tough, and island practice even tougher, he said, noting that she was unsure last week if she would have locum cover to travel in for the conferring.

Click here to view full article in The Irish Times

View also Press Release from NUI, Galway here

Roscommon Hospital in association with Galway University Hospitals wins 2013 Healthcare Award for the Rheumatology Telemedicine Service

The Rheumatology Telemedicine Service at Roscommon Hospital in association with Galway University Hospitals won the “Best use of Health Technology” award at the Irish Medical Times 2013 Healthcare Awards.

(l-r) Dr John Carey, Consultant Rheumatologist, Galway University Hospitals; Marie Doorly, Patient Services Manager, Roscommon Hospital; Pauline Conroy, IT Department, Roscommon Hospital; and Dr Robert Coughlan, Consultant Rheumatologist, Galway University Hospitals. 

The Rheumatology Telemedicine Service started in October 2011 and involves a computer link-up between patients in Roscommon Hospital and Dr Robert Coughlan and Dr John Carey, Consultant Rheumatologists in Merlin Park University Hospital, Galway who are able to discuss and review patients’ conditions with them and they no longer need to travel to Galway for their outpatient appointments.

Feedback from patients using the Rheumatology Telemedicine Service has been very positive with one patient commenting that the experience was similar to “skyping” her family, which she is familiar with, so therefore felt very comfortable about the whole experience.

Elaine Prendergast, General Manager, Roscommon County Hospital, said; “I am delighted for the staff involved in this project and for the patients that this initiative has been recognised at the IMT Healthcare Awards. The service makes it easier and quicker for patients from Roscommon to have access to Rheumatology outpatient services and it is an example where we have embraced change for the benefit of the hospital and all our patients”