As Congress examines the U.S. public health system’s response to Ebola this week, we need to take a look at laws and regulations that inhibit better treatment and increase protection for healthcare workers. Our existing rules and regulations around telemedicine are one such example.
News outlets have been chronicling the heroics of healthcare workers across the globe who are helping Ebola patients. In Sierra Leone alone, 320 health workers who have treated Ebola patients have died of the disease. Here at home, two nurses were infected after treating a patient. Healthcare workers are in a high-risk situation with Ebola, especially when exposed to patients in the later stages of the disease when the virus is highly concentrated within the body.
Telemedicine can be tremendously useful in protecting healthcare workers from the deadly disease by allowing patients to be examined, interviewed and monitored remotely. Human contact is minimized and frontline workers are protected.
For the last decade, telemedicine has been vital to the care of U.S. troops dispersed throughout regions of the world. Since 2005, specialty infectious disease tele-consultations have been provided through Army Knowledge Online. According to the Association of Military Surgeons, from 2005 through 2008, infectious disease tele-consults ranked second in the total number of online consults. By centralizing treatment, infectious disease physicians are able gain a situational awareness of the problems in each region and treat them accordingly. Additionally, a 2010 study of the infectious disease tele-consultation service found the service to be providing beneficial and relevant recommendations in a timely fashion.
From the evaluation of a potentially infected person to the routine communication of treatment, telemedicine can help patients receive the best care. Medical staff or specialists from the CDC can be at any remote locations – across a glass wall, across the building or across the world and still view the patient from different angles, zoom in to focus on hemorrhages, listen to the patient explain their symptoms, view medical monitors in the room, ask questions and experience the same visual and aural subtleties as if the patient were face-to-face in the examination room.
Telemedicine systems also allow patients to communicate directly and visually with family or loved ones for comfort and support.
As useful as telemedicine is in treating infectious diseases, there are regulatory obstacles in the U.S. Medicare does not reimburse physicians for patient telemedicine visits in urban areas – where most Americans live – just to those who live in rural and medically underserved areas. This limits the use of technologies that would provide greater access to healthcare, including treatment of infectious diseases.
The advantages of telemedicine are limited by geographic barriers. At the present time, where a senior citizen lives determines whether Medicare will reimburse the doctor for a visit with a Medicare beneficiary done via telemedicine. As a result of the current Medicare rules, few physicians and healthcare facilities have invested in the equipment that enables remote medical care.
Joel Barthelemy, whose company, GlobalMed, is a member of the Alliance for Connected Care, suggests that we would have a different healthcare system today had we been wise enough to understand that a telemedicine visit is a substitute for an in-person visit – not an additional cost burden for the government.
The use of connected care or other telemedicine platforms would allow the infectious disease community to centralize care and develop treatment and policies to fight diseases together.
For example, new technologies and smart phone applications are being developed by online physician communities to track, diagnose and treat infectious diseases. Programs like these will allow for real time clinical observations and exchange of information to track diseases. They will help physicians understand the geographical spread of infectious diseases and inform health policy planning.
While the use of telemedicine has successfully allowed medical advice to reach patients in remote areas, our technological advancements should not be limited by geography. Changes in Medicare rules would allow an infectious disease expert in one city to reach a patient located in another city.
As this country faces the challenges of Ebola, the need for telemedicine is clear. Let’s take the first step and encourage Congress to remove the geographic limitations to Medicare reimbursements.
