I have been attending the Canadian Society of Telehealth Annual Meeting in St. John's Newfoundland which runs November 5th and 6th. At this time, although Telehealth is out of scope for the majority of physicians who are implementing EMR systems in their practices, the boundaries between are becoming less defined. In time, Telehealth, EMR and EHR will become integrated with one another as patient care is provided remotely or via face to face consultations as integral components of the EMR.
This posting is not intended to be a broad-based overview of Telehealth, but rather to highlight interesting tools and technologies that I believe could be of value to physicians in their practices or other providers (nurses, nurse practitioners) who provide remote care. The range of tools available is only limited by the ability to pay and vary from relatively easy to use home monitoring devices costing approximately $100/month for remote home care to large 3D videoconferencing units that use a technology called 'Telepresence' and provide the user with a life size remote image of the person with whom they are communicating. These units can cost $40,000 or more and are definitely out of scope for the majority of physician practices.
Videoconferencing via a webcam with one or more individuals is now commonplace. Our kids use this technology to communicate with one another and the hardware is available for less than $100. How many physicians are using this type of technology in their practice at this time? Probably very few and for reasons that range from a lack of reimbursement under current models to an inability to fit any more care into very busy practices. The technology is available, however the workflow issues have yet to be resolved.
Last weekend I attended a conference on EMRs in Vancouver and met a physician who works in Northern BC providing care to remote communities. The six physicians in his group record telephone consults on a digital recorder and attach the files as audio files in their EMR. These are used for future reference and to serve as a record of the services provided for billing purposes. As a result of their location, they use videoconferencing as part of their daily care to reach nurses who provide outreach care in very remote settings. He commented to me that he would like to be able to automatically record his video-consults and attach them into his EMR as a chronological part of the care encounter. This is simply a good business and workflow decision. As a point of interest, this particular physician has already retired once before and returned to work well into his 60's. He is leading his telehealth/EMR initiative. In his case, age is definitely not a barrier to adopting technology in a clinical practice.
One of the most interesting devices that I saw at the meeting is a hand-held wireless video camera that looks like a large digital camera. However it is significantly more advanced in that it allows about 2 hours (per battery charge) of wireless real time videoconferencing with a 3rd party using a built in microphone and speaker and has a built in light to magnify small lesions. Manufactured by a company called LibreStream based in Winnipeg, I could see these devices being used to communicate with dermatologists, plastic surgeons, orthopaedic specialists etc. Once the camera is being used wirelessly, no further equipment is required as all the communication takes place directly through the camera. It is possible to shoot still images or video and once an image is captured, using a digital pen, areas can be highlighted by drawing on the screen on the back of the camera. The individual who is viewing the video-conference on a computer can similarly use a mouse to add to the drawings and highlight other areas. I believe that work is still needed to integrate the saved files directly into an EMR, however what is demonstrated is a tool that has been well thought through in terms of the business process of delivering care.
Could you see yourself using a device like the LibreStream in your practice? What are your thoughts on telehealth and remote monitoring? Have you had any experience with telehealth in your practice?
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