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Wednesday, March 5, 2014

Health & Tech: Using Technology to Improve Health Care— Part 1: Access to Specialists

Kim Bailey

Health System Improvement Program Director

Today, we’re kicking off an occasional series of posts that will focus on the intersection of health and technology. Over the coming months, we’ll explore ways in which technology is helping to improve the way that doctors and other providers deliver health care to their patients. 

In this first post, we’re going to explore how telemedicine can be used to increase access to specialist care. In future posts, we’ll explore topics that range from pills with sensors that track when they have been swallowed to electronic health records.

The problem: Medical specialists aren’t always readily available outside of cities and suburban areas, where they tend to be concentrated in order to practice at major hospitals and academic medical centers.

Patients who live in a rural area may live tens—or even hundreds—of miles from the specialist that they need to see. Interestingly, the problem also exists in urban areas, as well. For example, patients who lack reliable public transportation options or who see a doctor with limited office hours may face significant barriers to accessing specialist services. 

The technology solution: Telemedicine uses videoconferencing technology and secure transfers of data to help facilitate remote interaction between specialists and their patients.

These connections happen in real time, replacing a traditional doctor’s visit with an “e-consult” (a patient has a real-time appointment with a specialist via teleconference). These connections can also happen offline through a strategy called “store and forward.” “Store and forward” allows a  health care provider to upload a patient’s history and data (such as x-rays or lab results) to a secure server that is later accessed and reviewed remotely by a specialist. 

Both of these health care technology solutions have great promise and may help to meet patient needs where there is a shortage of specialists. Depending on the health needs of the patient, however, one strategy may be more appropriate than the other. For example, certain imaging-heavy specialties, such as dermatology and radiology, lend themselves to the store and forward approach because their data can be easily shared (for example, photos of skin lesions and rashes, and images such as CT scans and MRIs). Other specialties, like cardiology and obstetrics, benefit from face-to-face interaction between patient and provider and are better suited to e-consults. 

Case study—e-consults in practice: Arkansas’s Medicaid program, a pioneer in telemedicine, has been operating the Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS) program since 2003.

This program connects patients and providers in rural communities with obstetrical specialists at the state’s academic medical center. These specialists provide genetic counseling, real-time analysis of ultrasounds to detect fetal abnormalities, and other services. 

The ANGELS program is notable not only because it has been successful at increasing access to specialists and improving maternal and child health outcomes in rural Arkansas, but also because of how it does this. By leveraging the state university system’s existing interactive video network, the ANGELS program was able to achieve this connectivity at a relatively low cost. The success of the ANGELS program led to the development of similar programs in Arkansas for other specialties, including pediatric cardiology, behavioral health, asthma care, and HIV/AIDS screening and management.  

Considerations for consumers: While telemedicine has the potential to increase access to needed specialist care, the adoption of these technologies may create concerns for consumers.

For example, there is a risk of compromising sensitive information whenever a patient’s data is shared electronically. It is therefore essential that providers protect patient data and privacy, and that they invest the financial and technology resources necessary to ensure that patient data is protected at all costs. 

In addition, as the reach of telemedicine grows, the health care field will need to evaluate whether remote access to providers is an effective, high-quality substitute for seeing a specialist in-person. This has strong implications for ensuring that all populations get the care they need and are not treated differently—what we call health equity. Some health specialties may not lend themselves to telemedicine, and people with certain health conditions and those with complex health needs may be better served by seeing a provider in-person.  

Telemedicine offers great promise, but, as always, those who care about the interests of consumers must keep an eye out for any access issues or unintended consequences that may arise.