The doctor will see you now…

from approximately 350 miles away.

I practice a fairly uncommon specialty within general surgery (Burns) in the midst of a vast rural and frontier region (the Intermountain West).  Our patients come from a huge catchment area, one that covers about 1/11 of the land mass of the U.S.  My now-retired practice partner was visionary in his recognition of telemedicine as a potential component of our practice and got our burn center involved with Telemedicine a decade ago.  At that time, we were simply using telemedicine for acute burn consultations in the emergency departments of three different hospitals.  Our initial experience allowed us to show that we could use telemedicine to accurately evaluate patients at remote facilities, something that improved resource utilization and increased appropriate referral and transfer of patients from remote locations.

Fast-foward to now, when I have lost track of the number of facilities that are part of our telemedicine network.  In 2005, the first active year of our teleburn consult practice, we saw 12 patients.  In 2012 we had 321 teleburn patient consults.  In 2013, we broke the 500 visit mark.  We still see patients as emergency consultations, but we’ve added a Wednesday “teleburn clinic” to our schedule every week.  This allows us to continue to see our patients in Idaho, Montana, and Wyoming without the inconvenience of travel for them and their families.

Many potential limitations have been raised about the practice of telemedicine, some of which continue to be slow to resolve.  If a physician or APC is going to have a telemedicine practice, they want to be certain that their technology is HIPPA-compliant (sorry, folks, FaceTime doesn’t make the cut).    While licensing continues to provide a challenge for those of us who practice telemedicine- I now carry licenses in 4 states besides Utah strictly for our telemedicine practices- rules for delegated credentialing in telemedicine established by CMS have made that particular administrative hurdle less.  Arguments have been made that that telemedicine practices aren’t sustainable financially, and our experience indicates that simply isn’t true.  For the last 5 years, cumulative data from our center indicate that physician reimbursement occurs at similar rates for telemedicine and in-person outpatient visits.  There is also a profitability benefit to the originating site system; a sampling of 1/4 of our teleburn visits in 2010-2011 demonstrated that those visits directly resulted in $4.2 million in revenue to our institution.  An important aspect of that profitability is that our hospital absorbs all operating costs of our teleburn practice, including equipment upgrades.

Is telemedicine perfect?  Decidedly no.  I’m a tactile person, and sometimes I want to feel and manipulate an area of scar on a patient and simply can’t do that through our system.  Sometimes there are technology issues that mean I’m not able to “perfectly” visualize someone’s injury or scar.  Because of the nature and location of our practice, however, I simply can’t imagine NOT having telemedicine as a service for our patients and families.  Besides, there are a few patients in Idaho who can honestly say that they have had a middle-of-the-night telemedicine visit with a specialist in Salt Lake who was “assisted” by her cat.