Technology is going to radically change your office visit to the doctor in the years ahead.
An “office” may not even be associated with your visit.
You may already have seen the changes: Your doctor allows you to make your next appointment online or when you arrive at your doctor’s office, you sign in on an iPad instead of a clipboard.
In some states, physicians already conduct office visits via personal communication devices, using Skype, FaceTime, email or text.
Telemedicine in New Jersey is more evolution than revolution. That’s because the first step toward telemedicine is linking systems and sharing data, which begins with computerization of medical records. Proposed telemedicine laws have yet to find their way out of legislative committees.
But eventually, your doctor’s visit will go something like this:
Your doctor reviews your test results on his laptop or hand-held device in the examining room. As he listens to your concerns, he can access laboratory results from a facility five states away. Then, instead of reaching for that little blue pad to write a prescription, he quickly taps his computer and it is filed digitally to your pharmacy. As you drive home, your cell phone beeps or quacks or pings: the pharmacy has alerted you that your prescription is ready. No matter how far technology advances, however, you are still going to wait on line there.
Larry Downs, the chief executive officer of the Medical Society of New Jersey, was just one of many who likened the end result of the electronic revolution in health care to the way the practice of medicine was portrayed on the original “Star Trek” series where Dr. McCoy often worked alone, aided largely by a single small device that could not only diagnose but also treat the patient.
The more radical applications of telemedicine are likely 10 years or more away here, experts say. Telemedicine has evolved more quickly in states and regions that are largely rural where finding a medical specialist is difficult and often involves a lengthy wait for an appointment.
“Some of my patients are already asking, ‘Can I have a copy of my blood test today?’ and I can print it right out for them,” said Dr. John D. Gumina, founding member of the Jersey Shore Monmouth Family Medicine Group and chairman of Jersey Shore University Medical Center’s Family Practice department. “I like it because patients are becoming more involved in their care. This is especially true of seniors who like to be kept updated.”
The technology will mature very quickly, said those who are on the front lines now.
“We can take into account every patient at risk, and we will have the tools available to tell patients how they are doing,” said Dr. Anthony D. Slonim, chief medical officer of Barnabas Health, which locally operates three hospitals in Monmouth and Ocean counties. “They are in the game now.”
The primary reason why telemedicine has not moved forward in New Jersey as rapidly as in other states is it does not have the physician/specialist shortage or the geography of more rural states, said Dr. Mary Campagnolo, president of the New Jersey Medical Society. While credentialing of physicians who will practice telemedicine is also a concern, it is primarily an issue of miles traveled in a state considered small and densely populated
But even if telemedicine isn’t widespread in New Jersey, there are several pilot programs. For example, Virtua Health Care System in South Jersey has several programs, primarily one with the Children’s Hospital of Philadelphia that allows real-time consultations with Pennsylvania pediatric specialists.
In a Bergen County pilot program, for example, pediatricians also are able to video-conference with pediatric psychiatrists and psychologists who really are in short supply throughout the state, Campagnolo said.
Some pilot programs — including several in New Jersey — use special computers that allow physicians in remote locations to take vital signs, have real-time conversations with patients and potentially improve outcomes by having specialists see patients promptly, even over long distances. That, in turn, means a faster, more accurate diagnosis for which treatment can begin more rapidly. Less waiting and fewer duplicate medical tests may mean more economical and less physically intrusive practice of medicine.
Nine states require a special license for the practice of telemedicine. New Jersey does not. Thirteen states have some form of telemedicine legislation under consideration. New Jersey is not among them.
But medical officials say that moving telemedicine ahead in New Jersey is gaining traction among physicians, hospitals, and medical associations, and may result in additional legislation.
“I think it is timely now,” said Mishael Azam, senior manager for legislative services at the Medical Society of New Jersey. “I think people in health care are starting to talk about it. We have the technology now.”
According to 2012 data from an annual survey by the federal Centers for Disease Control and Prevention, 72 percent of office-based physicians used electronic medical record or electronic health record systems, up from 48 percent in 2009. Such record-keeping use ranged from 54 percent in New Jersey to 89 percent in Massachusetts.
New Jersey may be behind other states, but electronic record-keeping will become almost universally available within the next few years. Physicians face monetary penalties from the federal government if they don’t comply. The same is true of electronic prescriptions. Physicians will have no choice. The little blue pads will be history.
With more accessible health care information, physicians will be able to detect health care patterns.
Toms River resident Carol Nering, a registered nurse who has been a longtime patient of Dr. Diane G. Verga, said the electronic medical record has its pluses and minuses.
“I personally am a little uncomfortable with it because I know anyone can hack into a computer,” said Nering, 78, a former Bayshore resident who lived in North Jersey much of her working life. “I don’t think you are really secure with” the way the information is stored and protected.
Still, Nering said, “in the computer, the information is easily read and that saves time, and unfortunately, in some instances, time is of the essence.
What about malpractice?
While many physicians say it will likely reduce costs over the long term, one component of telemedicine practice still is the focus of debate and study. With telemedicine crossing state lines and with medical licenses still very much up to the states, how will questions of malpractice be handled?
“As the use of telemedicine grows, malpractice claims relating to telemedicine services may increase and, if so, these complications are likely to create a new body of law,” the University of Maryland School of Law concluded in 2010. “As the specter of telemedicine-related claims grows, the professional liability industry is studying how to write and price medical malpractice policies for telemedicine practitioners.”
The issue is complex. Telemedicine crosses state lines. Which state would have jurisdiction? Should a physician be held to the same standard of care as in face-to-face appointments? If a case goes bad, is the physician responsible or is it a failure of the technology as in the case of a lost Internet connection? Should telemedicine be its own category of malpractice law? What about informed consent from patients?
At this intersection of the age-old practice of medicine and the rapid development of technology, how malpractice and negligence questions will shake out is anyone’s guess, the law school study summarized.
But that does not seem to be in question is whether telemedicine can help make sick people better. The federal Department of Health and Human Services Office of Health Information Technology — which is overseeing the digital transformation of health care — says the medical applications of telemedicine helps patients, especially those who prefer to stay in their homes as they battle chronic conditions. And the government says the evidence demonstrates the quality of telemedicine.
Technology appears to help mitigate human error, which kills about 98,000 people every year, according to the American Association for Justice, a trial-lawyers’ consumer group. The federal Department of Health and Human Services said 64 percent of physicians using electronic health record software properly were alerted to potential medication errors while 62 percent of physicians were informed of a critical laboratory test finding, thanks for the software.
Telemedicine, digital doctoring, telehealth, e-health, cybermedicine — whatever it’ll be called — is appealing to physicians and their patients as insurers become more supportive. When Medicare pays, private insurers typically follow suit, and Medicare is authorizing reimbursement of telemedicine in limited ways, officials said.
“People are going to be seen by their doctor, either there or through a digital application,” said Dr. Paul Katz, founding dean of Cooper Medical School of Rowan University in Camden. “Now we must figure out a way to manage it, a way that is not excessive and unnecessary.”
Robotic surgery has been around for a number of years and is typically practiced with a patient appropriately draped in an operating room and the treating physician nearby or in the next room. But the day will come when such surgery is performed remotely with a patient laying bloodied and broken on a distant battlefield saved by a physician back at the military installation or possibly safely stashed in a stateside hospital, worlds away.
“When you think about medicine, there is a certain amount of laying on the hands, which is important,” Katz said. In other areas, such as monitoring blood pressure, glucose levels, EKG review or X-rays, these do not require real-time, face-to-face conversations between physician and patient, Katz said.
“The other part of this … is patients can monitor their own health,” said Katz, describing one application in which diabetic Patient X pricks his finger, inserts the strip into his smart phone, which then provides medical advice about next steps.
“So much of what we do in health care is about art and not science,” Katz said. “Empathy and professionalism and caring and compassion goes by the by and you may not be able to bring that back.”