The limiting factors in the past didn’t always have to do with payer and patient acceptance. It had to do with the sophistication of the technology, he says.
“The question was: How much information can you put into a pipe that will make it feel like a real visit?”
With the system from Cisco and instrumentation by AHA, quite a lot, it turns out.
How it feels
“I don’t play a doctor on TV—I am a doctor on TV,” Chomsky quips, as he visits from Winchester, using the Cisco HealthPresence system with a reporter in Nashville. “We’ve been at this for roughly a year, and we’ve been regularly seeing patients for seven to eight months.”
Ascension is one of only four or five organizations in the country working with this system. It basically converts office space at the central location—in this case, the hospital itself, into a room that simply contains a desk, a chair for the physician, and a computer. The monitor is a large HD television, and all of the communication with the remote site takes place through it. The physician plays the role of the director, instructing the assistant on what he would like to measure and take note of during a patient visit. On the other end, the patient room is purpose-built for the unit, with all the specialized monitoring devices the physician may need for the visit. A midlevel clinician operates the equipment for the doctor on the other end. No driving necessary.
“I can’t do a heart cath or an ultrasound through this, but a basic physical examination can be done this way,” Chomsky says. “The initial consultation and follow-up work—it works well for both. This is the ability not just to have a fruitful face-to-face, but to have all the technical aspects of a basic physical exam as good as it would be in person. In some ways, better.”
By that Chomsky means the technology is almost larger than life. Camera locations give the impression that the conversation is taking place at about two feet despite the fact that the patient and physician are about a hundred miles away from each other. That intimacy immediately ruled out concerns that patients would perceive the visits as impersonal.
“We’re sitting two feet from one another, and that’s not a typical patient interaction,” Chomsky says. “This is almost frighteningly intimate.”
Payers were adamant they wouldn’t support a product that generated two visits from one, which is why the system needed acceptance on both the physician and patient side as an even match with the traditional in-person visit. Plus, there was the possibility that this kind of visit would have a positive impact on the patient, as he or she is able to see and hear the same diagnostics the physician is seeing during the examination. Never mind the fact that the patient would have this access to their physician anytime they could make it to their local clinic—eliminating the need for disruptive and time-consuming trips into Nashville.