The field of telehealth is still emerging, and while there's anecdotal evidence of its benefits to care, there haven't been a lot of long-term studies to quantify it. That hasn't stopped organizations from pursuing the model. In the 2011 HealthLeaders Media Industry Survey of technology leaders, 46% of respondents said they have one or more telemedicine programs in place. Another 41% say they'll have one in place in one to five years.
What's driving the technology? The shortage of intensivists, specialists, and physicians willing to take call, for starters. Remote access brings doctors to patients regardless of where they happen to be. Another factor is that the technology itself is advancing so fast.
Remote units have high-definition displays, the ability to zoom right in and take high-resolution photos and high-quality videos, and digital stethoscopes that let docs listen just as well as—or even better than—they can in person.
Capabilities have also expanded rapidly. Healthcare organizations have access to faster and more reliable data networks, and abundant access to mobile devices.
And then there's that anecdotal evidence. Proponents say using technology to deliver care over a distance will improve access, ease physician shortages, create new revenue streams and increase volume for healthcare organizations by expanding market reach, and improve quality of care.
Still, there's that lingering lack of concrete evidence that remote care is significantly better than care delivered in person.
One new study that examined the impact of telemedicine ICU care on mortality and length of stay got a mixed answer to that question.
Researchers, who published their findings in the Archives of Internal Medicine in March, reviewed ICU outcome data from 60 years' worth of studies, including those that reported data on the primary outcomes of ICU and in-hospital mortality or on the secondary outcomes of ICU and hospital length of stay.
The researchers found that while telemedicine can impact ICU mortality and length of stay, it doesn't have the same impact on inpatient hospitalizations. The study suggests that organizations that are using the technology in the ICUs are on the right track.
Other studies are ongoing. A demonstration project at Wenatchee (WA) Valley Medical Center seeks to show that remote home monitoring can reduce hospitalizations, and, as a result, lower costs among patients with diabetes, congestive heart failure, and chronic obstructive pulmonary disease.
"The idea is that you would try to catch exacerbations at a milder stage before they require hospitalization," says WVMC CEO Peter Rutherford, MD.
In the first three years of the randomized trial, the organization met the program's goal of saving 5% net of costs. The number of clinic visits went up—and because patients had already been triaged by case managers, those visits were more productive. At the same time, hospitalizations and emergency room visits declined.
The study is currently in its second phase, which will expand screenings to include other disease states such as asthma and comorbidities such as depression.
Loyola University Medical Center implemented its telehealth program about four years ago as a way to increase after-hours coverage at its 14-bed pediatric ICU.
Clinicians, including rapid response teams, use the technology to evaluate patients and intervene in a timely manner wherever they are. About 75% of patients treated remotely are transferred to the ICU; doing so early is a best practice that lowers mortality rates among high-risk patients, Kathleen Webster, MD, director for pediatric critical care and the medical director for the pediatric ICU, told HealthLeaders Media.
"We went an entire year with no deaths in that group—and that's as low as I can go with the numbers," Webster says. "That tells us that we're doing a good job of seeing these patients early."
No doubt that zero is an impressive number. But as the field of telemedicine continues to emerge, so must research into its clinical effectiveness.