Where's the Technology?
The last ten years of medical advance has promised again and again the ability for physicians to remotely examine and even treat their patients. Federal government states and universities have spent that millions of dollars in the development of examination stations and robots to provide stereo two-way voice communication, stereoscopic video and even remote stethoscope capability to patient bedsides in remote hospital communities. This new science of telemedicine has brought advances to hospital and emergency room based medicine for those remote communities.
But what about the average consumer? The coming pandemic looms ominously on the horizon. But this ominous shadow may actually be a new dawn for telemedicine.
The SARS outbreak in Toronto and Singapore proved that quarantine does not work but that Social Distancing does. The message in Toronto was clear and simple. Dont go to hospitals and healthcare institutions unless you want to catch SARS. Thats where the SARS is. In Toronto it worked. The SARS epidemic fizzled out after only a few short weeks of social distancing.
But in the United States, emergency rooms, hospitals and urgent care centers are the destination for the treatment of after-hours illnesses and sudden onsets of the flu. Pandemic flu will strike like a blitzkrieg across the world. People will fall ill in a matter of hours not days. Doctors offices will be overflowing with the sick and those who are afraid that they will become sick. The default will be the urgent care centers emergency rooms and hospitals of the nation. This is where the disease will be concentrated and like with SARS in Toronto this is where it will be most likely that you will become ill.
Heres where telemedicine has the advantage, if somebody, anybody can produce a telemedicine technology solution within a reasonable price range for the average consumer to buy. What would be needed would be a high resolution web camera and a simple handheld stethoscope-like device that could produce high fidelity sound in real time. A web based portal for physicians would also be needed. The examination would need to be completable in real time.
Imagine a simple device with a webcam and a modified microphone similar to that already found on electronic stethoscopes used by physicians coupled with an electronic blood pressure cuff. Now imagine this device providing information in real time to the physician a rudimentary medical examination, a kind of telemedicine triage. With this consumer priced equipment, an examination could be performed and basic healthcare decisions such as the need for home healthcare nursing, antiviral medication prescriptions, or simple chicken soup could be made. This telemedicine triage would ensure that only the sickest of the sick would go to the hospital guaranteeing that the spread of the disease was decreased because fewer people would be sent home from the hospital not sick, but now contaminated.
Of course Medicare, Medicaid and other healthcare insurances would have to begin to actually pay physicians to perform telemedicine services. While the codes exist reimbursement is slow and difficult. Telemedicine takes more time than a regular examination and time does have a value.
Will anybody step up to the plate? That depends on demand for telemedicine triage by the public, the demand for a consumer telemedicine product and, unfortunately, the ability of physicians to get paid for what they do. On the other hand, the cost if telemedicine triage does not become is that the future pandemic will rage on.
Dr. Maurice A. Ramirez is co-founder of Disaster Life Support of North America, Inc., a national provider of Disaster Preparation, Planning, Response and Recovery education. Through his consulting firm High Alert, LLC., he serves on expert panels for pandemic preparedness and healthcare surge planning with Congressional and Cabinet Members. Board certified in multiple medical specialties, Dr. Ramirez is Founding Chairperson of the American Board of Disaster Medicine and a Senior Physician-Federal Medical Officer for the Department of Homeland Security. Cited in 24 textbooks with numerous published articles, he is co-creator of C5RITICAL and author of Mastery Against Adversity. Dr. Ramirez invites comments at: http://www.disaster-blog.com
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