Telemedicine is not a new service in many parts of rural America, where a scarcity of healthcare providers makes the distance patients have to travel to get care an access problem. But even in urban areas where clinics may seem to be only a short distance away, the reality is that numerous obstacles make it difficult for patients to access necessary healthcare appointments: transportation barriers, such as not having a car or living far from a Metro or bus line; or lack of childcare services, just to name a few. Whatever the reason, we know that skipping important healthcare appointments may lead to poor health outcomes. With this in mind, Mary’s Center is bringing elements of what has worked well in rural areas to population-dense Washington D.C. By harnessing the power of technology, we are bringing Mary’s Center providers into our participants’ homes to deliver timely and critical healthcare services – that’s urban Telemedicine.
WHAT IS TELEMEDICINE?
“Telemedicine,” or “Telehealth” as it is sometimes called, can be defined in a few different ways; Mary’s Center’s follows the D.C. law in defining telemedicine as “the delivery of healthcare services using interactive audio, video, or other electronic media used for diagnosis, consultation, or treatment.” Communication between providers and patients using audio-only telephones, email or fax messages does not constitute a “telemedicine” encounter.*
WHO IS A CANDIDATE FOR TELEMEDICINE?
Mary’s Center launched the Health at Home Telemedicine program thanks to an early partnership with AmeriHealth, one of D.C.’s Medicaid Managed Care Organizations. In addition to serving AmeriHealth patients, we also serve enrollees with Trusted, another Medicaid MCO. As the program grows and shows success, we hope to expand our work to other insurers in the coming months/years.
The Mary’s Center Telemedicine Team is focusing its efforts primarily on patients who have at least one of the following diagnoses: diabetes, hypertension, asthma and/or congestive heart failure. We chose these diagnoses because clinical evidence strongly indicates that regular clinician management and follow-up of these diseases results in improved short- and long-term health outcomes. Based on our providers’ clinical judgment and knowledge of their patients’ unique needs and circumstances, patients with other chronic conditions may be identified as good candidates for telemedicine as well. Conversely, not every patient with one of the four targeted diagnoses is appropriate for Telemedicine; it is important to note that not every patient’s insurance will pay for Telemedicine visits. The Mary’s Center Telemedicine Team will be reaching out proactively to patients who qualify for the program, and providers will be discussing Telemedicine as an option for future encounters with their patients who qualify.
HOW DOES TELEMEDICINE WORK AT MARY’S CENTER?
A Mary’s Center Home Visitor – who is a certified Medical Assistant or Nurse with experience in direct patient care and home visiting – travels to patients’ homes with a kit full of screening and diagnostic equipment, along with a laptop computer that allows the provider to see and talk to the patient through a secure video teleconferencing platform in real-time.
Other than the setting, the telemedicine visit is very similar to what a patient experiences if he/she comes to the clinic. The Home Visitor takes vital signs and asks questions about recent health history to update the Electronic Medical Record for the provider’s review; and notifies the provider electronically when the patient is ready to be “seen.” The Home Visitor launches the video teleconferencing software and the patient and provider see and speak with each other on the computer screen. In addition, the Home Visitor has special equipment – a variety of “scopes” – that allow the provider to examine the patient – just like in the clinic. The provider can, for example, listen to breath and heart sounds, look inside the ears, nose, or throat, take a close look at skin – even though she is in a different building in a different part of town! All of this is done over a secure internet connection so that we can ensure the privacy and security of patient health information.
After the provider finishes her examination and discussion, she may order the Home Visitor to collect a blood or urine sample or perform other diagnostic tests, like checking blood sugar – again, just like in the clinic! The Telemedicine Team wants to do as much as we can while we’re in the home, since the whole idea of telemedicine is to make getting healthcare as easy as possible for patients who have access barriers.
As we grow and can demonstrate the value of Telemedicine to payers in an urban setting, we expect that many insurance companies will begin to reimburse us for Telemedicine encounters. So even if your insurance company does not reimburse for Telemedicine today, we are hopeful that many more in our community will be served through Telemedicine soon.
If you have questions about Telemedicine at Mary’s Center, please contact Ellen Evans, Clinical Director for Telemedicine at firstname.lastname@example.org.
Participants should email email@example.com or call the Health at Home hotline at 202-851-3278.
* Source: DC Code Sec. 31-3861.