Telemedicine: Just how do you eat a bonus?

Dr Ed Brown, founder and head, CEO of Ontario Telemedicine Network, gave the keynote address at the OntarioMD EMR conference in London, Ontario Mar 27, 2014. The topic, you guessed it, was the state of telemedicine in Ontario, and a look to the future.


I ate lunch.

Black Beans Home Made Bred Burguer: Telemedicine, eating a bonus Jiuck via Compfight


I was between lectures, struggling to make my 53 year old brain dive through EMR hoops. I’m a paper and pencil guy. I gave a lecture once, and gravitated to a flip chart, and a marker. When it came to clinic EMR acquisition, I was the one with dragging feet.


So, I was eating lunch, in a neurological state of collapse, or at least recoil, when this man was talking. My pen was in my bag.


Shouldn’t have been.


I didn’t know anything about this, really, apart from a general awareness of telemedicine. Yes, specialists were doing remote science fiction type robotic surgery like some page straight out of Tom Swift. Yes, specialists were instructing, and helping remote healthcare workers in igloos. No. Telemedicine was here, in the south banana belt of southern Ontario, not just in the blowing snows. People with CHF were at home, doing simple self measurements like their weight, and getting appropriate advice from their MD.


And staying out of hospital.


Figures were presented, none of which were scribbled down by yours truly, for my one and true priority at all times is to feed my face, that showed statistical improvement in hospitalization rates, rehospitalization rates, and financial savings. The amount of money saved in mere transportation of a remote patient to a more urban center was mind boggling.


“There is no funding for telemedicine for primary care providers.” (Or, something like that…remember, I was eating!) I remember grunting, nodding my head, saying something like, “Figures”, and taking another bite.


Well, nonsense.


Of course there’s funding. There is funding for telemedicine for all physicians that have an alternate, (non fee for service) payment arrangement. We are being paid for taking care of our patients, even if we don’t see them. Telemedicine has been proven to work. It just takes someone to start doing it.


After a practice review recently, I have become aware that many of my patients are not getting their q 3 month diabetes check. I have a relatively large practice, and work full days, M-F, so really don’t have time to put in another clinic.


Largely, the K030 visit for DM could be done at home. Patients would need their regular blood work, would need their glucometer, a scale, a reliable BP cuff like an OMRON unit, and a filament to test their feet. An initial patient group meeting with an RN/ MD team could review how to use the OMRON, what to look for in a foot exam, etc, how to use the filament, and how to document. A template could be generated that would be internet accessible through a practice website.


Physician or nurse assessments could be limited to those patients that had areas of concern on their templates, patients that were uncertain about their foot exams, etc. Some issues could be handled by phone. Dramatically less patients would need to be seen.


After this intervention, we could track Hba1c levels, graph BP, percentages of patients getting their interventions done (such as seeing the optometrist).


I just wonder. Currently, I have several patients that are so overwhelmingly complicated, or who have overlapping in your face health concerns that are more urgent, that never seem to get that formal DM review. Are they getting best care? No.


I wonder. These special visits, that are eligible for an extra bonus through OHIP, could largely be done at home.


But that would require us eating that bonus, wouldn’t it?

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