Ann Johnson, a retired veterinarian, like numerous patients diagnosed with Parkinson’s disease, has been traveling long distances to get treated by a medical specialist at Rush University Medical Center. Her entire day is nearly spent at the hospital. However, thanks to a telemedicine pilot project, a recent appointment lasted not more than half an hour, and the only travel she had to do was to her living room.
Nine years ago Ann Johnson was diagnosed with Parkinson’s disease, and on a regular basis she and a family member would drive over 130 miles from Champaign to be treated by Christopher Goetz, MD, on movement disorders and director of the Parkinson's Disease and Movement Disorders Center at Rush.
Recently, she started taking part in a telemedicine pilot project that, when completely developed, would allow her to stay at home on certain appointments, and participate in her treatment via secure, live-streaming video.
As a medical professional, I know the importance of developing innovative approaches. When you see your vital signs right on the screen, it’s really quite neat.
Although, telemedicine with the aid of communication technologies such as telephone or the Internet has been around for awhile, optimized technology and reduced broadband costs have made telemedicine option more viable for patients like Johnson.
Being seen from far away
Diagnosing and observing the development of Parkinson’s disease and other movement disorders are based mostly on visual observation, as there are no brain scans or blood tests to validate the diagnosis. Rush University Medical Center had assisted in establishing and analyzing the visual criteria needed to diagnose Parkinson’s and related movement disorders many years ago, and has been using video technology as well during patient appointments to keep track of development of the disease.
Similarly, treatment alternatives and decisions are mostly based on visual data concerning the patient’s function. Goetz was keen on trying to illustrate that the same subtle symptoms of Parkinson’s disease development or improvement that he assesses in the office such as an unmistakable tremor, a specific variation in gait, a variation in fine finger movements, can also be evaluated by video communication from a patient’s residence in real time.
Since October 2015, over 20 patients have been using their own computers to connect with Rush for virtual one-on-one meetings with their neurologist as a part of the pilot telemedicine program. At the moment, only Goetz and neurologist Katie Kompoliti, MD are using this method. The rest of the Rush neurologists will soon adopt this as well.
So far, patients are quite satisfied and have given positive feedback. Similar to signing on arrival at the neurology department lobby, the patients now log into MyChart, online health record system at Rush, and use it to open a protected video feed using a standard webcam.
Goetz or Kompoliti then instructs them to do a set of movements and respond to the same set of questions they would have in a usual appointment.
‘It’s not like they are here, they are here’
Ninety-five percent of the information I gather is visual. Thus, with telemedicine visits where I can see and hear my patient right in front of me on the computer screen, there is no decline in the quality of information I gather.
Goetz refrains from using the term “virtual visit”, which is frequently used in the relation to telemedicine. When he assesses patients via video and has a detailed conversation with them “it’s not like they are here, they are here — just in two dimensions,” he says. “We have our interaction right here in my office, but they have not had to travel.”
That latter thought is receiving growing attention. Some policy experts state that the true costs of medical care need to factor in patient’s time, not only the payment made to doctors in hospitals.
Researchers have stated in a 2015 American Journal of Managed Care article that the time used up on a visit is more valuable than the financial sum spent by patients on a visit. The researchers discovered that the average total visit time for a person seeking medical care either for themselves, another adult or a child was 121 minutes.
By comparison, they wrote, “people spent only 20 minutes with physicians; they spent the rest of the time waiting, interacting with non-physician staff, or completing paperwork or billing.”
According to economists cited by the researchers in the study, the typical out-of-pocket cost per patient visit is $32, which when taking into consideration the value of those 121 minutes, referred to as opportunity costs, was $43.
Patients having advanced stages of movement disorders normally cannot drive, and would require assistance, thus doubling the time commitment.
Alan Lundin estimates that his visits to Goetz on the whole were approximately 13 hours for him and his wife, who frequently has to skip her work. Their round trip drive from Rockford, Illinois, for his appointment consumes much more than four hours, plus extra time spent at Rush besides the appointment itself.
“That’s pretty much the whole day spent on something that now takes half an hour” in his home, Ludin says.
Preparing for tomorrow’s telemedicine today
Currently insurance does not cover video visits, Rush does not charge patients for these appointments. Many health care organizations are keen on developing telehealth capabilities until Illinois joins nearly half of the states that presently need private insurers to cover telehealth just as they do in-person services.
Rush instead has opted to bear the cost of these appointments and pilot telemedicine services as of now.
In order to prepare ourselves for the future, we are perfecting the system. Rush had the vision to set up the infrastructure and have everything in place so that when the day comes that we can be reimbursed for providing these services on a wider scale , we’ll be able to launch immediately.
Brian Patty, MD, Rush’s chief medical information office and chairman of Rush's Telemedicine Steering Committee, adds that Rush has many telemedicine pilot projects in progress “in areas like neurology where telemedicine can likely have the most patient impact.” “When the laws catch up with the technology,” Patty says, “Rush will be ready.”