From his point of view, Paul Vanchiere's newborn daughter was healthy and developing normally. It was only when the pediatrician stroked the bottom of the baby's foot, causing her toes to curl the wrong way, that he learned his daughter had serious spine and brain damage.
Standalone direct-to-consumer (DTC) providers threaten to diminish the quality of the medical home, according to some experts. In response, some pediatricians are calling on the The American Academy of Pediatrics (AAP) to guide practices in the adoption of televideo and/or remote monitoring devices to improve care, reduce costs, and remain competitive.
But how practical and feasible is it for the average independent pediatric practice to acquire these technologies, which can be expensive and often a poor substitute for a face-to-face encounter between doctor and patient.
His daughter's case, in which only a doctor's hands-on expertise could have revealed the abnormality, is a good example of keeping the most important visits in the office, says Vanchiere, pictured above, who is also a nationally known practice management consultant.
“The art of medicine still requires the laying of the hands,” Vanchiere told PCC. “A little twitch of the eye or a tremble of the feet are sometimes small clues that telemedicine can't convey.”
Vanchiere predicts telemedicine will not be fully integrated into the average pediatric office for another three to five years.
“The biggest resistance right now is around who's going to pay for it, and how does it fit into the workflow?” Vanchiere said. “Most doctors would much rather return a phone call and tell their patients to come in the next day.”
Currently, pediatricians who can afford it find telehealth most useful for diagnosing ear infections. In 2004, Cellscope launched an iPhone otoscope attachment for parents to use at home. The device allows parents to capture video of an ear exam on their kids and connect with a physician for remote assessment and treatment.
But there are barriers to its use, both for the practice and the parent. The Oto HOME is $79 and comes with one Oto CONNECT session; subsequent sessions cost $49. Is the parent willing to pay $130 to get the device and a consultation? And will doctors take time out of the day to man the portal and deal with telehealth calls and remote appointments?
And when it comes to payments, telemedicine is often not reimbursed at comparable rates. The biggest resistance most doctors would much rather return a phone call and tell their patients to come in the next day.
Vanchiere suggests telemedicine may be best used for behavioral health, which is sorely underfunded, and routine parent concerns.
“Telehealth can be best used for follow-up type visits, and things that don't require physical contact between the pediatrician and the patient.”
Read Telemedicine - Part I: The Case for Adopting Telemedicine