As mobile health continues to grow in popularity and become a largely viable healthcare option for patients and physicians, mobile applications for smart phones and tablet devices need to keep up with the demand for convenience that m-health provides.
A North Carolina-based company TouchCare announced a new mobile app that allows physicians and their own patients to correspond in HIPAA compliant face-to-face video appointments.
Kevin J. Biese MD, MAT, assistant professor of emergency medicine and internal medicine and residency program director at the University of North Carolina School of Medicine in Chapel Hill, has been working with m-health for the last year-and-a-half. In addition, Dr. Biese not only serves as an advisor to TouchCare, but also speaks candidly about the upsides and downsides of m-health.
Dr. Biese is interested in the ways in which m-health can integrate America's healthcare system to "not be a silo of care, but to be part of the continuum of care," says Dr. Biese
This means, according to Dr. Biese, that m-health is a tool, and it can either integrate or disintegrate the health care system.
"M-health helps integrate our healthcare system by making it easier for patients to get back in touch with the doctors and care providers that already know them," said Dr. Biese. "For example, I use TouchCare for my patients that aren't feeling well but don't need to be hospitalized or seen in person the next day. It is really beneficial to be able to virtually see them over video consult as a follow up appointment."
On the other side of the coin, Dr. Biese also points out that m-health could disintegrate healthcare systems if patients contact physicians who do not know them, and may not be located in close geographic proximity to the patient.
Dr. Biese provided a great example of how m-health and TouchCare can best serve patients in integrated healthcare systems: a boy twisted his ankle during soccer practice the day his father had to fly out of town for business, and his mother was worried. Instead of taking the child to a high-cost emergency room that evening, the parents contacted Dr. Biese via TouchCare.
"Because I can see the child, I can get a much better sense of how ill I think he is. Then I look at his ankle and there is no bone coming out. I get the dad to touch his toenail and I can see he has good blood flow. If he does need a splint, like a cast, that needs to happen, but it does not have to happen that night. Because I know the healthcare resources in the area (this is just 15 minutes from my house), I say do not go to the ER tonight, but go to this orthopedics clinic tomorrow," recalls Dr. Biese.
"The average ER visit is much more expensive than the average urgent care or even orthopedic care clinic. And, if this child had gone to the ER, they would have just sent him to the urgent care clinic the next day," says Dr. Biese. "Dad was able to go Miami, mom knew everything was okay, and they got to the appropriate resources. If I am in Idaho I do not know what resources are available in North Carolina and I am going to say go to the ER. That is where this is advantageous. What I was able to say is where the right place to go was to get care."
In 2014, there were 75 million mobile health consults in the United States. Due to this large number, Dr. Biese states there is no question as to whether or not m-health is happening, but the question, rather, is how physicians can best implement m-health and make it sustainable for patients and themselves.
TouchCare is not directly involved with reimbursements. In North Carolina, Blue Cross Blue Shield has an e-visit policy. Some groups, in different states, ask the patients to pay out-of-pocket for the service.
Regarding the concern about not being able to accurately administer medical advice and diagnosis over a mobile device, Dr. Biese reiterates that this is another reason that connecting patients with their own physicians over m-health – as TouchCare does – is vital, so the physician can ask the patient to come in if necessary. However, Dr. Biese says he can diagnose a number of conditions over the TouchCare app, including rashes, skin infections and other minor ailments.
"The American Telemedicine Association has some guidelines for diagnosis, but they are suggestive only. At the end of the day it comes down to me, as an experienced physician, saying, 'I have all the information I need, I am comfortable diagnosing and treating, just as comfortable as I would be if the person was here in front of me.' Or, I am not, in which case they need additional care, and I can give them a better sense of what that care should be. I still have to use my judgment as to whether or not I have all the information I need," says Dr. Biese.
Laws concerning prescriptions over m-health also vary state-to-state, and in North Carolina, physicians are prohibited from prescribing controlled substances over m-health.
There is also legislation and attitudes toward m-health which are stalling the further popularity. According to Dr. Biese, the path to integrating m-Health into providers’ workflows is clearing.
"There are over 22 parity states now, which means there is a law that has been passed that mobile health should be compensated the same way as in-person health. If there is not yet a parity law in a specific state, the question of reimbursement is not clear," said Dr. Biese. "Obviously if physicians cannot charge for their service, that is an impairment toward good deployment of mobile health.
“Using mHealth as a tool for the provision of quality care is going to be invaluable to providers as they deliver continuous, value based care. If we don't implement m-health, someone else will, and then our patients probably won't get the care they need," says Dr. Biese.