The ability to keep the patient out of hospitals and nursing homes is crucially important as the overuse of antibiotics in the twentieth century comes back to haunt us. Keiji Fukuda, Assistant Director for health security at the WHO was quoted in 2014 as saying “A post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a real possibility for the twenty-first century”. This is a chilling thought when you consider that before antibiotics, Staphylococcus aureus was fatal in 80% of infected wounds.

Telemedicine offers the possibility of treating the patient without exposing them to the bacterial and viral hazards of a Dr’s office. In many situations, having the patient record vital signs and then discuss signs and symptoms with their provider is sufficient to arrive at a diagnosis and care plan. Prescriptions, not yet including controlled substances, can be written electronically and sent to a pharmacy for dispensing. In complex cases the Dr’s office provides an important fallback.

On of the more interesting telemedicine services called Doctor On Demand provides access to medical doctors, psychologists and lactation consultants from your home and accepts insurance for select plans. While prescriptions cannot be written for controlled substances, the service is perfect for many typical medical complaints, and at the current pricing on $40 for fifteen minute intervals it’s a no-brainer for a large slice of the medical population. With an all star cast of executives and the backing on healthcare luminaries such as Dr Phil and Jonathan Bush from Athenahealth, Doctor On Demand is a very promising entrant into the Telemedicine market.

Is telemedicine as safe and effective as physician office visits? It’s not clear yet as the data will take time to accumulate. However, in 2014 one in six Dr’s visits were performed virtually and this number is set to grow dramatically over the next six years, particularly in rural areas. Health and Human Services and the USDA recently launched a pilot project that provided more than $38 million in financing to Critical Access, and small rural hospitals, across thirteen states. For patients with chronic disease, and long travel times to medical care, these services are vitally important.

One of my favourite examples of the value of telemedicine involves the company where I work. In 2013, a patient in Upstate New York came into a Critical Access Hospital with stroke symptoms. As you may be aware, there is a three to four hour window in stroke cases during which the clot busting medicine TPA (Tissue plasminogen activator) can be administered with seemingly miraculous outcomes. The catch – it only works on ischemic strokes and may worsen symptoms if used inappropriately on hemorrhagic cases. The only way to know the type of the stroke is to perform a CT or MRI scan of the head. Unfortunately, critical access hospitals do not have specialist radiologists on staff who are qualified to read the exam.

Luckily for our patient, the eHealth Technologies software solution was installed in the critical access hospital. Once the scan was performed it was sent via a web link to the specialist qualified to make a diagnostic interpretation. Using their iPad and a mobile medical app the stroke was identified as ischemic and TPA was administered. The patient suffered significantly less damage and is now living a normal life.

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