Bridging the Technology Gap and Geographic Divide

This morning, I attended a webinar on the transitioning to ICD-10 CM and its impact on Public Health Surveillance presented by Peter Hicks of Centers for Disease Control and Prevention (CDC). While its benefits and challenges were discussed, the question to ask is the cost implications of the transition. Another question to ask is its compatibility to existing health information technology. I believe at this point, we need to embrace its advantages, and explore the merging of this initiative on its potential for higher quality and patient-centered care. Setting this topic aside for future dialogue, let me follow-up last week’s discussion on the true, meaningful use of personal health records (PHR), and health information exchange (HIE). In this milieu, let me discuss the promise of telehealth on higher quality and patient-centered care. The geographic separation between regional multi-site healthcare system in which one site is 32 miles or even 51.4 miles away is no longer a logistic problem using telehealth. The quality of care of the traditional model, where health care takes place when the patient and the provider are together at the same time and place can be amplified by current modern system of healthcare. It is important to acknowledge the importance of modern telecommunications and information technologies in providing management flexibility to providers, administrators and managers. It bridges the geographic separation between the patient-provider and management-staff, and allow us to challenge the notion of location and time. Video conferencing can be used to communicate with the provider, where the patient is located one part of the state and the physician is located at another part, or to show new Mohs technicians to perform cryotomy or frozen section immunohistochemistry. In this model, we can remotely monitor patient’s physical condition. Telehealth in concert with disease-specific surveillance data can assess the need for community outreach to educate and inform about the significance of the intervention.

The ability to capture and transmit images using the internet, teleconsultation can be used as an additional approach to teaching new surgical techniques, unbiased by doctrine or surgeon’s experience, enabling accurate quantitative criteria to evaluate the effectiveness of surgical cuts. In the context of cutaneous surgery, whereby contemporary research tools may become one of the criteria in the designing and performing of operations—telemedicine could be an innovative teaching platform presenting systematic pursuit of accurate, optimal cutting patterns and new surgical techniques. This capacity, when used in combination with digital pathology, could offer an alternative method to comply with Clinical Laboratory Improvement Amendments (CLIA) proficiency testing compliance on sharing Mohs slide images with another laboratory to confirm the quality of test of patient frozen section samples. In a multidisciplinary approach, it could bridge the consultation with dermatopathologist on the critical success of a high-quality Mohs surgery program. The dermatopathologist can play a role in quality assurance by reviewing Mohs slides at regular intervals to satisfy the requirement for proficiency testing. Teleconsultation and digital pathology can help assess margins in rare and difficult tumors. Moreover, consultation with dermatopathologist helps in ruling out residual disease or for further immunohistochemistry studies, as well as consultation to assess perineural involvement and uncertain frozen section diagnosis of unusual proliferative lesions. High ground such as remote monitoring of the progress of surgical repairs; we need to acknowledge the challenge in which many of these technologies can impact privacy and security. Telemedicine network structure may have an advantage over competitive hospital- or university-based networks, but the challenge will always be funding and organizational support.

References

Edwards, M. A., & Patel, A. C. (2003). Telemedicine in the state of Maine: A model for growth driven by rural needs. Telemedicine Journal and e-Health, 9(1), 25-39.

Labilles, U. (2014). Telehealth: Bridging the Geographic Challenge. (Unpublished, PUBH-8270-2. Health Informatics and Surveillance. 2014 Spring Qtr. WK8Disc) Walden University, Minneapolis.

Laureate Education, Inc. (Executive Producer). (2011). Introduction to health informatics and surveillance: Telehealth. Baltimore, MD: Johnson, K. & Speedie S.

Sanders, T. B., Bowens, F. M., Pierce, W., Stasher-Booker, B., Thompson, E. Q., & Jones, W. A. (2012). The Road to ICD-10-CM/PCS Implementation: Forecasting the Transition for Providers, Payers, and Other Healthcare Organizations. Perspectives in health information management/AHIMA, American Health Information Management Association, 9(winter).

Terry, N. P. (2012). Anticipating Stage Two: Assessing the Development of Meaningful Use and EMR Deployment. Annals Health L., 21, 103.

Tilleman, T. R. Optimization of Incisions in Cutaneous Surgery including Mohs’ Micrographic Surgery.