Karim Godamunne, MD, watched the moving images on the computer screen as he maneuvered the joystick with his hand. Using the computer screen as a guide, he traversed hallways, entered rooms, and zoomed the camera lens in on patients and equipment—all with a slight flick of the controller.
Sounds like a doc playing video games in the back office, right? But entertainment wasn’t what Dr. Godamunne, a hospitalist medical director with Eagle Hospital Physicians in Atlanta, was after. He was busy overseeing a study on admitting ED patients to St. Joseph’s Hospital in Atlanta, but he and the other participating physicians weren’t physically in the ED: With the help of a robot, a computer, and a secure high-speed Internet connection, the physicians obtained patients’ medical histories, performed physical exams, and admitted them in about the same time it normally takes on-site doctors.
“It’s like a video game, but much more. That’s how I describe it to people,” Dr. Godamunne says of the technology used in the study. “You have to be able to visualize what you’re doing.”
About 10 Eagle hospitalists participated in a pilot program last year that aimed to determine whether ED patients could be admitted by remote hospitalists using the RP-7 robot, which was developed by Santa Barbara, Calif.-based InTouch Health. Eagle was so pleased with the small study’s results that it began offering its remote-robot program to hospitals last October and anticipates deploying the first robot for HM work this spring. Eagle CEO Robert Young, MD, MPH, conceived the study and considers his company’s fledgling telemedicine program a solution to the hospitalist shortage, particularly for covering night shifts.
The Future of Round-the-Clock Rounds
Is telemedicine the right fit for your HM group? Consider the following pros and cons before you make a decision:
BENEFITS
- Less burnout for hospitalists, leading to higher productivity and longevity;
- Easier hospitalist recruitment, because applicants know they are less likely to work nights;
- Ability to cover multiple hospitals at one time, mitigating the hospitalist shortage that many areas face;
- Enhanced access for hospitalists and their patients to medical specialists;
- Higher technology comfort level among many patients; and
- Ability to expand hospital market area by employing telemedicine technology at outlying medical clinics and offices.
BARRIERS
- Reimbursement obstacles for Medicare and some private health insurers;
- Medical licensing can be time-consuming for telemedicine doctors who serve patients in multiple states;
- Difficulty getting buy-in from on-site doctors and primary-care physicians who are worried about liability and telemedicine doctors’ competence;
- Fear of lawsuits by patients treated via telemedicine;
- Startup technology and training costs; and
- Potential patient resistance to telemedicine.
“Eagle’s experience is that many hospitalists will be skeptical at first, but once they see it in action, not only does much of the resistance go away, but some become champions for its use,” Dr. Young says. “It is largely a matter of exposure to and experience in using the technology.”
While increasingly common in hospital ICUs and radiology departments, telemedicine is catching on more slowly in HM. Experts and practicing hospitalists cite reimbursement hiccups, a laborious medical licensing process, technology costs, physician and patient resistance, and risk aversion as the main reasons telemedicine isn’t embraced throughout HM. Some think it will take a concerted government effort to nudge hospitals and HM groups to buy into the technology.
Nevertheless, a growing number of physicians and administrators think telemedicine is inevitable, especially as the demand for HM services outpaces the supply. As in within the Eagle system, some hospitalists are positioning themselves to capitalize on the advancing technology.