In April of this year, New Mexico became the 17th state in the U.S. to enact laws governing the use of telemedicine as a method to deliver healthcare to our citizens. The New Mexico law mandates that private health insurance plans provide coverage for care delivered by telemedicine. For anyone interested, you can read the bill here.
For those of you not familiar with telemedicine, this is the process that delivers health care services by licensed physicians over great distances through the use of video, audio, and photographic means. Simply, if you live in Taos and want to see an Ear, Nose, and Throat (ENT) specialist that practices in Albuquerque – you can either drive three hours to see the specialist, then drive three hours to return home, or you could drive to a local facility with telemedicine equipment and have a “virtual” visit with the specialist. While the concept is simple, actual implementation of such systems poses a number of challenges.
Before I came to Taos, I worked for a health system in Bethel, Alaska. One of my major goals was to implement a telemedicine system that could connect each of our 53 different villages to our main hospital in Bethel. This was no simple feat considering that there were no roads that connected these villages to the city of Bethel, much less any sort of fiber or copper connectivity for data. Over the course of about 2 years we were successful at building a microwave telecommunications network and installing hi-definition video teleconferencing equipment at every one of the 53 villages, and providing telemedicine capabilities to the people of western Alaska, 24 hours a day/7 days a week.
Northern New Mexico is a similar large, open, sparsely populated geography with a small number of healthcare facilities for our patients. There is exceptional potential for telemedicine to open up new opportunities for specialty and primary healthcare. This is part of the reason that I was hired in early 2012 –to bring this experience to our local hospital and see how we could expand our capabilities past the boundaries of Taos County.
As I mentioned earlier, telemedicine can be implemented logistically, and now we have a legal framework within New Mexico to provide these types of services, but there are significant technological and financial challenges to implementing a “medical grade” system.
One of the most significant challenges is simply the cost of a medical grade telemedicine solution, which for a hospital the size of Holy Cross, can cost as much as $200,000. This type of medical grade system provides high-definition video, high-quality audio, and has the ability to integrate with various types of medical equipment ranging from the simple such, as an otoscope (the thing a doctor puts in your ear to look at your ear canal), to the complex such as a 12-lead EKG machine.
To meet malpractice insurance requirements, these systems need the ability to record the interaction between the patient and the physician, and store those interactions for years to comply with a variety of record retention laws. If this isn’t enough, these kinds of systems must not only be able to perform all of these functions, but the system must also be simple to operate for the physician, the office staff, and the patient.
Finally, both ends of the equation must have enough secure (i.e. encrypted) bandwidth to carry the real-time, hi-definition signals and medical information. Remember the Internet, cell phone, and long-distance outages that occurred in Taos in June 2013 and in 2012 – no connectivity, no telemedicine.
Another challenge that faces facilities, even with recently passed legislation, is the payment question. The reality is, because of the details of how telemedicine payments work, the physicians on the remote-end of the connection receive the bulk of payments. This makes sense, since it is this physician that is actually providing care to the patient. However, the hospital or clinic where the patient is physically located has expenses that need to be addressed as well. Not only does this location have the burden of providing the telemedicine cameras, microphones, medical equipment, and connectivity – but the clinic or hospital is also providing physical space, which in today’s world of intense medical licensing regulations can cost between $300 - $400 a square foot. With typical reimbursement to the clinic or hospital where the patient is located averaging around $42 per visit, the justification of the expenses required to implement telemedicine is difficult.
Taos Health Systems has spent the last 18 months creating a technology infrastructure that supports advanced patient care technologies such as telemedicine. Currently, we are evaluating the possibilities of partnering with other hospitals around the region to provide some specialty services through telemedicine. Most recently, I have been speaking with the leadership team at the New Mexico Telehealth Alliance and the University of New Mexico to evaluate what specialties may be available to our area via telemedicine. While I have been working on these details, our Director of Outreach and our Director of Development have been exploring funding possibilities with agencies such as USDA, the FCC, and the Health Resources and Services Administration (HRSA). Our goal is to identify:
We realize that telemedicine is not going to be an area of significant financial income for Taos Health, but we believe that enabling our residents to receive as much care close-to-home is what is right for those that depend on Holy Cross Hospital and Taos Health Systems for their daily healthcare needs.
If you have any questions about what Taos Health Systems is doing to enhance patient care, secure your private data, or to make healthcare safer, please feel free to email me directly at firstname.lastname@example.org. I answer all emails personally.
Chief Information Officer
Taos Health Systems