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Cisco and telepresence: If you have a hammer, everything looks like a nail

Okay, you know that you can count on tech vendors to put 2 + 2 together and get 5, especially where their own product is involved. Let's start with today's CNET quote from Cisco: "What is different right now is that the health care system in this country is being asked to deliver service more effectively and efficiently without increasing the available resources," said Nick Augustinos, senior director with Cisco's Internet Business Solutions group for global health. "So what's needed now is a health care system that can scale. And that is what telepresence and other remote monitoring technologies can do by extending the natural reach of doctors and clinicians in a nontraditional way."  Hold on, Nick.

I'll give you non-traditional. Telepresence from Cisco, where $300K gets you the sense that you're all in the same room.  But a) there are alternatives and b) there are some disconnected thoughts in this article:

Telemedicine hasn't taken off because of cost - nope. This isn't quite correct. Telepresence as a widely used telemedicine technology hasn't taken off because of cost. From the article: "And because these systems require the use of high-definition audio and video, which must be transmitted over an Internet connection between doctors and patients, these systems require significant amounts of bandwidth. This means that without ubiquitous broadband access throughout the country, the cost benefits and usefulness of the technology is limited." Telepresence is one instance (and a megabucks one at that) of telemedicine. The telephone consultation -- that's telemedicine.* So is e-mail. So is remote monitoring of glucose, and so is remote management of medication dispensers.

Telemedicine is more and less than telepresence. From CNET: "One of the challenges in deploying telemedicine has been the fact that insurance companies have been more likely to reimburse traditional face-to-face doctor visits rather than procedures done remotely using telemedicine. But with the partnership between UnitedHealth Group, which insures some 70 million people in the U.S. and Cisco, it looks like insurance companies may be realizing the economic benefits of scaling the health care system virtually." Not necessarily. Doesn't seem like United has come out with a specific endorsement of all the other 'tele' technologies. Important to note -- it is feasible for doctors to code a 'virtual' visit today for Medicare reimbursement.  But feasible is not the same as widely endorsed or standardized in practice.

Meanwhile, back at the ranch, telephone and e-mail up, cost is low. Before leaping to the conclusion that Cisco's telepresence offering is just the ticket to telemedicine, let's see a big boost in all the other mechanisms that are low cost. Telephone and e-mail also enable advice to individuals who can't easily travel from their home to the doctor's office. In 2008, the VA issued a study that validated lower cost/higher satisfaction use of telehealth technologies like remote monitoring, video conferencing, medication reminders, and other technologies -- when part of overall case/care management.  Maybe overall care management is the key to to better and lower cost care.

Finally, this industry begs for problem-solution tiers. Incentives are misplaced for delivery of medical care outside of hospitals and clinics. Inside a hospital, care is triaged, with patients being separated into urgency tiers, information is collected by technicians and administrators prior to examination by a nurse or doctor (higher cost, scarcer availability). That same tiering of capability can be applied outside of the doctor's office, regardless of the access method. This means splitting off informational queries, pre-qualifying care by urgency levels, encouraging use of the lowest cost tier first (e-mail, then phone, then video conf, then referral to specialist, then telepresence under limited circumstances.)

* Telemedicine: the transferring of medical information by telephone, the Internet or other networks to facilitate consulting, chronic disease management and self-care - to help contain cost inflation and provide other benefits that greatly exceed the costs." (Bashshur, University of Michigan)



I have been in the teleom industry for over 40 years. I have been through the telemedicine fiasco many times. Here are my key findings.

1. If you provide a special telepresence or video conference room in a hospital facility it ususally sits empty most of the time and ROI estimates fall apart.
a. doctors do not want to take time to go to a special room to hold the call.
b. patients are reluctant and many times not mobile enough to move to the equipment.
c. color quality does not lend itself to the same "real touch" diagnostics that doctors and patients prefer.
d. Insurance Companies have provided comnplex rules for particular use and payment making claims difficult, paper intense and open to interpretation and negotiation.

Most hospitals are reluctant to accept xrays, lab reports and diagnostics from other hospitals and doctors due to risk. This forces duplication (additional costs) and most will do this even if telepresence is approved by insurance companies. Speed of diagnosis may improve but actual treatment will take the same amount of time.

This is a case for politics, not engineers to figure out.

From Aging News Alert 7/22/09

Health & Human Services Dept. is making available $1.2 million to fund 20 awards averaging $85,000 each to provide essential health services to frail and elderly residents living in rural areas. The deadline is Sept. 14.

The goals of the Network Planning Grant Program are to (1) achieve efficiencies in rural health, (2) expand access to coordinate and improve the quality of essential healthcare services, and (3) strengthen the rural healthcare system as a whole. 

The program supports one year of planning activities that assist rural entities in the development of an integrated healthcare network if the proposed participants in the network do not have a history of collaborative efforts and a 3-year grant would be inappropriate.

For access to the rest of this funding opportunity and other issues affecting senior citizens, click on or cut and paste the following link into your Web browser for free access to Aging News Alert, one of CD Publication's continuously updated online funding and news services:

what is the government web address for information on grant details please?


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