Understanding the Emergence of Telehealth

Telehealth brings the doctor to your screen



Illustration by Gloria Diianni

In this modern era, we can renew our driver’s license, order back-to-school supplies, and buy a week’s worth of groceries from the comfort of our couch. Sometimes we can even skip the trek to the doctor’s office and instead just open a new window on our laptop, and sit back for a virtual visit with a medical provider.

What would Marcus Welby think? He just might approve. Though in-person healthcare offers many benefits, including the documented power of physician empathy and the human touch, the reality is that not all of us can easily get to the medical help we need. Telehealth removes the geographic barriers that separate providers from patients, leading to improved medical access, reduced healthcare costs, and a better chance for patients to convalesce at home rather than in a medical facility.

Generally speaking, telehealth or telemedicine (the two terms are often used interchangeably) refers to the use of technology to deliver healthcare, and includes everything from video conferencing and remote patient monitoring to keeping and sharing electronic medical records.

Telehealth has been around for decades, but continues to evolve with technology. Concord Hospital, for example, now equips one of its cardiac specialists with Bluetooth-enabled stethoscopes that enable him to stay in Concord while listening to the hearts of patients who reside miles away in Laconia, says Michael McLeod, DO, associate chief medical officer and a board-certified family medicine and clinical informatics physician at Concord Hospital. The specialist “is a limited resource in the state,” McLeod says. “All the time that he would spend driving to Laconia is time that patients don’t have access to him. So we’ve set it up for him to do visits virtually.”

Telehealth in New Hampshire also links local VNA nurses with patients, says Rachel Chaddock, MSHSA, BSN, RN, vice president of Home and Community Services at the Visiting Nurse Association of Manchester and Southern New Hampshire, a subsidiary of Elliot Health System. The VNA provides patients with the equipment they need to transmit blood pressure readings and other health data over the internet so that providers can monitor the patients’ condition and, when needed, suggest adjustments to medication or other aspects of care. Multidisciplinary team members such as physical or occupational therapists are dispatched to the homes of patients who struggle to take or send readings, Chaddock says, and in-person visits from clinicians and other team members still occur whenever needed.

Telehealth enables more efficient use of everyone’s time and resources, and it can enhance patient engagement and compliance, and sometimes help avoid unnecessary hospitalization — all while still resulting in good or even improved medical outcomes compared to patients who do not receive telehealth services, Chaddock says. It is a particularly welcome innovation, she adds, in light of the nursing shortage that currently exists across the Granite State.

There are concerns surrounding telehealth, such as potential security problems and the loss of in-person interaction. But at least in some cases, the advantages seem to outweigh the drawbacks. Compared to nurses who must travel to patients’ homes, Chaddock says, telehealth nurses can interact with more patients per day, and have more time to spend on each patient. “You’d think that nurses going in and out of the home would establish a stronger relationship [with patients],” Chaddock says, “but I think that a telehealth nurse ends up having perhaps even a stronger relationship than [health professionals] entering the home” because patients typically hear from telehealth nurses more frequently than they do other providers.

In addition, family members who care for ill or injured loved ones at home appreciate the support they get through telehealth, Chaddock says, with frequent check-ins and follow-up assuring caregivers that someone has their back. “That’s a huge advantage for the caregivers,” she says, “who are very often overwhelmed and afraid [that they’ll make a mistake].”

Continued implementation of telehealth faces a variety of hurdles, including ever-evolving legislative restrictions and insurance reimbursement limitations, McLeod says. Limited internet access also prevents telehealth from gaining a foothold in some communities, plus not all forms and specialty areas of medicine are amenable to virtual visits.

There is no question, however, that telehealth has the potential to improve people’s access to care, and by extension, people’s health — not just across New Hampshire or the United States, but worldwide as it opens virtual doors that separate medical expertise from underserved populations.

And those who relish face-to-face time with healthcare professionals needn’t worry. While telehealth is likely, McLeod says, “to exponentially expand as technology advances,” moving forward, it is expected to remain a supplement to — not a replacement for — in-person visits.

TeleStroke connects Granite Staters with medical specialists

Minutes count when it comes to preventing possible long-term damage from a stroke. Luckily for New Hampshire residents, some of our local medical facilities participate in an initiative called TeleStroke, which harnesses high-tech capabilities to link patients with round-the-clock specialty care.

Through TeleStroke, Mass General neurosurgeons can remotely examine patients in New Hampshire hospitals by using “stroke robots.” The robots can be wheeled directly to patients in the hospital, and are equipped with a camera and video screen that enable specialists to see and communicate with patients while directing the exam, says Michael McLeod, DO, associate chief medical officer and a board-certified family medicine and clinical informatics physician at Concord Hospital.

“For an individual organization to provide good care to a stroke patient, you really need to have access to neurosurgery 24/7, 365 days a year,” McLeod says, “and for a lot of hospital systems — especially in rural areas — there just aren’t that many neurosurgeons.”

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