Telehealth gaining popularity but obstacles remain

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Capital News Service
LANSING – Although more health systems in the state encourage their members to use telehealth services, some patients and physicians are hesitant, experts say.
Telehealth delivers health information and services through computers. It connects patients at one site with health providers at another site, according to the state’s health policy.
The main services include real-time consultations, electronic transmission of patient’s medical records to health care providers and remote patient monitoring, according to the Senate Fiscal Agency.  
With the improvement in technologies and bandwidth capabilities, there is more recognition that telehealth services are worthwhile, said Bree Holtz, an assistant professor in the Department of Advertising and Public Relations at Michigan State University.
“The population is growing older and needs more health care while the research shows it [telehealth] provides the same level of care as in-person care,” Holtz said.
Stacey Hettiger, the director of medical and regulatory policy at the Michigan State Medical Society, said patients are encouraged to use telehealth services for minor problems, such as the early stage of a cold, flu, rashes and headaches.
“Telehealth is seen as option to more costly emergency room visits for non-emergency health conditions,” Hettiger said.
The telehealth service of Upper Peninsula Health System in Marquette had 4,293 telehealth visits in 2017, an increase from 3,547 in 2016, said Pamela Davis, the system’s analyst.
The most frequent uses were for neurology and behavioral health, Davis said.
With more knowledge of what telehealth service is, how it works and positive user experiences, an increasing number of members from rural areas are using it, she said.
The utilization rates of telehealth visits at Blue Cross Blue Shield of Michigan, a nonprofit health insurance company based in Detroit, have doubled since early 2017. Member registrations on the web and app have also doubled in the same time frame, said Meghan O’Brien, the company’s public relations manager.
The company’s telehealth service, Blue Cross Online Visits, “is especially helpful in areas of the U.S. where access to providers isn’t as robust as Southeast Michigan,” O’Brien said.
“The Online Visits app is rated 4.8 stars and 4.9 stars (out of 5) in the Apple App Store and Google Play, with members citing the convenience, low wait times and helpful doctors,” she said.
However, some rural areas face access problems, said Jennifer Morse, the medical director at the District Health Department #10. The district covers Crawford, Kalkaska, Lake, Manistee, Mason, Mecosta, Missaukee, Newaygo, Oceana and Wexford counties.
Some rural areas don’t have internet service and some people don’t have computer skills, Morse said.
There are other challenges as well. For example, U.P. Health System in Marquette is dealing with a decreasing staff size in its telehealth service.
Due to a corporate staff reduction, Davis said, “currently I’m the only one working this field. A few years ago there were four people.”
To promote its telehealth service, she said, “I would love to get out into the field to spread awareness and to go to the areas we service to see how we can do things better.”
Although telehealth services are broadly available in the state, some physicians raise additional questions.
District #10’s Morse said, “The other concerns I have, especially with urgent care needs, is over-prescribing antibiotics or misusing diagnostic tests.”
Morse also cited concerns that telehealth would negatively affect the doctor-patient relationship.
She said although technology provides doctors with advanced equipment to diagnose patients from hundreds or thousands of miles away, patients don’t always feel the same closeness or satisfaction they get from visiting a doctor in person.
As for doctors, they express concern that the use of virtual technology could affect reliability and worry that if there’s something they didn’t see, they may be sued if  something goes wrong with their patients, she added.
Another problem for physicians is “how to incorporate telehealth into their existing in-person patient workflow and how to bill for such services,” said the Medical Society’s Hettiger.
As for patients, their concern is reimbursement for services they receive, Hettiger said.
“Although there are significant concerns regarding reimbursement for telehealth services by insurers, as its application continues to grow, the states and the federal government are likely to take an active role in developing policies to address these concerns,” according to a 2017 Senate Fiscal Agency analysis.
Morse said patients need more education about telehealth services, such as “how and when it’s appropriate to utilize telehealth visits versus in-person visits.”

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