Wednesday, May 28, 2014

Telemedicine, Here I Come!

By Hind Benjelloun, MD @hbenjelloun 

My decision to pursue a career in telemedicine was a long process. I had a comfortable, stable clinical position at a highly regarded academic center in a lively city. But I kept wondering if my career needed a boost. I found myself thinking, career development takes risk. Medicine is an ever-changing and growing field. I felt that I had to embrace some changes myself if I wanted to keep up.

Telemedicine is a relatively new discipline. The idea of incorporating health care with technology, specifically the web, may have some rolling their eyes or shaking their heads. But, simply put, it is the future of healthcare; and it is certainly getting the buzz these days.

The American Telemedicine Association is rapidly growing and developing its services and its role in healthcare. Many medical and scientific organizations are recognizing the importance of the discipline as well. You can see it reflected in the number of publications, conference seminars, and available CME. Tech gurus are predicting that the recent acquisition of Oculus by Facebook will be a game changer in the tech industry and will further grow telemedicine’s influence.

So I took the plunge into a field in its infancy. I went for it.  Telepsychiatry! After almost ten years at Georgetown University Medical Center, I drastically shifted gears to pursue a full time career in crisis telepsychiatry.

In this career change, I have been labeled a pioneer among colleagues and friends. It feels wonderful to immerse myself in such an innovative healthcare movement. My healthy narcissism embraces it and it strengthens my confidence in what some may call a risky career decision. Today, telepsychiatry is revolutionary in the way it enhances access to care. And although right now telepsychiatry is primarily seen as a means of engaging the rural patient population, it will progress in the medical community as a future medical norm. The evidence is growing and continues to demonstrate the boom of telemedicine and its success.
Still, taking the leap into telepsychiatry had its downsides.

Because of its youth, telemedicine lacks a number of accessible mentors who can guide the process. There are few clinicians who have an “institutional” knowledge of telemedicine to share. This means that other than the anecdotal accounts that you may read in a journal or blog post about what it’s like to venture into the world of telemedicine as a provider, there aren’t many reputable sources to turn to.  I had trouble knowing what to expect.

I started working with InSight, a national telepsychiatry provider company earlier this year. As a crisis telepsychiatrist with InSight, I have the ability to seamlessly transition between seeing patients at multiple hospitals in multiple states back to back. Today, I love my job. But the legislative hurdles I had to jump through to get going were a major headache.

I was completely committed to offering services right away when I made the decision to start practicing telepsychiatry. I was ready to go. But I had no idea what kind of challenges I would encounter as I attempted to receive licensing from medical boards that all work independently of each other.

After the first hurdle of becoming licensed, I thought I had passed the finish line. But to my surprise, I was back to waiting on privileges from hospitals that were scrutinizing my immunization records and testing my knowledge of their fire code. This all seems so frivolous and a waste of time, effort and money. Didn’t they understand that I would be seeing patients remotely?

When I finally began working with a regular schedule, I found myself asking, why did it take so long for me to be able to actually see patients and provide care?

The answer lies in legislation. The laws and regulations in place for telemedicine are significantly outdated. Why is my medical license in one state insufficient in another? Big changes are needed to reflect the advent of technology’s integration into medicine. And when it comes down to it, it’s the patients who suffer from these outdated practices the most.

The shortage of psychiatric prescribers, as well as other types of providers in the United States is a growing problem. Telemedicine is an important way of addressing that shortage with the providers we already have.

Thankfully, there is yet hope. The Federation of State Medical Boards (FSMB) has recognized this unnecessary obstacle to patient care and the strain inflicted on telemedicine as an industry.  At its annual meeting at the end of April, the FSBM will vote on adopting the federation’s Interstate Medical Licensure Compact, a licensing option that would allow qualified physicians to expedite licensure in all states who participate in the Compact. Telemedicine as a field of practice would be transformed dramatically with the adoption of the Compact. Fingers crossed.

I am enthusiastic about potential for growth of telepsychiatry and telemedicine. But I believe providers must take an active role in pioneering this new form of care, and pushing for its successful implementation for the people who need it—our patients.

Bottom line—we are in this for our patients, and it is our patients who will benefit the most from telemedicine and a successful reevaluation of the legislation that regulates it.