Using telemedicine, pediatricians can diagnose rashes and sore throats on children who are at home in their pajamas. Emergency doctors can assess patients in hospitals many miles away.
Those projects, already underway at Johns Hopkins Medicine, are just the beginning, says Rebecca Canino, administrative director of the Johns Hopkins Medicine Office of Telemedicine. Canino and clinical director Ingrid Zimmer-Galler, an ophthalmologist and medical director of the Wilmer Eye Institute satellite office in Frederick, are creating a telemedicine program that incorporates scheduling, documentation and billing within the Epic electronic medical records system. Dome sat down with Canino to talk about how Johns Hopkins is harnessing the power of telemedicine.
Q: Why did Johns Hopkins create the office of telemedicine?
A: Johns Hopkins has a long history of telemedicine innovation, but the projects were isolated in different specialties. It made sense for us to consolidate and support our remote care initiatives because telemedicine is an important part of our strategic plan, under the Integration pillar.
We established the office in July 2016 and spent our first year building the infrastructure and collaborating with clinical champions to pilot telemedicine programs.
Anyone can come to our office with proposals for new projects. One that we are working on now is providing remote retina eye exams for people with diabetes because these patients have a higher risk of eye damage. Johns Hopkins Community Physicians will conduct the tests and send the images to Wilmer specialists to interpret. If we catch problems early, we can save someone’s vision.
Q: What are some of the hurdles to telemedicine expansion?
A: With telemedicine, we can reach patients who are far away, so being able to practice across state lines is important. The problem is that the physician has to hold a license in the state where the patient resides.
Our doctors treat Maryland patients, and many also have licenses to treat patients in other states. Hopkins is joining the national effort to look at how we can make it easier for doctors to reach more patients. This is important as we expand services like our medical second opinion. Patients in 11 states and 15 countries can send information about their cases to Johns Hopkins doctors who opt into the plan, and receive opinions about their illness and treatment—all within Epic.
Another challenge is reimbursement. The law says, if you can perform the equivalent service via telemedicine that you can provide in person, then you can bill for it. But each payer sets its own rules. For example, Medicaid typically won’t pay for telemedicine visits in a patient’s home. We’re working closely with our government affairs people for change at the payer level, the state level and the national level.
We can already see change. Medicaid recently announced that it will cover remote monitoring in patient homes for diabetes, chronic obstructive pulmonary disease and congestive heart failure.
Q: What specialties have the most telemedicine potential?
A: Pediatrics is loving this. They are launching a program that will help them reach very sick kids on the Eastern Shore, saving the children and their families that three-hour drive. This really tugs on the heart strings.
Nicholas Maragakis, an expert in ALS [amyotrophic lateral sclerosis], can now do video visits with his Maryland patients in their homes. This means the caregivers don’t have to pack up the patients, along with their wheelchairs and oxygen, and travel to the hospital. Even better, as many as three additional remote people can be on the video call, so patients can include a daughter who is at college or a spouse who is at work. This is patient- and family-centered care in action.
Q: Are there technological or age barriers to telemedicine?
A: Very few. Our goal is for patients to be able to access care from any device. You would think age would be a factor, but it’s not. We have lots of older folks who are great on their smartphones. They are using all the tools, video chatting with their grandkids every day. It’s the same technology to see your doctor. So, comfort with the technology seems to be individual, not generational.
Q: How many projects have come to you so far?
A: Right now, there are 31 projects on our list. We started the year with four. Our clinicians are very clear on what gaps need to be filled in order for them to reach their patients. For example, infectious disease specialists at The Johns Hopkins Hospital want to offer remote consultations to patients with HIV and hepatitis C in western Maryland, and we are working to make that happen.
Pediatric cardiologists can now remotely assess irregular heartbeats in fetuses of mothers at Sibley Memorial Hospital clinics and talk through treatment plans with the parents in real time. Patients with eye trauma at the Howard County General Hospital Emergency Department can now be triaged by a remote ophthalmologist on call and avoid the cost and time of transferring to The Johns Hopkins Hospital.
If you can show us the gap, we can give you some options. People are very engaged and excited.