P. Daniel Knott, MD, an associate professor of facial plastic and reconstructive surgery and director of facial plastic and aesthetic surgery in the department of otolaryngology and head and neck surgery at the University of California, San Francisco (UCSF), said otolaryngologists can use remote video examinations to make sure a patient is appropriate for a physician’s expertise. Otherwise, they may have to rely on someone else’s opinion of a patient’s condition.
Explore this issue:July 2017
A study by Dr. Knott and colleagues compared in-person flap assessments with telehealth assessments (Otolaryngol Head Neck Surg. 2017;156:1035–1040). “The latter allowed more efficient examination of free tissue reconstructions, while yielding seemingly equivalent information,” he reported. Saving residents’ time was a significant benefit, because UCSF has five hospitals across the city, and excessive work hours means they are often plagued with fatigue.
Telehealth can also bring specialist expertise directly into the primary care setting; otolaryngology is no exception. Primary care providers can, for example, collect videos or images using digital devices—possibly along with other data, like otoacoustic emissions [OAE] test results—which can be reviewed by an offsite specialist, who either provides diagnosis and treatment guidance to the primary care provider or refers the patient to a higher level of care. “When programs like these are employed, one of the most common outcomes is a decrease in wait times at specialty clinics—only the patients who really need the services of a specialist go there for care,” said Linda Branagan, PhD, director of the Telehealth Resource Center at UCSF. “Newborns in rural areas who fail their OAE are a common population target for these types of programs—rural hospitals partner with urban medical centers for access to specialists.”
Drawbacks and Difficulties
Telemedicine does pose some challenges. Being willing to use the technology required for telemedicine can be a significant hurdle. “Both physicians and patients may be reluctant to use it, as this may be a departure from the traditional model where the physician directly examines the patient,” Dr. Essig said. “We need to make sure that the virtual visit is as accurate as a traditional visit.” In a recent study, his group assessed the diagnostic accuracy of evaluating patients remotely and found a high level of diagnostic congruency with a standard visit (unpublished data). Furthermore, both patients and physicians involved in the study expressed a high degree of satisfaction.
Actually using the technology required for virtual medicine, such as obtaining and sending photos, can be difficult for some patients. “Image quality can vary and may require a repeat photo or even a visit if resolution is inadequate,” Dr. Keefe said. “However, today’s smartphone cameras are usually more than sufficient.”