Additional drawbacks include the fact that it can take several hours to get a photo into a patient record for review, and the need for coordination of the physician, patient, and a technological device for live video consultation.
Explore This IssueJuly 2017
For medical centers, purchasing telemedicine equipment is an expense. “But usually for a limited investment cost and minimal training, you can obtain excellent images,” Dr. Keefe said. Multiple camera adapters allow for the attachment of smartphones to be flexible and rigid endoscopes to examine most head and neck pathology.
Regarding telemedicine’s limitations, Dr. Knott noted that it doesn’t allow for a face-to-face examination, nor can a physician perform procedures such as biopsies or endoscopies. “It limits interaction to simple history acquisition and taking a superficial topical examination, restricting the depth of information that a physician can obtain,” he said.
A major hurdle slowing the widespread use of telemedicine in otolaryngology is the lack of reimbursement from most health insurers. “This significantly limits the applicability of telemedicine for many subspecialty practices, which would otherwise be interested in building telemedicine programs,” Dr. Moberly added.
Where It’s Most Useful
Telemedicine is particularly useful in rural areas. More than 60% of otolaryngologists are located in large cities, where they tend to be over-represented. In contrast, rural areas, and those with relatively low socioeconomic status, tend to have few otolaryngologists. “Clearly, a significant percentage of the United States does not have access to a local otolaryngologist,” Dr. Holtel said (Laryngoscope. 2017;127:95–101).
“Telemedicine solutions can provide better subspecialty healthcare to patients who would not otherwise have access due to geographic and transportation limitations,” Dr. Essig said. “We have the technology and expertise; we just need to coordinate our efforts so that we maintain a high level of care and continue to develop tools that help us bring specialists closer to the patients.”
Tele-access is extremely helpful in patient management in the areas of triage, disposition, and follow-up; it is also ideal for emergency consults, such as photos of tympanic membranes/ears, oral pathology, nasal pathology, skin pathology, and review of pertinent radiologic studies. “Physician extenders (i.e., physician assistants and nurse practitioners) use it to review physical findings while we are in the operating room or at a different location. This expedites care,” said Dr. Keefe, who added that this also decreases the cost of healthcare. Telemedicine can also be used for patient and physician education, because it offers the ability to transmit patient education through a patient portal.
Dr. Keefe foresees the increased use of common tools in telemedicine, particularly the smartphone, which he believes will play a much more important role in the delivery of real-time medical care in the future. This would include blood pressure and electrocardiogram monitoring, laboratory testing, and other medical tests. “Many groups are already implementing trials of patient smartphones as a care device in the perioperative period to remind the patient about medications as well as postoperative care regimens,” he said.