Telemedicine is a technology with almost unlimited applications — most of which healthcare hasn’t even thought of yet.
Currently, however, telemedicine is primarily applied in pretty narrow ways. Commonly, telemedicine is used for provider-to-provider communication within the usual structure of visits. Or, it is used to allow far-flung patients to approximate a usual visit, but at a distance.
A new study turns a lot of this on its head, bringing into question our ideas about where healthcare need take place, and under what conditions.
A recent study, published in the New England Journal of Medicine, looked at the ways that it’s not just the treatment or the information that matter — it’s also where that treatment comes from, and from whom. In the study, a cluster-randomized trial, black men got blood pressure intervention in two different ways. The control group had their blood pressure measured in a barber shop, but were then referred to a physician for management. The intervention group received treatment in the barbershop itself.
More than 63 percent of the intervention group achieved a normal blood pressure level after 6 months, compared with less than 12 percent of the control group.
Dr. Aaron E. Carroll wrote a great piece on the study in the New York Times recently. As he summarizes, “Health care need not take place in a doctor’s office — or be provided by a physician — to be effective.”
In fact, Carroll argues that this approach was dramatically more effective than it would have been had it been a more traditional, hospital-centered approach. He identifies a few key factors that made this intervention such a success. The care was:
- From a trusted source.
- Low inconvenience.
- Integrated with peer support.
Dr. Carroll does point out that there are reasons that this kind of approach isn't common, however. “Health care reimbursement in the United States usually focuses on the clinical encounter, at a physician office or hospital. This reflects a belief that care is best offered there, even when evidence says otherwise. Coverage and payment focus on the individual patient, not on the community, even when research shows that the latter is more effective.”
This analysis really resonated with us as well. Telemedicine has the profound potential to support care that is from a trusted source, low inconvenience, and integrated with peer support. It has the potential to enable care that is deeply embedded into the communities, culture, and lives of the patients we serve, allowing the most advanced care, but in nontraditional settings, and with nontraditional providers as core parts of the care. Because ultimately, we don't have a failure of technology to support it -- we have a failure of imagination for what these initiatives can look like. And, as Dr. Carroll says, we have a failure of the reimbursement and payment systems.
This powerful study is proof positive, though, that we don't have to wait for the whole healthcare system to change in order for brilliant things to happen. A simple initiative, caring participants, and thoughtful, respectful design -- these are the things that enable change to happen.