Written by: Ryan Smith,
Managing Consultant at Telemedicine Partners, TorontoCanada.
Widespread adoption ofvirtual care models is well underway on a global scale. This trend has beenaccelerated by the COVID-19 pandemic.
Hosted vs Non-Hosted Points of Care:
Maintaining the standard of care determined by aclinicians’ respective college is a persistent challenge in many telemedicinemodels. This challenge is amplified when medical practitioners working within asocialized healthcare system (i.e, a capped fee-for-service model) must conductintake in a virtual setting. In primary care, more often than not, visual andaudio files or real-time examination and follow-up lab work is required toconfirm or rule out a diagnosis. The methods of assessment possible via phoneor video inevitably limits what the consulting clinician can safely andaccurately diagnose.
When you boil it down there are currently twomodels of telemedicine: Hosted and Non-Hosted points of care (POCs). Hosted POCs use existing physical infrastructure and trained techniciansto create a link between the patient and the clinician. Non-hosted POCsrely entirely on the patients ability to communicate and gather necessaryimagery or audio files. Not realistic or sustainable when operating under apubic payer model.
Hosted POCs are safer for patients, moreefficient for the doctor, and sustainable. A traditional hub and spoke model isa good way to envision the architecture. The doctor is the hub and the spokesrepresent communities the doctor serves virtually with assistance from atrained and supported technician at the point of care.
An example of a hosted point of care is a retailpharmacy. Pharmacies are keen to play an active role in a patient’s care planand typically have personnel that can be trained to become telemedicinetechnicians. The role of the telemedicine technician is to gather informationfrom the patient side in a standardized and reliable format that can be relayedto the consulting physician on a store-forward or real-time basis. Atelemedicine technician can also be equipped to be mobile and see patients intheir home. This is particularly relevant for seniors who may have difficultywith mobility. This model represents a value-added service that can beoffered by local pharmacies around the world.
Many pharmacies have private consultation roomsthat can be equipped with the necessary digital medical peripherals.Additionally, it is more economically viable for a pharmacy to purchase therequired peripherals that help ensure the recommended standard of care can beachieved. Most small towns support a pharmacy. The value of this pharmacy onlyimproves once it becomes the one stop shop for patients seeking convenient andquality care.
Non-Hosted POCs allow a patient to connectdirectly with a doctor are appropriate for situations such as minor healthissues, prescription renewals, psychiatry, dermatology, and remote patientmonitoring, to name a few. Doctors typically manage the video consultation ontheir own.
A primary care doctor working within anon-hosted scenario faces significant challenges. For example, how is a doctormeant to confirm an inner ear infection without imagery from an otoscope? Rareis the patient who owns an otoscope; rarer still is the one who can captureaccurate imagery of the inner ear.
Electronic Medical Records (EMRs)
Leading up to 2020, Electronic Medical Records(EMR) companies dictated what virtual care software their customers could use,due to how the software was built. This is equivalent to telling generalsociety what type of computer they have to buy based on the email they use andyou can’t switch your email. Completely backward, but fortunately, thelandscape is evolving quickly.
As a practicing clinician, you should be able tosee patients on the platform of your choosing regardless of your EMR.Interoperability among telemedicine platforms and all EMRs is inevitable and inthe best interest of all stakeholders. As an industry, we are looking at a12-36 month period of mass consolidation. Dapasoft, a company based in Toronto,is leading the way on implementing interoperability among EMRs and telemedicinesoftware platforms.