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House Calls Trump Telemedicine

Big hospitals, including Johns Hopkins, are getting back to house calls. You read it of our nation's finest is going old school to offer patients a renewed level of service.

Their ROI is partly based on avoiding fines from Medicare, who since October 2012 has begun fining hospitals when patients are discharged but readmitted within 30 days. A key Medicare assumption is that if a patient is sent home and re-hospitalized, they were either not properly cared for while in the hospital or provided subpar follow-up care. Either way, Medicare levies fines on providers to cut into an estimated $26B annual cost.

With so much available telemedicine technology available, how come hospitals like Hopkins aren't using more video? They could consult a client remotely via video to see how the patient's feeling, ensure they're taking their medication, and schedule a follow up appointment if necessary. It's not so cut and dried, though, for some of the following medical and technical challenges:

* Most check-ups require taking the patient's vital signs in person.

* Some acutely ill patients can't or don't want to check into the hospital, and are treated at home, an "in-home hospital" trend noted by Johns Hopkins. Some simply are safer staying at home.

* Consumer-grade telemedicine technology only recently became available outside of the boardroom (let alone the firewall), and in the past, enterprise solutions have been hard to use.

* Acutely ill patients need face time (note, not FaceTime). Having volunteered at a retirement home to teach the elderly how to use computers, it wasn't the knowledge they appreciated so much as the visit itself.

Two of these four reasons could be short-lived. First, IP-enabled monitoring equipment can replace the need to take some vital signs in person. Heart, blood sugar, and blood pressure monitors can be used to alert caregivers over the Internet of a problem. Second, as video user interfaces become easier to use for baby boomers familiar with Facebook, FaceTime, and Skype, video checkups will become more feasible. This will leave the in home-hospital scenario and the personal face time, more of a psychological plus rather than a clinical or financially necessary benefit.

Even when house calls make sense, there is a case for video telemedicine to lower cost for the care provider. Sending a doctor on rounds around town is an inefficient use of resources. Consider the time wasted commuting. Why pay a doctor to sit in beltway traffic?

Instead, a traveling RN or intern could take a video-enabled tablet computer out to visit the patient while a doctor is consulted via video at the clinic or hospital. The RN could take the vitals, assess and provide in person TLC, while the more expensive resource is conferenced for a fraction of that time. Hospitals adopting home care services could lower the cost of labor and lower the risk of readmission penalties.

The race is on to perfect easy-to-use video tools that reach consumers through firewalls. Skype leads the way in overall deployments, but even after Microsoft's acquisition, is not meant to be an end-to-end enterprise solution. Cisco WebEx has the enterprise market share, and Microsoft Lync has added support for tablets, smartphones and browsers. Innovative video software-only solutions like Vidyo are simple to set up and use. Polycom's had telemedicine solutions for years, and have tuned their approach with RealPresence CloudAxis, enabling their enterprise systems to federate with Skype, Facebook and others. What ends up happening is the consumer/patient is invited to a browser-based video call using browser-based codecs, like WebEx and Microsoft do.

WebRTC is addressing the need for common standards-based codecs across browsers, and will provide some innovation in the space. However, the enterprise vendors' own software UI may be marginalized by WebRTC, so total adoption will likely be slow.

So until the products mature and the market flushes out, with the risk of readmission penalties high, we will see more home care providers' vans like Hopkins on the roads. We may hear "take two and conference me in the morning" as parting words!

Taking their services on the road – a Hopkins Home Care van in suburban Baltimore.