The University of Miami Miller School of Medicine has been involved in telemedicine and telehealth since 1973 and has had a formal telehealth program since 1993. But the field is changing in a way never before seen, thanks to mobile technology.
"Devices are coming out of the consumer world, not the medical device industry," notes Scott Simmons, director of telehealth at the South Florida school. Commoditizing the price of a monitoring device could accelerate the shift of healthcare from the hospital to the home, he says.
"Advances in quality and speed will open it up," Simmons adds. M-health will be useful for homes and emergencies and, obviously, getting in touch with physicians when they aren't physically present. But it won't revolutionize healthcare by itself.
"Mobile is part of the continuum," says Simmons, a former NASA engineer who was project manager on development of the first space-certified telemedicine system. Some of it is hype but a lot of it is real. "We really see it not as the solution but as part of the solution," Simmons explains.
A lot is still up in the air, of course. "The role the FDA is going to play in this is a big question mark," Simmons says.
Regulation aside, off-the-shelf technology already is finding its way into more traditional forms of telehealth. The University of Miami provides remote dermatology consultations for Royal Caribbean employees on cruise ships, in both real time and with store-and-forward technology. "Dermatology is one that works really well with store-and-forward," Simmons says.
The ships have consumer-grade digital cameras and encrypted software for security. All they need is bandwidth of 384 kbps to 512 kbps, or the equivalent of a low-end DSL connection, for the link to work properly, an important consideration for a ship at sea that must rely on expensive satellite communications.
"The software-based videoconferencing systems are getting better," Simmons says. This is helping Miami expand telemedicine for humanitarian and disaster response. The school recently provided teledental support for a U.S. Army mission to help Haitian refugees in the Dominican Republic.
The telehealth program also collaborates with the department of family medicine to provide care for children at six schools in low-income pockets of Miami-Dade County. The students, in kindergarten through 12th grade, likely would not otherwise have access to primary and urgent care, or even a school nurse.
Grant funding and Medicaid pay for the doctor, the nurse and remote consultations with specialists. Children's Medical Services, Florida's safety net for kids, also helps out. "We’re looking to expand that, too," Simmons says, if funding allows.
"In the state of Florida, the reimbursement for telehealth is pretty lousy," according to Simmons. Instead of relying on insurance reimbursements, Miami provides telemedicine services through annual contracts with the Indian Health Service, Royal Caribbean, community hospitals and physician practices that pay the university per consult. "We do a lot of teledermatology at state-owned clinics," Simmons adds. Many of those clinics lack pediatric subspecialists.
Simmons believes patients might be willing to pay for services such as secure electronic communications and video chats with their doctors if see it as a convenience.
The university, which is self-insured, will be testing the convenience factor itself when Simmons and his team launch a telehealth program for employees late this summer. "We're very excited about that," Simmons says.
The University of Miami Health System is across town from the main UM campus. Though employees may go outside the network, many don't, and it's time-consuming for main-campus employees to get to the health center. "We're starting with an on-campus telehealth clinic," Simmons explains. This will mean less time away from the office.
"Employee telehealth is really part of the next wave," he says.