An island-based lobsterman using telehealth to see his wellness coach? A group of seniors connecting via video with a physical therapist in one distant location and a tai chi trainer in another to improve their mobility and prevent falls?
These situations might be unique to Maine, but drop in on a telehealth discussion in any state, and you're likely to hear the same challenges and potential – from not enough broadband coverage or reimbursement opportunities to the untapped possibilities of reaching people who might not see a doctor when they should due to time, technology or terrain.
[See also: Is broadband capacity hindering telehealth?]
When Angus King, Maine's former governor and freshman senator, recently conducted a telehealth round-table at the University of Maine's flagship campus in Orono, he heard all of this, and more. He heard about simple telehealth connections being made through an old-fashioned DSL service, specialists calling ion from all over the world to help with unusual cases, and healthcare providers looking to reach areas of the decidedly rural state where residents aren't underserved – they're not served at all.
"We can't just get into a car and drive to a doctor," said Donna Wiegle, who runs the Mill Pond Health Center on Swan's Island, a 350-resident spit of land off the coast of Maine, where emergency cases have to be helicoptered to the mainland for emergency care. "When we do, it (includes) a boat ride" of some four hours.
Nearly all of the 50 or so healthcare and education officials in attendance see the value of telehealth. Geoffrey Gratwick, a state senator and rheumatologist in Bangor, noted some patients have to drive several hours to see him because he's one of the few specialists serving northern Maine.
"It's a big hassle and a very inefficient use of my time for a 20-minute follow-up visit," he said.
Pret Bjorn, of Bangor's Eastern Maine Medical Center, estimated 90 percent of primary care services could be handled by telehealth. And that's just what his patients want.
"I can get out my smartphone and find an app that will connect me to a doctor who will listen to me in real-time and prescribe a medication for 25 bucks off of my credit card," he pointed out.
King, who noted a consumer's healthcare annual bill has doubled from 12 percent to about 25 percent of his/her overall expenditures in 15 years, sees telehealth technology as a means of improving access and driving down costs. But he wants "modest expenditures" and simple solutions rather than high-tech gadgets and platforms – off-the-shelf technology, he said, rather than big, expensive, "clunky" systems.
And that begins with broadband.
"The technology is there, in many ways, although the big gap is in broadband, which is something we spent a lot of time talking about," he told a Maine Public Broadcasting Network reporter after the roundtable, adding that he feels only about a quarter of the state is adequately covered. "It really doesn't work unless you have pretty good broadband connections and the very people we're trying to help the most are those that are in rural areas where broadband coverage is spotty."
King also wants a more defined reimbursement strategy for telehealth, noting it's different for state and private payers and often fails to help providers use the technology where they could make an impact. "We often don't reimburse for prevention," he pointed out.
Educational leaders also chimed in. Ellen Beaulieu, vice president of strategic initiatives for the Biddeford-based University of New England, said today's crop of student clinicians are learning that telehealth "isn't something different," but a regular means of delivering healthcare. And just like today's tech-savvy consumer, they expect to be able to use that technology when they get out of school, added Mary Jude, coordinator of graduate nursing programs at Bangor's Husson University.
Tying all the loose ends together was Andrew Solomon, of the Augusta-based Northeast Telehealth Resource Center, one of 14 such centers scattered across the country that helps to launch and support telehealth programs in every state. Solomon took note of the confusing regulatory landscape that sees each state charting its own path to telehealth (more than 80 bills alone were filed during the spring in the six-state Northeast). He said everyone seems to accept that telehealth is "reaching a tipping point where (it's) becoming mainstream," but they're all following a different path to the top.
To Wiegle on Swan's Island, that means keeping the system up and running so she and her patients can avoid the helicopter- and boat-rides. Though she did enjoy the trip to the mainland for the roundtable – it gave her a chance to ride her motorcycle.