Re: Re: Telemedicine (Rochester, NY) on Discovery Channel

[Guest guest]

well I dunno  I disagree Brady  I think this stuff vastly expands access and I wish to heck it WOULD be paid for   Aren'e we friends Brady -  and how often do I see you ?? I think phone and email and  wav files  still encompass maintaining  the relationship, they  are;t the  entire relationship

However the heck you could see  ear drums?? or  do egophony?? by wav or skype?? has potential to vastly expand access. I think about  being the patient- what a pain it is  to go to the office! Sometime you are too sick to  go to the docotrs:)

 

Much of effective primary care team stuff is outreach -- calling  those chf'ers r keeps them out of the hospital ..so I think calling or       e visits  etc 

works. I do think i that health care should encompass real visits as well  I dunno As a severe introvert the idea of not actually seeing human beings  has some merit:)

 at the VA we had a dermatologist  in RI though   the PA was local with t he patietns here in MAine , he  took a detailed hx and to  do  the bx etc if needed

 In alaska there was all kinds of distance stuff I am intrigued by this

Jean

 

So when I read this, I think this is one logical way medicine can move forward. I mean, it is convenient for the patient. It can also be convenient for the provider. So what is the problem? Well, I have been thinking a lot about processes lately and I have particularly been interested in the concept being brought forward that a physician should only do what they (and nobody else) can do—essentially the model. This model has someone else taking the history, the vitals,

has a scribe to write everything down during the conversation with the patient, and finally, the nurse closes out the visit with patient education and a follow-up appointment (LOTS of overhead and the antithesis of IMP). But, everything fits in a nice neat package and creates a very attractive business model-- except it totally ignores the fact that the most important thing in medicine is the doctor-patient relationship. The more people who get involved in that relationship the less likely anyone actually knows anything about what is really going on with the patient.

This telemedicine model goes a step farther and totally eliminates a longitudinal relationship with the patient. That in and of itself should give all of us pause in desiring to adopt such a business practice. It might make a heck of a lot of good business sense, but it is not good medicine.

 

From: [mailto: ] On Behalf Of pricklyfinger2007

Sent: Tuesday, January 03, 2012 10:07 AMTo: Subject: Re: Telemedicine (Rochester, NY) on Discovery Channel

   God help us.grace

>> IMPs, Thu & Debra,> > I am just getting started with Telemedicine, but so far I like the> flexibility. (It is also nice to be able to go to work in your> slippers..LOL.) We have not expanded to having providers from out of the

> state yet, but when this happens, it will be the ideal job for those who> want to add extra hours but want to work remotely. It is definitely> different to see tympanic membranes through a digital picture or listen to

> lung sounds through a wave file. It is not a job that everyone would like,> but I think it will expand our ability to help those in underserved areas. > > > > I also envision Telemedicine helping those who are IMPs to see patients out

> of our area. There is a technician at the location where the patient> arrives and they collect the data to enter into the computer, pictures etc.> and the provider can see the patient through Skype and then the

> documentation is done in TeleAtrics, which is a web-based record. There are> two sites..one for pediatrics and one for geriatrics (or adults).> > > > I envision IMPs someday, once Telemedicine takes off and is more mainstream,

> having their patients arrive at a Telemedicine site in their area where a> technician can collect the exam data (vitals, pictures etc) and then the> provider can see the patient over skype or be telephone for the interview.

> Technicians can collect ROS information but it must be confirmed by the> provider as the techs are not licensed but trained to collect what> information the provider will need.> > >

> A real virtual visit cannot be done unless an exam can be completed. There> are " virtual visits " that can be done but there is no means to collect vital> signs and do an exam and just talking to the patient is really no different

> than doing a phone visit (IMHO). Some situations where the patient just> needs a follow up on clarification of how to use a new medication etc. may> not require an exam, but to evaluate the efficacy and side effects of the

> medication, for example, would require an exam. So until we have a means to> collect this data, such as with Telemedicine, there are limitations to what> can be done as a virtual visit. As Telemedicine progresses I see a world of

> opportunity opening up for health care providers and patients everywhere.> One provider can cover multiple sites and the scheduler makes it a planned> visit, so the provider knows when the patients will be " arriving " for their

> visit.> > > > The program that I work for was included in a special documentary that the> Discovery Channel did from across the nation. Markwick is the other> Family NP that I work with and she is the Director of the Adult Telemedicine

> program.> > > > Here is the link..> > http://link.brightcove.com/services/player/bcpid1280283152001

> > > > Tammy> > > > Tammy L. McGarvey, MSN, RN, FNP-BC> > Board Certified Family Nurse Practitioner>

--      MD          ph    fax

[Guest guest]

I have been thinking about practicing to the extent of your license concept (as john said “that a physician should only do what they (and nobody else) can do—essentially the model”) The problem I have with that is that I use all those things i.e. taking a history, measuring VS, drawing blood etc to build my relationship with the patients. You would not believe what things patients tell you when you are about to stick a needle in their arm. Medicine is not only practiced when you examine or you diagnose, it is a whole process. If telemedicine is going to be part of the tools I use to build the relationship I am all for it; if on the other hand it is going to be part of what they use to keep me in the hamster wheel, well…. Telemedecine, EMRs, telephones, measurement strategies are all tools whose value is on the way we use them not in themselves. Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone " Don't ever let injustice go by unchallenged. " From: [mailto: ] On Behalf Of Dr. BradySent: Tuesday, January 03, 2012 10:51 AMTo: Subject: RE: Re: Telemedicine (Rochester, NY) on Discovery Channel So when I read this, I think this is one logical way medicine can move forward. I mean, it is convenient for the patient. It can also be convenient for the provider. So what is the problem? Well, I have been thinking a lot about processes lately and I have particularly been interested in the concept being brought forward that a physician should only do what they (and nobody else) can do—essentially the model. This model has someone else taking the history, the vitals, has a scribe to write everything down during the conversation with the patient, and finally, the nurse closes out the visit with patient education and a follow-up appointment (LOTS of overhead and the antithesis of IMP). But, everything fits in a nice neat package and creates a very attractive business model-- except it totally ignores the fact that the most important thing in medicine is the doctor-patient relationship. The more people who get involved in that relationship the less likely anyone actually knows anything about what is really going on with the patient. This telemedicine model goes a step farther and totally eliminates a longitudinal relationship with the patient. That in and of itself should give all of us pause in desiring to adopt such a business practice. It might make a heck of a lot of good business sense, but it is not good medicine. From: [mailto: ] On Behalf Of pricklyfinger2007Sent: Tuesday, January 03, 2012 10:07 AMTo: Subject: Re: Telemedicine (Rochester, NY) on Discovery Channel God help us.grace>> IMPs, Thu & Debra,> > I am just getting started with Telemedicine, but so far I like the> flexibility. (It is also nice to be able to go to work in your> slippers..LOL.) We have not expanded to having providers from out of the> state yet, but when this happens, it will be the ideal job for those who> want to add extra hours but want to work remotely. It is definitely> different to see tympanic membranes through a digital picture or listen to> lung sounds through a wave file. It is not a job that everyone would like,> but I think it will expand our ability to help those in underserved areas. > > > > I also envision Telemedicine helping those who are IMPs to see patients out> of our area. There is a technician at the location where the patient> arrives and they collect the data to enter into the computer, pictures etc.> and the provider can see the patient through Skype and then the> documentation is done in TeleAtrics, which is a web-based record. There are> two sites..one for pediatrics and one for geriatrics (or adults).> > > > I envision IMPs someday, once Telemedicine takes off and is more mainstream,> having their patients arrive at a Telemedicine site in their area where a> technician can collect the exam data (vitals, pictures etc) and then the> provider can see the patient over skype or be telephone for the interview.> Technicians can collect ROS information but it must be confirmed by the> provider as the techs are not licensed but trained to collect what> information the provider will need.> > > > A real virtual visit cannot be done unless an exam can be completed. There> are " virtual visits " that can be done but there is no means to collect vital> signs and do an exam and just talking to the patient is really no different> than doing a phone visit (IMHO). Some situations where the patient just> needs a follow up on clarification of how to use a new medication etc. may> not require an exam, but to evaluate the efficacy and side effects of the> medication, for example, would require an exam. So until we have a means to> collect this data, such as with Telemedicine, there are limitations to what> can be done as a virtual visit. As Telemedicine progresses I see a world of> opportunity opening up for health care providers and patients everywhere.> One provider can cover multiple sites and the scheduler makes it a planned> visit, so the provider knows when the patients will be " arriving " for their> visit.> > > > The program that I work for was included in a special documentary that the> Discovery Channel did from across the nation. Markwick is the other> Family NP that I work with and she is the Director of the Adult Telemedicine> program.> > > > Here is the link..> > http://link.brightcove.com/services/player/bcpid1280283152001> > > > Tammy> > > > Tammy L. McGarvey, MSN, RN, FNP-BC> > Board Certified Family Nurse Practitioner>

[Guest guest]

I am not against telemedicine. I am against telemedicine without a relationship. If you know the patient and they are too sick or too far away to come in, then by all means do it remotely. But, I worry that the trend for technology is to replace the physical encounter with a virtual one and, taken to the extreme, this will mean that there does not even need to be a relationship. We have done a remarkable job of virtualizing a lot of stuff in this country and have eliminated a lot of professional relationships and jobs in the process (think about using e-banks, Amazon to buy stuff, etc). The question is whether the loss of the physical relationship is worth the convenience of the virtual one.Much of the time the answer can be a resounding yes. However, in primary care medicine (specialty stuff like virtualization of CT scan reading may be different), a lot of what we do is based on subtle signals we intuitively pick up when the patient walks into the room or moves a certain way or says a certain thing that is out of character for them. This is not going to be translated through the computer and is the reason that, for now, computers are not as good as docs in diagnosing and treating. It is also the reason we need to be careful diagnosing and treating people we do not know. There is a huge amount of potential in this technology. I get that. But, it will only work well if we base it off a strong doctor-patient relationship. P.S. I will grant you that we have only seen each other perhaps 5-6 times over the years and I would agree that we have formed a virtual relationship, but I still would not ask you to be my primary care doc unless I relocated to an area near your office (the chances of that are as low as the current temp up there). And that is with the knowledge that you are a fabulous doc that anyone would be lucky to have. From: [mailto: ] On Behalf Of Sent: Tuesday, January 03, 2012 11:49 AMTo: Subject: Re: Re: Telemedicine (Rochester, NY) on Discovery Channel well I dunno I disagree Brady I think this stuff vastly expands access and I wish to heck it WOULD be paid for Aren'e we friends Brady - and how often do I see you ?? I think phone and email and wav files still encompass maintaining the relationship, they are;t the entire relationshipHowever the heck you could see ear drums?? or do egophony?? by wav or skype?? has potential to vastly expand access. I think about being the patient- what a pain it is to go to the office! Sometime you are too sick to go to the docotrs:) Much of effective primary care team stuff is outreach -- calling those chf'ers r keeps them out of the hospital ..so I think calling or e visits etc works. I do think i that health care should encompass real visits as well I dunno As a severe introvert the idea of not actually seeing human beings has some merit:) at the VA we had a dermatologist in RI though the PA was local with t he patietns here in MAine , he took a detailed hx and to do the bx etc if needed In alaska there was all kinds of distance stuff I am intrigued by this So when I read this, I think this is one logical way medicine can move forward. I mean, it is convenient for the patient. It can also be convenient for the provider. So what is the problem? Well, I have been thinking a lot about processes lately and I have particularly been interested in the concept being brought forward that a physician should only do what they (and nobody else) can do—essentially the model. This model has someone else taking the history, the vitals, has a scribe to write everything down during the conversation with the patient, and finally, the nurse closes out the visit with patient education and a follow-up appointment (LOTS of overhead and the antithesis of IMP). But, everything fits in a nice neat package and creates a very attractive business model-- except it totally ignores the fact that the most important thing in medicine is the doctor-patient relationship. The more people who get involved in that relationship the less likely anyone actually knows anything about what is really going on with the patient. This telemedicine model goes a step farther and totally eliminates a longitudinal relationship with the patient. That in and of itself should give all of us pause in desiring to adopt such a business practice. It might make a heck of a lot of good business sense, but it is not good medicine. From: [mailto: ] On Behalf Of pricklyfinger2007Sent: Tuesday, January 03, 2012 10:07 AMTo: Subject: Re: Telemedicine (Rochester, NY) on Discovery Channel God help us.grace>> IMPs, Thu & Debra,> > I am just getting started with Telemedicine, but so far I like the> flexibility. (It is also nice to be able to go to work in your> slippers..LOL.) We have not expanded to having providers from out of the> state yet, but when this happens, it will be the ideal job for those who> want to add extra hours but want to work remotely. It is definitely> different to see tympanic membranes through a digital picture or listen to> lung sounds through a wave file. It is not a job that everyone would like,> but I think it will expand our ability to help those in underserved areas. > > > > I also envision Telemedicine helping those who are IMPs to see patients out> of our area. There is a technician at the location where the patient> arrives and they collect the data to enter into the computer, pictures etc.> and the provider can see the patient through Skype and then the> documentation is done in TeleAtrics, which is a web-based record. There are> two sites..one for pediatrics and one for geriatrics (or adults).> > > > I envision IMPs someday, once Telemedicine takes off and is more mainstream,> having their patients arrive at a Telemedicine site in their area where a> technician can collect the exam data (vitals, pictures etc) and then the> provider can see the patient over skype or be telephone for the interview.> Technicians can collect ROS information but it must be confirmed by the> provider as the techs are not licensed but trained to collect what> information the provider will need.> > > > A real virtual visit cannot be done unless an exam can be completed. There> are " virtual visits " that can be done but there is no means to collect vital> signs and do an exam and just talking to the patient is really no different> than doing a phone visit (IMHO). Some situations where the patient just> needs a follow up on clarification of how to use a new medication etc. may> not require an exam, but to evaluate the efficacy and side effects of the> medication, for example, would require an exam. So until we have a means to> collect this data, such as with Telemedicine, there are limitations to what> can be done as a virtual visit. As Telemedicine progresses I see a world of> opportunity opening up for health care providers and patients everywhere.> One provider can cover multiple sites and the scheduler makes it a planned> visit, so the provider knows when the patients will be " arriving " for their> visit.> > > > The program that I work for was included in a special documentary that the> Discovery Channel did from across the nation. Markwick is the other> Family NP that I work with and she is the Director of the Adult Telemedicine> program.> > > > Here is the link..> > http://link.brightcove.com/services/player/bcpid1280283152001> > > > Tammy> > > > Tammy L. McGarvey, MSN, RN, FNP-BC> > Board Certified Family Nurse Practitioner>-- MD ph fax

[Guest guest]

Hey Grace- Brady would like to be your doctor I am sureJean

 

so telemedicine eh?

so doc, ive got this thing on my arse...

(picture runs through my virtual head)

so help me God.

g

> >

> > IMPs, Thu & Debra,

> >

> > I am just getting started with Telemedicine, but so far I like the

> > flexibility. (It is also nice to be able to go to work in your

> > slippers..LOL.) We have not expanded to having providers from out of the

> > state yet, but when this happens, it will be the ideal job for those who

> > want to add extra hours but want to work remotely. It is definitely

> > different to see tympanic membranes through a digital picture or listen to

> > lung sounds through a wave file. It is not a job that everyone would like,

> > but I think it will expand our ability to help those in underserved areas.

>

> >

> >

> >

> > I also envision Telemedicine helping those who are IMPs to see patients

> out

> > of our area. There is a technician at the location where the patient

> > arrives and they collect the data to enter into the computer, pictures

> etc.

> > and the provider can see the patient through Skype and then the

> > documentation is done in TeleAtrics, which is a web-based record. There

> are

> > two sites..one for pediatrics and one for geriatrics (or adults).

> >

> >

> >

> > I envision IMPs someday, once Telemedicine takes off and is more

> mainstream,

> > having their patients arrive at a Telemedicine site in their area where a

> > technician can collect the exam data (vitals, pictures etc) and then the

> > provider can see the patient over skype or be telephone for the interview.

> > Technicians can collect ROS information but it must be confirmed by the

> > provider as the techs are not licensed but trained to collect what

> > information the provider will need.

> >

> >

> >

> > A real virtual visit cannot be done unless an exam can be completed. There

> > are " virtual visits " that can be done but there is no means to collect

> vital

> > signs and do an exam and just talking to the patient is really no

> different

> > than doing a phone visit (IMHO). Some situations where the patient just

> > needs a follow up on clarification of how to use a new medication etc. may

> > not require an exam, but to evaluate the efficacy and side effects of the

> > medication, for example, would require an exam. So until we have a means

> to

> > collect this data, such as with Telemedicine, there are limitations to

> what

> > can be done as a virtual visit. As Telemedicine progresses I see a world

> of

> > opportunity opening up for health care providers and patients everywhere.

> > One provider can cover multiple sites and the scheduler makes it a planned

> > visit, so the provider knows when the patients will be " arriving " for

> their

> > visit.

> >

> >

> >

> > The program that I work for was included in a special documentary that the

> > Discovery Channel did from across the nation. Markwick is the other

> > Family NP that I work with and she is the Director of the Adult

> Telemedicine

> > program.

> >

> >

> >

> > Here is the link..

> >

> > http://link.brightcove.com/services/player/bcpid1280283152001

> >

> >

> >

> > Tammy

> >

> >

> >

> > Tammy L. McGarvey, MSN, RN, FNP-BC

> >

> > Board Certified Family Nurse Practitioner

> >

>

>

>

>

> --

>

>

>

> MD

>

>

> ph fax

>

>

--      MD          ph    fax