When it comes to healthcare in rural areas, the overarching question is how to level the playing field between geographically isolated healthcare facilities and their urban counterparts, says Ronald S. Weinstein, director of the Arizona Telemedicine Program at the University of Arizona.
That’s exactly why the Arizona Telemedicine Program was launched, he says.
Telemedicine is the remote diagnosis and treatment of patients by means of telecommunications technology. When the telemedicine industry began, the majority of the companies were university-based, but the trend has since shifted into the private-sector, he says.
“And I think that where you’re going to see acceleration, or we are seeing acceleration, are the large integrated healthcare systems, which have lots of rural sites and lots of technology,” says Weinstein. “They’re trying to level the quality throughout their entire systems.”
The Arizona Telemedicine Program, a branch of the UA’s Health Sciences Department, was co-founded in 1996 by Weinstein and Robert Burns, a member of the Arizona Corporation Commission. The program is designed to provide telemedicine services, distance learning, training in informatics (the science of processing data), and telemedicine technology assessment capabilities to communities throughout the state.
The array of specialties in telemedicine can be broken down into three major application categories, Weinstein explains: gap services, where, for instance, a rural hospital will have remote access to a specialist who may not work in-house; urgent services, which can save lives remotely when time is of the essence; and mandated services, such as entitlement health services that are required by law for prisons and jails.
The ATP will host the Third National Telemedicine and Telehealth Service Provider Showcase Conference Oct. 2-3 at the Hyatt Regency Phoenix. The two-day event offers attendees practical advice from national experts on bolstering telehealth services and negotiating legal, regulatory, and payment hurdles. The conference will also feature an expo hall that showcases telemedical specialty services and models. In 2016, the SPS conference had almost 400 participants, from 36 states and four countries, and an expo hall with 40 exhibitors. This year, the ATP hopes to see 500 attendees at the event, says Weinstein.
“They really want it for networking purposes,” Weinstein says. “They’re learning from one another and that’s exciting to see.”
Weinstein, known as the “father of telepathology,” participated in the first telemedicine cases in 1968 as a resident-physician at Massachusetts General Hospital in Boston. He invented, patented, and commercialized robotic telepathology in 1986. His extensive body of work and research for the last three decades acts as the fundamental basis for telepathology programs in more than 35 countries.
He grew up in Schenectady, New York, and earned a Bachelor of Science in medicine at Union College. He attended Albany Medical College from 1960 to 1962, and graduated from Tufts University School of Medicine, Boston, in 1965.
After completing his internship and residency at Massachusetts General, under Dr. Benjamin Castleman, Weinstein became a teaching fellow at Harvard Medical School. He spent three years as an associate professor at Tufts, and was named the Harriet Blair Borland chairman and professor of pathology at Rush Medical College, Chicago in 1975 — a position he held for 15 years. In 1990, Weinstein relocated to Tucson and was hired on as the head of pathology at the University of Arizona’s College of Medicine.
There are several invaluable telehealth services that prevent serious disease and save lives, Weinstein says, the best example is the telestroke application. Ischemic stroke — where a blood clot blocks an artery to the brain, which prevents blood flow and can kill brain cells within minutes — accounts for about 87 percent of all stroke cases. Because of telestroke monitoring systems, doctors can prevent this type of stroke from evolving and thousands of lives are saved each year, he says.
“That’s been very important in terms of being an absolutely essential application … it’s become standard of care in the stroke arena,” Weinstein says.
Although the market penetration for telemedicine services is relatively small, as smartphone use continues to increase so does the potential for diagnosing illness via video conference, Weinstein says. Kaiser Permanente recently released a report that stated that during the past year more than 110 million interactions between patients and doctors were electronic, he adds.
Despite the fact that no other developed country even comes close to the United States in annual spending on health care, 20 percent of Americans still live in areas where shortages of physicians and healthcare specialists exist, according to an article published on Aug. 15, 2016 by the Robert Wood Johnson Foundation.
Many believe that the answer to issues of cost and access in the U.S. health system lies in telehealth.
Thirty states have passed parity legislation, which requires health insurance companies to pay doctors the same premiums for in-person or telemedicine health services, says Weinstein. In 2017, UnitedHealthcare offered 20 million policies with a telemedicine benefit option for the first time.
“I think that’s a major step forward,” Weinstein says.
During the last three years, an entire industry of telemedicine service companies has blossomed nationwide, Weinstein says, and approximately $280 million was invested in these private-sector businesses in 2015. The ATP’s service provider directory lists 108 telemedicine companies, 48 of which are based in Arizona.
Private companies have the resources to license doctors in multiple states, expanding the reach of telehealth services, and more than a dozen states have passed compact legislation that allows them to do that, says Weinstein, adding, “Arizona is right up there in the lead in that category.”