Could Nurse Practitioners Soon be Treating Their Patients Online?

In the ER where I work, X-Rays and CT scans are read 24 hours-a-day by a radiologist.  Fortunately for the radiologists, those responsible for nighttime readings are located in Hawaii.  This setup provides these specialists with a better schedule (and location!) allowing physicians to avoid the dreaded overnight shift.  This practice has been used for quite some time in specialties where face-to-face patient interaction is typically unnecessary.  But could long-distance medicine become a day-to-day component of your life as a nurse practitioner?

What is Telemedicine?

According to the American Telemedicine Association, telemedicine refers to the transfer of medical information via email, video, smartphone, and other technology.  This field of medicine began about forty years ago and is rapidly expanding as technology becomes more integrated into the medical field.  It allows medical providers to consult, diagnose and treat patients without the traditional in-person interaction.  Currently, many websites offer these services.  Using sites like, and, patients can consult a physician online for a cost of $10 to $40 depending on the site.

How is Telemedicine Currently Used?

The scope of telemedicine is constantly increasing.  Currently, it is used mainly in rural areas such as Nantucket, a town over an hour away from the nearest hospital, and Nebraska, a state where 89 out of 93 counties experience a shortage of mental health professionals.  Psychiatry, radiology, pathology, neurology and dermatology are the fields currently most involved in telemedicine as they lend themselves to a decreased amount of in-person interaction.

The Veteran’s Health Administration (VHA) utilizes telemedicine in many of it’s facilities.  48,000 chronic disease patients are monitored in their homes through this technology.  These at-home services have cut cost of care for veteran’s by reducing the number of hospital admissions.  Some prisons have also implemented telemedicine technology so potentially dangerous inmates do not require transfer to hospitals.

Insurers are also getting in on telemedicine technology.  WellPoint, the nation’s second largest health insurer is planning to offer a new service to all of it’s individual and employer-based plans allowing individuals to consult with physicians using laptop webcams.  The company hopes this will ultimately reduce the cost of patient care by decreasing the number of trips to the emergency room.

What are the Barriers to the Spread of Telemedicine?

The major barrier to the spread of this useful technology is reimbursement.  Currently, Medicare pays only for telemedicine visits in ‘Health Professional Shortage Area’ or in a county that is outside of a ‘Metropolitan Statistical Area’.  The patient must also be present in a medical facility, not their own home. Medicaid programs have varying reimbursement programs for telemedicine services depending on state.

State laws also inhibit the scope of services provided by telemedicine websites.  For example, providers must often be licensed in the patient’s home state to write prescriptions.  If the provider is treating an individual in a different state who needs a prescription, they will still have to visit a local medical provider for complete treatment.

What Does the Future of Telemedicine Look Like?

Telemedicine holds great potential for improving the lives of patients and medical providers.  Imagine if you could work from home while still providing patient care.  Patients across the country will have greater access to primary care physicians and specialists alike as use of this technology increases.  As telemedicine increases in popularity, Medicare and Medicaid will recognize the decreased cost of care associated with this service and increase coverage.

What do you think of telemedicine?  Can quality patient care be delivered safely via webcam?