Telemedicine in the rapidly changing healthcare landscape.

Telemedicine in the rapidly changing healthcare landscape.

As we have talked before, the Triple Aim of improved outcomes, improved patient experience and decreased cost is an essential part of the successful health care solution. We know that there is a physician shortage and especially in places around the country like northern Michigan, access to specialty care is a big issue. Telemedicine is one model which enables a patient, who may be geographically removed from a specialist office, to get specialty expertise without the financial and time costs of traveling long distances.


Cyber-Care Telemedicine is a product which brings the specialist’s opinion to the primary care physician’s office for accurate and timely consultation, all while saving the patient time and money. As a specialty physician, I have given “curbside consults” in person or over the phone hundreds, if not thousands of times. Those interactions will likely continue but what Cyber-Care allows us to do, is scale that process to allow more physicians and patients to be involved and benefit from the process. The primary care physician best knows the patient, has broad knowledge skills, facility and equipment but on occasion needs specialty input to optimize care.


A good example of this is a patient I saw in the office last week who had a chronic stye in one eyelid. The patient had seen their primary care physician who placed the patient on oral antibiotics and antibiotic eye drops. The patient was seen in follow up with no resolution of the stye,  which instead of resolving, had become more enlarged. After a month and another course of antibiotics, the patient was referred to my office. Because the stye had now been present for over 2 months, incision and drainage was performed and the patient healed well.  Styes are due to blocked oil glands in the eyelids. Rarely they can become infected, but typically they are swollen without a true infection. The involved eyelid may be tender or may cause a sensation of irritation in the eye. Most will go away with warm compresses, but some need to be treated medically or drained surgically.


The reason I bring up this case is that it fits perfectly into the Cybr-Care telemedicine model. I could have received a Cybr-Care consult with a photograph and brief history and responded by giving instructions to use aggressive warm compresses and get an appointment to see me in 3-4 weeks if not completely resolved. The patient would see me if not resolved and undergo incision and drainage in the office setting without the need for follow-up unless they had problems. The end result would be that the patient had their problem resolved in a maximum of two office visits and would not have undergone the cost of antibiotics, office visits and time off work to attend those office visits. In the coming world of value-based-reimbursement instead of fee-for-service, this would also have been a success because the primary care physician could use those office visit slots for patients who needed to be seen.


There is a paucity of studies evaluating telemedicine in primary care. Cyber-Care and NPO are currently involved in a pilot study to show the benefits of this technology and these processes. We are in the process of collecting 100 cyber consults to complete this pilot study over the next month. We have specialty representation from dermatology, ophthalmology, infectious disease, neurology, orthopedics, pharmacy, and allergy. We much appreciate the involvement of our primary and specialty physicians who are engaged in this pilot. We are seeing from the early data that this will do much to improve health care in northern Michigan and encourage all of those involved in the pilot project to continue to refer when appropriate so ensure that we reach our goal of 100 completed cases.  If you have any questions about Cybr-Care, please contact Lisa Nicolaou at Northern Physicians Organization.  or if you are interested in speaking with Eugene Helveston, MD, the founder of Cybr-Care, to more fully understand the program, he may be contacted by calling the NPO office at 231-421-8505.


Peter Sneed MD
President Northern Michigan Health Network
NPO Board Member

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