Telemedicine puts a doctor virtually at your bedside

JUDY WOODRUFF: Videoconferencing has become so commonplace that we have grown comfortable communicating with one another through pixels on a screen.

That comfort, combined with rapid advances in health monitoring technology, is fueling a new boom in telemedicine. Teladoc, a big player in providing video and telephone medical consults, had an extremely successful launch when it went public on the stock market earlier this month. It raised more than $270 million on the first day.

As Hari Sreenivasan explains, telemedicine is beginning to transform the way we experience the medical system. It's the latest in our Breakthroughs series on invention and innovation.

HARI SREENIVASAN: A simple ritual, like gardening on a hot summer day, is something Tom and Trisha Uhrhammer don't take for granted anymore.

TRISHA UHRHAMMER: Can you use some basil?

HARI SREENIVASAN: Just a year ago, Tom had a massive stroke.

TOM UHRHAMMER: I was sitting right next door here in this room watching TV. Time to go to bed. So I got up and walked up the stairs, and I didn't make it. I collapsed short of the bed.

HARI SREENIVASAN: The paramedics took Tom, who was paralyzed on his left side, to nearby Mercy General Hospital in Sacramento. With blood seeping into his skull, creating enormous pressure on his brain, time was of the essence. That's when a telestroke robot was deployed to the E.R.

TRISHA UHRHAMMER: Pretty soon, this machine came toward me, and in the screen appeared a doctor. And he said: "Good evening. My name is Dr. Nee. I'm a neurologist and I'm here to examine your husband."

And, lo and behold, that robot turned around, went around the bed to the other side and started examining Tom. It was remarkable.

HARI SREENIVASAN: Dr. Nee was also able to remotely access C.T. scans and other vital data need to quickly determine Tom's surgical needs. Mercy is one of 43 Dignity Health hospitals in the West using the telestroke robot, and there are others in use all over the U.S.

We got a demonstration from Dr. Asad Chaudhary — he's the one on the screen — and nurse Eleanor Vigilante.

ELEANOR VIGILANTE, Director of Emergency Department, Sequoia Hospital: It's faster for us to always use teleneurology, because our physicians are not 24 hours a day in the building. So, we can actually get a physician to the bedside of a patient within three to six minutes.

HARI SREENIVASAN: And three to six minutes is the difference between what?

ELEANOR VIGILANTE: Every minute that we waste is potentially more brain function that's lost.

HARI SREENIVASAN: Stroke is the leading cause of serious long-term disability in the United States. Widespread use of telemedicine for stroke care is improving patient outcomes.

Hoping to build on its success in hospitals, the telehealth industry is now focused on bring more basic health care services directly to patients wherever they may be.

From the comfort of her San Francisco home, Dr. Raveena Rihal is diagnosing and treating patients for primary care ailments like sinusitis, pink eye and bladder infections.

DR. RAVEENA RIHAL, Doctor on Demand: A patient can download the app on their mobile device, either laptop, iPhone or tablet. And if they want to see a doctor, they just press a button, and they will connect to a doctor that licensed in their state and can see them over video.

HARI SREENIVASAN: Rihal works for Doctor on Demand, one of a handful of companies connecting patients with physicians almost instantaneously.

DR. RAVEENA RIHAL: Hi there. I'm Dr. Rihal with Doctor on Demand. Welcome.

HARI SREENIVASAN: On the day we visited, Rihal took a call from Carmen Crandell and her 11-year-old daughter, Alyksandra McKaymick, from Naples, Florida.

DR. RAVEENA RIHAL: If you feel here, do you feel any lumps or bumps?

CARMEN CRANDELL: It feels a little swollen in here, just a little bit.

DR. RAVEENA RIHAL: And now I want you to bring the camera real close to your mouth and say ah.


DR. RAVEENA RIHAL: Yes. I got a good look there. It looks red, but I don't see any white patches.

You can point the camera in the back of your throat and get a really good look at tonsils. It's surpassed my expectations, the technology piece of it, and I think the future holds even more with all of the wearable devices and all the information we're going to be able to transmit soon.

HARI SREENIVASAN: By the end of a 13-minute exam, which cost $40, Alyksandra was diagnosed with viral sinusitis and her prescriptions were sent to a nearby pharmacy electronically.

Why did you choose this service? Why not just go to a doctor that's in Naples?

CARMEN CRANDELL: You can't get an appointment. If your child is sick and you call them, they say they can't see them until the next week. It's pointless. Then you end up at the emergency care clinic and that costs $100 for your co-pay. So why not pay $40 and do it right then?

HARI SREENIVASAN: Beyond the convenience factor, Doctor on Demand's chief medical officer, Dr. Pat Basu, says the cost savings on a large scale add up.

Chief Medical Officer, Doctor on Demand: In the United States, there's a total of about 1.3 billion cases where people walk in to see a doctor. Of the type that Doctor on Demand is ideal for, you're talking about 300 million to 500 million that we can treat.

HARI SREENIVASAN: At a rate of $40 per telemedicine visit vs. an average of $1,000 for a trip to the emergency room or about $300 for urgent care, Basu says the potential savings are enormous.

DR. PAT BASU: Right off the bat, that would save $25 billion to the U.S. health care system.

HARI SREENIVASAN: Such figures have caught the attention of insurance companies. In April, UnitedHealthcare, the largest private insurer in the U.S., launched a partnership with three telemedicine companies, NowClinic, American Well and Doctor on Demand, to cover video-based physician visits just as it covers in-person visits.

Health industry observers say it's the strongest sign yet that telemedicine is entering the mainstream.

DR. PAT BASU: Now we have over 20 million patients who have access to Doctor on Demand through insurance. On the government side, Medicaid and Medicare, that progression has still not fully occurred, but we are in conversations with state Medicaid agencies and national Medicare to cover this.

HARI SREENIVASAN: Dr. Abraham Verghese, vice chair of Stanford's School of Medicine, applauds the efficiencies and cost-saving telemedicine will bring, but he's concerned about preserving the doctor-patient relationship.

DR. ABRAHAM VERGHESE, Stanford University School of Medicine: A very important, I would say ministerial, function of being a physician is to be attentive, is to be present, is to listen to that story, is to locate the symptoms on that person of that patient, not on some screen, not on some lab result, but on them.

HARI SREENIVASAN: Do you ever feel like you're missing something by not being able to touch the patient?

DR. RAVEENA RIHAL: No. If I was taking care of heart failure and diabetes and things like that, I think I would feel really uncomfortable doing that over video. But the more common things that I'm taking care of, I feel good about what I'm doing, and I feel like I actually connect with the patients really well.

Even though Doctor on Demand chooses not to allow its home-based doctors to treat serious illnesses, outdated regulations don't necessarily prevent them from doing that. Verghese says the industry needs some clear national guidelines.

DR. ABRAHAM VERGHESE: I have no doubt that we're going to learn a lot more about the blessings and pitfalls of telemedicine as more and more people start to do it. And I suspect we're going to realize that it's very good for some things. And there will be a fairly hazardous tiny little live-wire area that perhaps we will develop guidelines that you don't go near.

HARI SREENIVASAN: National regulation won't be easy, as all 50 states have their own unique laws governing the practice of telemedicine, something Christa Natoli, associate director of the Center for Telehealth and e-Health Law, spends her time studying.

CHRISTA NATOLI, Center for Telehealth and e-Health Law: States really focus a lot on the physician-patient relationship and physical examination, but states that are clear will say and define what an appropriate examination looks like.

States that are vague do not define what appropriate means in any context. It's in the gray area where states are silent on these issues that could potentially lead to patient harm.

HARI SREENIVASAN: As policy-makers determine how to define and regulate the industry, there are a growing number of patients who've experienced virtual medicine firsthand.

In the year since his stroke, Tom Uhrhammer has fully recovered. He and his wife, Trisha, are grateful to be back to their normal routine.

For the PBS NewsHour, I'm Hari Sreenivasan in Northern California.