Telemedicine and the Changing Healthcare Landscape in America

By Michael Fratkin, M.D.
Founder/Director
ResolutionCare






As a palliative care physician, I’m not really a technology guy. My choices in gizmos reflect this…the intuitive Apple computer, Zoom videoconferencing, athenahealth’s EMR, etc… My view of “meaningful use” is very different than that of the Department of Health and Human Services.

While they define “meaningful” with a carrot and a stick, I tend to define it in relational terms. As somebody who has worked with thousands of patients approaching the end of their lives, I have come to realize that in all of human history, people have never suffered in the approach to dying as they do today. Even without the incredible technology, advanced medicines, and the defined roles for healers that we have today, our predecessors had what people have always needed the most…the presence, intimate connection and care of those who loved them most.

I daresay that our ancestors also had a much better understanding that death is simply a natural part of our experience as human beings on this earth. We need to restore the traditions of compassionate home-based care and the capable use of a few simple principles of medicine. And we also need to integrate telemedicine technologies as a way to strengthen the relationships we have with our patients.

Because I believe that if technology is used to better serve the doctor/patient relationship, and if technology is used to improve the patient’s experience of their care, only then we can successfully achieve the “Quadruple aim” of healthcare: improved outcomes, better quality care, lower costs, and sustainable well-being for healthcare professionals.

To me, the amazing technology at our fingertips is only as valuable as its ability to serve and support our relationship to each other and to our collective well-being. And most importantly, to the patients we serve. Telemedicine doesn’t replace face-to-face, compassionate communication between doctor and patient. But it can increase its value. The “house call” is one of the oldest and most effective means of delivering care. If you boil it down to boring health economics terms, its value to cost ratio is really hard to beat.

Telemedicine cannot—and I would argue it should not—ever replace the house call. But it can significantly add to the doctor/patient relationship, improve communication, and provide the ability of a multidisciplinary team to follow up with comprehensive, coordinated care between home visits.

Telemedicine has become an important part of the necessary changes taking place across our healthcare landscape. What we know from our own lives is that our character and sensibilities are forged by adversity and difficulty. As an observer in the care of people facing the completion of their lives, I am convinced that the “pain points” are what awaken the inspiration needed to confront habitual problems, narrow self-interest, and self-destructive tendencies. Our healthcare system belongs to us, and it is our responsibility to recreate it so that it becomes entirely centered on value. And value, in our new healthcare system, must be defined by the experience of the very ill and those of us who wish remain as well as possible throughout life as we interact with our healthcare system.

This is an exciting time to be a care provider in the United States. Incredible change is afoot, and those of us who have long dreamed of better ways to care for patients are finding ways to challenge the status quo and change things for the better.

At the same time, technology has reached a tipping point. Cloud based technologies, mobile health platforms, patient engagement platforms and telemedicine technologies are all available to us. The challenge is to fuse the powerful technologies we have at our disposal with a real understanding and appreciation for the fact that technology cannot replace compassionate, soulful care.

Is there any better definition of “meaningful use” than that?

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Michael D. Fratkin, M.D., is an experienced educator and physician with a diverse background in Internal Medicine and Hospice and Palliative medicine. He is dedicated to the physical and spiritual well-being of patients and their families as they face complex medical conditions in the context of integrated health care delivery.

Dr. Fratkin is the Founder and Director of ResolutionCare, established in August 2014. He launched this social enterprise to bring greater capacity for Palliative Care services to the community and to enhance capable and soulful care to everyone, everywhere as they approach the completion of life. ResolutionCare innovates with emerging payment models and technology to restore the tradition of home-centered care.