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Re: Unconvincing definitions and excuses for limitations
RogerD116   7/18/2014 4:48:05 PM
CEO, I agree with you that medical records should be available to patients.  Perhaps, some day they will be.  As to your practice of going to a variety of minute clinics, choose wisely.  The ones in Walgreens are not connected with those at Costco or Walmart, so your medical records including test results could reside in pieces in a variety of locations.  And the stand-alone urgent cares are rarely connected to larger healthcare enterprises. 

A medical home is more than a primary care provider - it's a network of physicians in various specialties.  And they all have access to your medical records for continuity of care. And when you need to gather up your medical records to see a specialist outside the network for a second opinion, it takes just one request.

The DoD and the VA are unique in that each is like a single payer system.  Their medical record systems are not together either, so the VA has no direct way to access your military medical records.


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Re: Unconvincing definitions and excuses for limitations
RogerD116   7/18/2014 4:34:50 PM
Sounds like a great case for telemedicine, the real-time, live videoconferencing consult variety.  If the physician has an arrangement with the specialist, he could do a telemedicine consult right there in his office with the specialist using his laptop.  If you were covered by Medicare, both the PCP and the specialist would receive a fee.  21 or 22 states have passed legislation requiring private insurance companies to reimburse for telemedicine.

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Re: Unconvincing definitions and excuses for limitations
Bert22306   7/18/2014 4:19:59 PM
There is no need for a "face to face" interaction with a physician IF you already have a medical home - a primary care provider.

I wouldn't even make that statement. There's no need in principle to have a unique individual as "your doctor." Medical records for yourself should and can be made available to any care provider you choose to use at a given time. And this is already possible.

In the US, some drug stores have "minute clinics," for instance, and there are also many walk-in medical faciilties. There's no reason why people can't use those exclusively, for most of their needs. Certainly for tests, to check out a sore throat, to get vaccinations, and on and on and on, you can do this.

Once people become used to this way of taking control of their own health, the step to do these procedures with telemedicine become rather obvious.

At work, we are now required to have certain blood tests done annually (or pay extra for health insurance). No problem. No need to go to "your doctor," even though that's an option. You can have the test done remotely, from home.

I had a prolonged sore throat a few years ago. No problem. Had a strep culture taken at a walk-in clinic, in and out, no appointment, issue resolved (it wasn't strep).

This is the way it's going to have to be, to increase efficiency of the system. And that increase will become pretty much mandatory now, in the US. But the good news is, it works better this way. It's infinitely more convenient for individuals. The more medical sensors are automated, miniaturized, and mass-produced, the more of these procedures you will be able to do from home.

And by the way, this is similar to how medical care is administered in the military. No one has "their doctor." People move around to much for such quaint concepts. What you do have is medical records that any doctor can access. So that's an important ingredient.

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Re: Unconvincing definitions and excuses for limitations
elizabethsimon   7/18/2014 4:17:00 PM
You make a good point about having a primary care provider but what about the case where your primary care provider requests that you see a specialist who may be some distance away? Is there a need for the "face-to-face" contact for the referal? I live in a location where to visit some specilists requires an almost two hour drive one way so 1/2 day for a brief doctor visit.

One of the local hospitals has put in a system to allow specialists to interact with patients who shouldn't be moved. Since there is a local provider in attendance does this mean that its doesn't fall into the "telemedicine" category.

At this point there's a loft of confusion. Which was the point of the article.


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Re: Unconvincing definitions and excuses for limitations
RogerD116   7/18/2014 11:11:05 AM
There is no need for a "face to face" interaction with a physician IF you already have a medical home - a primary care provider.  Why people don't take the time to establish a relationship with a physician when they're healthy so that they can call the doctor on the phone when they're ill is beyond me.  And the physician needs to know you so that he can make an informed judgment on whether you need a test or not.  Otherwise, you're simply self-diagnosing yourself. To borrow a phrase, a man who is his own doctor has a fool for a patient.

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prabhakar_deosthali   7/18/2014 3:04:19 AM
I also agree with @Bert.

 So many non medical services are now on line and done remotely - for example all kind of money transactions are carried out legally without the physical presence or signature of either party involved.

So why single out the medicine?


Since the doctors are now totally dependent on various tests carroed out by machines - x-ray, MRI, pathological tests and sonography and so on.

So it really does not make any difference if the doctor physically meets the patient or using telecommunications  interacts with the patients after getting the requisite test results from the machines.


Faster the lawmakers understand this , better it will be for the good of the people in remote areas where doctors cannot reach physically.



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Unconvincing definitions and excuses for limitations
Bert22306   7/17/2014 4:34:11 PM
The article assumes that when conducting telemedicine, prescribing controlled drugs is an essential part. It's not, necessarily. There should be nothing wrong with at least permitting tests and monitoring to be conducted remotely, without an initial "face to face," and that would still qualify as telemedicine. (Honestly, the older I get, the more convinced I am that insistence of "face to face" is made by those who want to do the least possible amount of real work in the most amount of time.)

I think of telemedicine as something inevitable in the coming years, simply because it allows a lot more health care to be provided at much lower cost. It's like any other innovations. As innovations are introduced, because they improve what came before, laws and regulations for them evolve in time. It does not seem hard to imagine how eventually, complete physicals will be able to be offered remotely, the way bio sensors are being developed these days. I think it's wrong to assume that "face to face" would necessarily provide more reliable and consistent results than what modern sensor design can achieve.

In fact, one can probably make the case that telemedicine has been with us for many years already. It's just that the electronic sensors, e.g. MRI machines, or CT scans, or what have you, are not yet small and cheap (and safe?) enough to be in the hands of the patient. But this has been changing gradually. Any number of tests can now be self administered. Sending the results to a medical service is a no brainer.

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