Optometry as a profession has been distracted for many years with changes, both good and bad, which affect our ability to compete fairly, provide patient care and generate income. Teleheath is one of those changes that have been foreseen for decades, which we have chosen to ignore. The changing demographics, convenience, rapidly evolving technology, and the escalating costs of healthcare have poured capital into this market and is something optometry can no longer ignore and challenge. With some background and understanding we can finally embrace these changes to become more competitive with the demands and needs of our patients.
There are many definitions of telemedicine; however, the American Telemedicine Association states the technology should indisputably improve quality, equity and affordability around the world.1 In other words, it should follow 3 specific rules: allow greater access, lower costs and better outcomes.
Telehealth and telemedicine are used interchangeably; however, they are different classically. The traditional term of telemedicine refers to the clinical diagnosis, monitoring and treatment delivered over telecommunications, whereas telehealth is much broader, including a wider range of diagnosis and management that includes education and wellness monitoring.2 It dates back as early to the Civil War when the telegraph was used to order medical supplies and transmit casualties between Washington and Baltimore.3 As technology changed, from telegraph to telephone, telephone to radio, radio to television, and so forth, the combination of technology and healthcare grew, especially in areas of telemetry, psychiatry and radiology. The Centers of Medicare and Medicaid (CMS) have been reimbursing telehealth services since The Balanced Budget Act of 1997 and the different kinds of services, starting with the synchronous, or “live” conferencing.4
Telemedicine is comprised of 4 types of services: (1) synchronous, which is “live” that is typically done with video conferencing, (2) store-and-forward, which is also known as asynchronous where health history and/or images are transmitted, stored and forwarded to a healthcare provider for consultation, diagnosis and treatment, (3) RPM or Remote Patient Monitoring, which is the collection of chronic care vitals that are transmitted for monitoring purposes, and (4) mHealth, also known as Mobile Health, which comprises the use of wearables and applications that monitor virtually anything where a supporting healthcare sensor can track.
Our profession has experienced plenty of applications that entered the market that were labeled as telehealth that did not follow the overall definition and should not be considered as such. Optometry is typically cautious to always ensure the utmost standard of care and providing the best for our patients. However, there are still plenty of populations across the United States that do not have access to quality eye care services and technology has been closing the gap. I encourage ODs to follow peer-reviewed research regarding eye care and telemedicine to see how their role is crucial for the profession and patients. Here are just a few: (1) “Telemedicine for ophthalmic consultation services: Use of a portable device and layering information for graders” from 2016,5 (2) “Reliability of telemedicine for diagnosing and managing eye problems in accident and emergency departments” from 2003,6 and (3) “Long-term Comparative Effectiveness of Telemedicine in Providing Diabetic Retinopathy Screening Examinations: A Randomized Controlled Trial” from 2015. All these studies have conclusions that the efficacy and sensitivity of telemedicine is safe and increases access, reduces healthcare costs and improves outcomes. As technology continues to evolve how can we as optometrists (or eye care professionals) embrace telemedicine in our everyday practice and stay on the forefront of great patient care?
Bryan M. Rogoff, OD, MBA, CPHM has a unique background in areas of holistic eye care, business management and healthcare reform. He specializes in LEAN clinical management and operations, technology implementation, healthcare strategy, and strategic partnerships. Currently, he serves as a consultant for for the FDA, Immediate Past-President & Education Chairperson for the Maryland Optometric Association, Federal Keyperson and Meetings Committee Member for the American Optometric Association, reviewer for the Council on Optometric Practitioner Education and is the Founder of Eye-Exec Consulting, LLC. To contact Bryan, visit www.eye-exec.com or email firstname.lastname@example.org. He can also be found on LinkedIn, Facebook, Twitter and Instagram.