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CIO Halamka on the benefits of telemedicine

For many health IT professionals, the benefits of telemedicine are undeniable. However, some regulators are concerned that this technology could possibly be abused because the doctor or physician is not physically there with the patient. In fact, some states, including Texas, are so wary that they've enacted laws that limit the practice of telemedicine.

However, there are some health IT experts who believe this fear of telemedicine is unnecessary, and John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston, is one of them. In his opinion, the benefits of telemedicine that apply to treating patients are too valuable to pass up. And he would know, as Halamka said he does about 600 telemedicine consults every year.

"In my case it's a bit of an esoteric practice because it's around poisonous mushrooms and plants," Halamka said. [Editor's note: Find the full video transcript below the article.]

Halamka is one of the country's leading mushrooms experts, and doctors from all over the United States will consult him when one of their patients has eaten something that could be poisonous. Halamka explained that the doctor will send him a high resolution photo of the mushroom the patient ate, and Halamka will view it on his iPhone. From there, Halamka can identify whether that mushroom is actually poisonous or not. Halamka explained that when someone consumes a poisonous mushroom they then have to ingest ground charcoal to absorb the toxins, which is very unpleasant to say the least.

My father-in-law was treated perfectly for his stroke, was discharged the next day and had absolutely no lasting effects from it. And that was all telemedicine.
John HalamkaCIO, Beth Israel Deaconess Medical Center

"So if I can say, 'Oh that is a completely harmless mushroom. Don't worry, send them home,' that actually saves patients and their families a great deal of grief," Halamka said.

Halamka has also personally experienced the benefits of telemedicine when his father-in-law suffered a stroke. In that case, driving all the way into Boston was not appropriate, so Halamka and his family went to Beth Israel Deaconess Hospital-Needham just a few minutes away from Halamka's home. However, the Needham hospital had a CT scanner and an emergency department, but no neurologist. Luckily, Beth Israel has TeleNet: Stroke throughout their network. This means once a scan is done a trained neurologist will come on the telemedicine connection, look at the patient and the CT scan and then make therapeutic decisions.

"In this case, my father-in-law was treated perfectly for his stroke, was discharged the next day and had absolutely no lasting effects from it," Halamka said. "And that was all telemedicine."

Despite all these benefits, there are still significant obstacles, Halamka said.

One dilemma is if a doctor or physician is licensed to practice in Massachusetts and needed or wanted to prescribe a medication to a patient in California; what license does that doctor need, a Massachusetts license or a California license?

"This is murkiness that is to be worked out," Halamka said. "Today 37 states have agreed that if I am licensed to practice medicine in Massachusetts and I'm doing a telemedicine connection in Massachusetts that the Massachusetts license is sufficient. But that means that there are 13 states, like Texas, that have said, 'Mmm no. You need to be on site here.'"

Ultimately, Halamka believes that having an expert -- even if they are not physically present -- conduct a consultation would be more beneficial to the patient than an untrained person standing next to the patient.

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Transcript - CIO Halamka on the benefits of telemedicine

Kristen Lee: Telemedicine has not been completely adopted or accepted the United States yet. In fact some states have enacted laws that limit the practice of telemedicine due to concerns including that a doctor may not get the whole story about a patient if the doctor is not physically present. But John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston, thinks concerns surrounding telemedicine isn't necessary and that the benefits it can bring are too valuable to pass up. As one of the country's leading mushroom experts, Halamka said he conducts telemedicine consults daily to help patients who may have ingested poisonous mushrooms.

John Halamka: I do 600 telemedicine consults personally every year. In my case it's a bit of an esoteric practice because it's around poisonous mushrooms and plants, and what happens is a doctor in some place in the U.S. with a patient says, "John, this patient just ate this." He sends me a photograph, and on my iPhone I have a high resolution photograph of whatever it was that was eaten. Sometimes it's pieces, sometimes it's a whole mushroom or plant, and I'm able to say, "Okay, well, that's a Marasmius oreades or that is an Amanita rubescens, or whatever species it is and the toxins in it are these and the treatment is this and the patient's follow-up should be that. So far 600 consults a year, and I've been doing this for a decade, so about 6,000 patients; the outcomes have been universally good.

Lee: Halamka explained that when someone ingests a poisonous mushroom, they usually have to ingest ground charcoal to absorb the toxins.

Halamka: It's a very unpleasant thing to do. So if I can, "Oh, that is a completely harmless mushroom, don't worry." Send them home. That actually saves patients and their families a great deal of grief. So it's worked.

Lee: Halamka has also personally experienced the benefits of telemedicine when his father-in-law suffered a stroke.

Halamka: It would not have been appropriate to drive all the way into Boston to treat him for his stroke. So we went to the Needham hospital which is just a few minutes from our home where they have a CT scanner and emergency department but no neurologist. So what happens? We do telestroke at Beth Israel Deaconess throughout our network so that a CT scan of the head is done. Of course, stabilization of vital signs or whatever is done by the emergency physician, but then a Harvard-trained neurologist 24 hours a day comes on the telemedicine connection, looks at the patient, looks at the CT scan and makes therapeutic decisions based on the patient, his CT scan and the history. And in this case, my father-in-law was treated perfectly for his stroke, was discharged the next day and had absolutely no lasting effects from it. And that was all telemedicine.

Lee: But Halamka recognizes that there are still many obstacles to telemedicine being fully realized in the United States.

Halamka: Sure, there are challenges with state laws today. So I'm licensed to practice in Massachusetts. If I wanted to prescribe a medication for a patient in California and we were on a telemedicine connection, what license do I need? California or Massachusetts? Am I writing the prescription in Massachusetts or California? And so this is murkiness that is to be worked out. Today 37 states have agreed that if I have license to practice medicine in Massachusetts and I am doing a telemedicine connection from Massachusetts, that the Massachusetts license is sufficient.

But that means there are 13 states, like Texas, that have said, "You need to be onsite here." "Okay, so maybe what we have to do is have a physician standing next to you while I do the telemedicine connection." I offer advice and the physician standing next to you writes the prescription.

Lee: Halamka, like many other health IT experts out there, thinks telemedicine will be beneficial to everyone, especially people living in rural parts of the country. However, the overall goal he said, "Should be to care for patients in the comfort of their own homes."

Halamka: And of course, like anything in medicine there's never a black and white answer to it, so there are shades of gray. But I will say for the vast majority of conditions in patients, an expert [who is] able to do a consultation [via telemedicine can do more] than an untrained person standing next to the patient.

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