Rutgers Pilot Could Signal a Move Toward Telemedicine

Lilo H. Stainton | July 18, 2016 | Health Care
New initiative targets Newark residents; legislation for state policy could follow this fall

New Jersey often leads the nation when it comes to innovation in healthcare or technology. But the state has lagged behind the pack when it comes to combining the two in the form of telemedicine, or the use of videoconferencing or similar electronic communication to connect healthcare providers and their patients.

But last week, Rutgers University launched a pilot program that seeks to improve care for a test group of 10 residents of Newark public housing. It will connect providers from the Rutgers School of Nursing’s community health center with the patients through a secure internet connection to a laptop computer, enabling them to help check vital signs, obtain an electrocardiogram and more — all in real time.

In addition, Sen. Joseph Vitale (D-Middlesex) said Friday he plans to hold another round of legislative hearings on a new version of bill that would result in the state’s first policy on the practice, including which providers could participate and how they would be paid. “It’s a complicated issue and we want to get input from all the stakeholders,” said Vitale, the longtime chair of the Senate Health Committee.

So far, New Jersey has lagged behind the nation when it comes to implementing telemedicine. Most states have adapted legal definitions and policies dictating how remote diagnoses and treatment can be used and at least 29 states now have laws that require insurance companies to pay for these services. Some places, like Virginia, have invested significantly in telemedicine programs and have seen health outcomes improve, including a drop in hospital readmissions.

The matter has proved controversial here in the Garden State. Vitale led a series of hearings last fall to explore the use of such technology and create a clear telemedicine policy, like those adopted by other states. Many communities here suffer a shortage of healthcare providers — especially psychiatrists and other behavioral health specialists — and Vitale has said remote technology can help reach patients who are currently not getting the care they need.

While most healthcare experts agree telemedicine can benefit rural and underserved populations, the legislative hearings underscored the concerns some have about the practice. Physicians want to ensure New Jersey doctors aren’t replaced by those out of state, that they are fully compensated for any work they do remotely, and that they still can establish a personal relationship with their patients.

Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, said it’s time we joined the national movement. The state needs to adopt laws and regulations that will enable the healthcare industry to embrace the use of more technology to treat patients here.

“The absence of clarity and predictability is holding us back from services that are already proven in many instances and hold great promise in others,” Schwimmer said, noting that telemedicine has proved beneficial elsewhere for addressing prenatal care and mental health and for reducing unnecessary emergency room visits.

In a column published last week titled “Don’t Let Turf Battles Destroy The Potential of Telemedicine,” Schwimmer wrote that not every complaint should be treated remotely. “But relatively healthy, busy people with straightforward needs or common ailments should have access to safe and convenient alternatives to the in-person physician visit. Allowing consumers to connect with health care providers through phone, email, and video-conferencing provides accessibility and the potential for cost savings.”

[related]While doctor-patient telemedicine is not generally available in New Jersey, some organizations have launched test efforts that use electronic communication to connect healthcare providers here with physicians or other experts in a remote location. The state has backed a pilot program that uses remote technology to connect pediatricians with behavioral health experts, in an effort to better address mental-health issues among children. A two-year project backed by the nonprofit Nicholson Foundation linked primary care doctors in underserved communities with pain management experts elsewhere to reduce the dependence on opiate prescriptions.

The Rutgers project — which also involves support from the schools of business and public affairs — may be the first in the state to link providers with patients; Professor Ann Bagchi, a registered nurse and the point person on the project said she was not aware of any similar efforts. And while it is small — focusing on a limited amount of data, to be collected over several days from 10 patients — Bagchi said it is a chance to evaluate the process and the software involved and explore other possibilities.

“Telemedicine is rapidly becoming an accepted part of the healthcare delivery system,” Bagchi said. “When the technology is used appropriately, it has a unique capacity to improve access, lower costs, and improve healthcare outcomes.”

Rutgers School of Nursing dean and professor William Holzemer said he was excited by the potential telemedicine holds and noted it could “be a real asset to our ability to provide high-quality, accessible primary care through our school’s federally qualified health center serving Newark communities.”

But legislative action is required to create the statewide policy advocates said is needed. Vitale said the discussion will target a measure (S-291) that he sponsored with Sen. Jim Whelan (D-Atlantic) and Sen. Diane B. Allen (R-Burlington); a similar measure sponsored by the trio failed to advance last year. Vitale said Deputy Assembly Speaker Pamela Lampitt (D-Camden), who has been a champion of telemedicine in the past, will sponsor an Assembly version of the latest bill.

Introduced in January and amended before it has come up for a hearing in Vitale’s Senate Health Committee, the 53-page proposal would authorize an array of healthcare providers licensed by the state — including doctors, nurse practitioners, psychiatrists, psychologists, licensed clinical social workers, and physicians assistants, among others — to use electronic communications or information technology to diagnose and treat patients remotely.

The measure envisions the use of two-way video links or other technology designed to mimic the traditional in-person encounter between doctors and patients; it would exclude audio only, or telephone consultations, email, instant message, or text consultations.

The proposal would allow out-of-state physicians to treat New Jersey patients if they hold a reciprocal medical license, which was made possible under a 2014 law. It also would require the state Board of Medical Examiners to evaluate an interstate telemedicine licensing compact now being drafted by national experts, with an eye to adapting a universally accepted standard in the future.

In addition, to encourage the expansion of telemedicine, the bill would prevent the state’s publicly funded Medicaid and NJ Family Care programs, as well as private insurance companies — including policies these firms provide for state workers and school district employees — from blocking its use by requiring patients to have in-person appointments. Unless there is a medical reason telemedicine is inappropriate, the proposal would require insurance companies to cover remote sessions at the same rates they paid for traditional visits.

Schwimmer agreed with Vitale on the complexity of the issue — particularly the licensing issue — but called for a slightly less restrictive approach, noting an out-of-state specialist might be the best clinical choice for a patient’s condition. It is also important not to exclude phone, email, and text, as not everybody has access to the high-speed internet required by most software.

In addition, Schwimmer said that while legislation must ensure telemedicine is covered, but dictating a specific payment level, as Vitale’s bill does, is likely to stifle innovation. The reimbursement structure needs to be flexible to allow providers and payers to explore new options. And while telemedicine is ideal for issuing some prescriptions — like birth control — she cautioned against using remote technology alone for dispensing opiates or other controlled substances.