How Can Telehealth Help Labs Expand Their Mission?

Contributing LabLeaders: Donald Karcher, MD, FCAP; Robert I. Field, JD, MPH, PhD; and Steven Gudowski, MBA, C-PM(APF), MT(ASCP)

Operational

Article highlights:

Telehealth is growing rapidly, but its "stars" are primary care providers and specialists.
Telepathology can help pathologists offer cancer patients "virtual tumor boards" to explain their diagnoses and treatment plans.
Growth in home healthcare may present labs with other opportunities to communicate directly with patients.

Telehealth is making rapid inroads on patient care. Three out of four health systems offer at least some telehealth services, and at Kaiser Permanente, more than half of physician office visits are now virtual.

From 2016 to 2017, insurance claims for services rendered via telehealth grew 53 percent nationally, more than any other avenue of care, according to a study by the nonprofit FAIR Health. (In contrast, urgent care center visits increased 14 percent, and retail clinic visits increased 7 percent. Usage of emergency rooms decreased two percent.)¹

CVS Health announced in August 2018 that it will partner with leading telehealth provider Teladoc to offer MinuteClinic Video Visits, a 24/7 app-based service to treat minor illnesses, injuries, and skin conditions.

A Place for Telepathology?

But the stars of telehealth, understandably, are primary care providers and specialists. Is there a place for telepathology to help get the lab “out of the lab" to expand its mission and enhance its value?

Telemedicine offers obvious convenience to the patient, especially when narrow provider networks can create long travel times and long waits for office appointments, says Robert Field, professor of health management and policy at the Dornsife School of Public Health at Drexel University, Philadelphia.

“As the technology continues to improve, I think we're going to see huge amounts of patient-provider interaction moving to that platform," Field says.

Field says that with pharmacists providing primary care services (and even angling for reimbursement for them), it's not such a stretch to imagine laboratorians in a similar role. “[Pharmacists] have been doing it for several years now, rounding with doctors in the hospital," he explains. “You'll see more and more of a movement this way in retail pharmacies."

Pathologists at Thomas Jefferson University Hospitals have so far been using telehealth to talk to other pathologists, says clinical laboratories administrator Steven Gudowski. “We've been using it primarily to look at sections from other states and other countries," he says. “There may be some potential" for direct patient contact, but he says it's too early to tell.

On More and More Convenient

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Robert I. Field, JD, MPH, PhD

Professor of Law and Professor of Health Management and Policy

Drexel University's Thomas R. Kline School of Law and Dornsife School of Public Health

Telehealth for "Virtual Tumor Board"

At George Washington University Medical Center in Washington, patients are already asking for direct access to pathologists, especially those patients seeking to understand their cancer diagnosis, says Donald Karcher, MD, chair of pathology and lab director. In response, the medical center is working toward establishing a “virtual tumor board," where pathologists would participate in a video conference with patients and their oncologists and/or surgeons. “This would be a more seamless way of providing them all the information they need to really understand their diagnosis and the treatment plan that's been developed for them," he said.

Opportunities in Home Health

This concept could conceivably extend to general laboratory tele-consultations, though Karcher concedes that it's “a little bit more of a stretch." The most promising application, he adds, is in situations where the patient's care in general has been moved to a home setting. The aging of the population, combined with technology that can allow many chronic diseases to be managed at home, has set the stage for home healthcare to skyrocket: the Bureau of Labor Statistics projects that the home healthcare workforce will grow 41 percent between 2016 and 2026.²

“As home healthcare is delivered to people via telemedicine using other technology, we do think that the laboratory can provide additional information to make that care more effective for the patient," Karcher says. “The advanced care provider could link us in to answer a particular question for a patient that they're caring for remotely through telemedicine."

1. Fair Health, Growth in Health

2. Bureau of Labor Statistics, Home Health Aides and Personal Care Aides

Contributing Lab Leaders

Donald Karcher, MD, FCAP

Chair, Department of Pathology

George Washington University Medical Center

Robert I. Field, JD, MPH, PhD

Professor of Law and Professor of Health Management and Policy

Drexel University's Thomas R. Kline School of Law and Dornsife School of Public Health

Steven Gudowski, MBA, C-PM(APF), MT(ASCP)

Administrator, Department of Pathology, Anatomy and Cell Biology

Sidney Kimmel Medical College, Thomas Jefferson University

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