The Opportunity Awaits to Lead Orthopaedic Telehealth Innovation

Abstract

Telehealth is a way to provide health-care services to a patient from a provider who is at another location. The most common methods include a live interactive visit with the patient, interpretation of imaging, and monitoring of patient progress. Principally, telehealth is a way of providing a service rather than a type of service. It is about patient care, not data care.Examples of orthopaedic applications include conducting patient examinations, interpreting imaging studies, and providing postoperative care. Teleconsultation has been shown to be cost-effective. Other examples in orthopaedic research include the application of telemedicine when measuring patient-reported outcomes. Especially in cases when the patient lives far away from the provider, telehealth reduces time, produces good patient satisfaction, and costs less than hands-on care. As in everyday life, consumers have learned to demand convenience, ease of use, choice, control, and direct access. The ubiquity of telecommunications, combined with consumer technology savviness, drives the demand for telehealth. Unfortunately, the nation's largest payer for health services is one of the most restrictive for telehealth coverage. Medicare's restrictions are mostly the work of the U.S. Congress under Part B law. Video visits are very narrowly covered. Another major policy barrier is that interstate telehealth requires multiple state licenses for the physician, who must be licensed in the jurisdiction of each patient as well as the provider's physical locations. As Medicare shifts toward capitated payment and other value-based methods, there are opportunities to remove such restrictions.Despite these challenges, some states have been proactive in implementing telehealth systems. Arkansas is one of these states, and being a rural state with 2 main population centers, specialty care is relatively sparse. Implemented in 2014, the hand trauma program has been a partnership between the University of Arkansas for Medical Sciences (UAMS) and the Arkansas Trauma Communications Center (ATCC). This program has been very successful in decreasing the rate of hand trauma transfer, allowing patients to be treated closer to home while having coordinated access to fellowship-trained hand surgeons when necessary.More widespread innovation of orthopaedic applications for telehealth requires physician buy-in and health-systems partnerships. The regulatory environment will need streamlining. Ultimately, consumer demand will drive the implementation of technology to make care more accessible, convenient, and cost-effective.

The Efficacy of Telehealth for the Treatment of Spinal Disorders: Patient-Reported Experiences During the COVID-19 Pandemic

“…Telehealth, or telemedicine, involves the delivery of virtual healthcare via digital communication platforms. Although often thought of in the context of next-generation innovation, applications, and remote patient monitoring, telehealth has demonstrated initial utility for orthopedic consultations, follow-up care, and rehabilitation services [ 6 , 12 , 13 , 22 ]. While early polls have demonstrated provider enthusiasm for telehealth [ 22 ], patient perspectives remain to be fully elucidated.…”

“…Initial studies evaluating patient attitudes toward electronic delivery of musculoskeletal care have been largely positive, though a full understanding of patient satisfaction remains to be determined [ 11 , 13 , 17 , 22 , 23 ]. For example, a randomized controlled trial evaluating the utility of telehealth for post-operative care following rotator cuff repair suggested that a remote platform was safe and effective based on post-visit surveys [ 11 ].…”

Telemedicine: Is It a Tool for Orthopedics?

“…Orthopedics is a specialty that can benefit greatly from telemedicine. In addition to being cost-effective, it presents good patient-reported outcomes and is considered an opportunity with potential to be explored [ 5 •]. Since COVID-19 pandemic is tipping point in telemedicine adoption curve, which now shows exponential growth in most countries, there are multiple appropriate telemedicine applications suggested for orthopedic practice, such as teleconsultation for diagnosis, treatment, and patient follow-up; virtual rehabilitation; or even offering specialized advice in a teleconsultation for non-specialist doctors [ 1 , 6 ].…”

Online Patient Consultation

“…Generally speaking, medical staff take a positive view of digitisation. In one survey, for example, over 60 % of the orthopaedists participating in the survey in the US would be in favour of the use of telemedicine [4]. A similar trend was identified even earlier among patients.…”