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Connecting the Dots

Telemedicine, electronic medical record-keeping and the ongoing technology shift that will shape the future of medical management in workers’ compensation.
By: | October 15, 2016

FROM LEFT, Dan Reynolds, Dr. Nina McIlree, Dr. Brian Buck, Dr. Teresa Bartlett and Dr. Robert Hall.

Technology’s promises and perils are profound in health care and in its sister practice, workers’ compensation; perhaps more so than in any other profession.

In July, Risk & Insurance®, in partnership with the workers’ comp and auto no-fault division of Optum, convened a roundtable of workers’ compensation medical directors to get their take on the top-of-mind issues in their profession.

It didn’t take long for the potential upsides of technology, and some of the concerns that accompany it, to emerge as a dynamic area of discussion.

In addition to his technology-focused comments, Dr. Buck gives some guidance on claims adjuster participation.

One technology innovation that the medical directors focused on intently is telemedicine, the use of which is still in its infancy in group health and workers’ compensation.

“We’re getting a lot of questions about telehealth and telemedicine and what we’re doing in that space,” said Dr. Teresa Bartlett, senior vice president for medical quality with third party administrator Sedgwick.

Optum_roundtable_101516“We’re getting a lot of questions about telehealth and telemedicine and what we’re doing in that space.”

— Dr. Teresa Bartlett, senior vice president for medical quality, Sedgwick

In addition to Dr. Bartlett, attendees included Dr. Brian Buck, medical director for workers’ compensation and claims administration with the Texas Association of School Boards’ Risk Management Fund; Dr. Robert Hall, the corporate medical director at Optum workers’ comp and auto nofault division; and Dr. Nina McIlree, vice president, medical management with Zurich Insurance.

The panel members agreed that conferencing technology which enables a physician to assess and counsel a patient remotely has the power to bridge gaps. In rural areas with poor access to medical specialists, for example, the approach can get care for someone who might otherwise need to travel hundreds of miles to see the right physician.

The approach can also bridge language barriers. Health care organizations can use video conferencing with patients to connect them to a physician or caregiver who speaks their language in cases where physical access to that language speaker would be difficult or not cost-effective.

The panel did have concerns about the “no-touch” aspect of telemedicine, which runs counter to the traditional training that many physicians receive.

“My medical school professors are probably rolling over in their graves now thinking that you might not be able to touch the patient, and physically examine them,” said the Texas Assocation of School Boards’ Dr. Buck.

Dr. McIlree of Zurich said the industry has a lot of ground to make up to ensure both providers and patients are familiar with the technology and can come to trust it.

Dr. McIlree shares some additional thoughts on the topic of evidence-based medicine.

“I don’t think we’ve gone through the evolution where the providers are truly comfortable providing the care through a telemedicine portal,” she said.

“Nor have we gone through the cultural revolution or change management to help the injured workers understand that this is a good thing to do,” she added.

But the panel members agreed that change is coming and that there are substantial upsides with telemedicine. Creating the algorithms that can help caregivers decide when a teleconference check-in is appropriate and which cases mandate a physical visit will be important, the physicians said.

And the use of telemedicine doesn’t signal or mandate a final physical disconnect, said Optum’s Dr. Hall.

He said a series of telemedicine consultations can always be punctuated by a physical visit if the physician feels they are losing touch with the patient, or is concerned that the medical outcome of the case is deteriorating.

Panel members also reported that many physicians are more comfortable conducting an assessment remotely; that it can help their objectivity in many cases.

Optum_roundtable_101516“I don’t think we’ve gone through the evolution where the providers are truly comfortable providing the care through a telemedicine portal.”

— Dr. Nina McIlree, vice president, medical management, Zurich Insurance

“That electronic distance can create a comfort zone,” said Zurich’s Dr. McIlree.

She said industrywide diligence will be required, however, to make sure that any loss of physical proximity doesn’t lead to worse outcomes.

“We’ve got to create the right expectations of what the practitioner will bring to that dialogue,” she said.

“But I think we’re seeing the opportunity for this in a number of interfaces,” she added.

The collaboration between the physician and the claims case manager is another area where telemedicine has real potential. Say, for example, a field case manager is visiting a patient in their home.

Should a medical question come up that the case manager isn’t comfortable handling, they can bring the physician in through a teleportal in situations where it’s difficult or not possible for the physician to be there.

Beyond the technology focus, Dr. Hall shares some ideas on bio-psychosocial issues.

Conversely, if a patient using telemedicine consultation feels that additional patient care or assessment is needed, case managers may be able to provide the human element desired in patient care.

“Do we have someone closer, say from a case management standpoint that can be there with the injured worker?” Dr. Bartlett asked.

“How do we work with those injured workers and caregivers differently so that we don’t lose that personal touch?”

In cases where a claims or case manager can’t physically visit the injured workers’ home, a remote evaluation can facilitate observation of and insight into some of the challenges the injured employee may have getting into their home or accessing items in the kitchen, for example.

As with other areas of information technology, a younger professional, for example, a recent medical school graduate in the early stages of their career, can be more comfortable with telemedicine than a more senior physician.

Optum_roundtable_101516“We can spend more of our time performing bureaucratic tasks than we do spending time with the patient.”
— Dr. Brian Buck, medical director, workers’ compensation and claims administration, Texas Association of School Boards’ Risk Management Fund

In his home state of Texas, the TASB’s Dr. Buck said the Texas Medical Board qualifies telemedicine as the practice of medicine and has strict dispute currently with telemedicine companies, as the issues revolve around insuring patient safety.

“Right now, it’s limited in scope but I see it as a tremendous advance and it will continue to grow,” Buck said.

Electronic Medical Records

Physicians trained in utilizing new technologies, such as electronic medical records, may feel more at ease with this technology than their colleagues who were trained where or when this technology was unavailable.

“They’re comfortable with it,” said Zurich’s Dr. McIlree.

But the EMR has its detractors. Some patients complain that the physician spends too much of the visit typing information into their laptop and not enough time assessing them.

“We can spend more of our time performing bureaucratic tasks than we do spending time with the patient,” said the TASB’s Dr. Buck.

“Every physician you talk to, it adds time to their day and it adds complexity,” agreed Dr. McIlree.

But as with telemedicine, she said, a transition is under way. More and more physicians will become comfortable with electronic medical recordkeeping and the method will result in much better documentation of the patient’s condition.

After all, the storied shortcoming of physicians’ penmanship does have its roots in fact in many cases.

Optum_roundtable_101516“The use of telemedicine doesn’t signal or mandate a final physical disconnect.”
— Dr. Robert Hall, corporate medical director, Optum

“It can also contribute to the quality of care by providing a template to the physician suggesting the necessary elements of a care plan. The provider should be comfortable editing the elements of the information gathering and exam appropriate for the patient. They do not have to rely solely on memory and experience alone to address all the issues of the patient,” she said.

Whether it’s advances in telemedicine or more widespread comfort with the use of electronic medical records, technology has the potential to increase patients’ education about their well-being and lead to better coordination of care: two key aspirations in the medical management of workers’ compensation cases, members of the Chicago roundtable agreed.

“I think these are the things that will significantly advance our ability to get the right care to the right person at the right time,” said Zurich’s McIlree.

Service providers succeeding in the era of rapidly advancing technology will be those that most effectively use technology to create better coordination of care. That means not only getting all the treating physicians on the same page, but sharing important information with case managers, and perhaps most importantly, the patient themselves.

Opinions of the roundtable participants are the opinions of each individual contributor and are not necessarily reflective of their respective companies.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Optum. The editorial staff of Risk & Insurance had no role in its preparation.

The Optum workers’ compensation and auto no-fault division works to collaborate with our clients to deliver value beyond transactional savings while helping ensure injured parties receive safe and effective clinical care throughout the life of their claim. Our innovative and comprehensive cost management programs include pharmacy care services, ancillary benefit management, medical services, and settlement solutions.

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