Ernestine Marshall's every move is being watched: morning, noon and night.
Motion-activated sensors are everywhere in her Tampa apartment: on the toilet, the front door, even the kitchen cabinet where she stores medications help manage her multiple sclerosis.
It's been a year since the 60-year-old former teacher volunteered to let her health insurance company track her daily activities. If she oversleeps or if she’s up and down during the night, sensors around the house or those tucked into her bed trigger a check-in call from a Humana nurse.
“One thing about it, I like that they check,” she said. “Why’s she up at 2 o’clock in the morning? Why’s she up again 5 o’clock in the morning?”
Marshall's experience is just one way technology that didn't exist a few years ago is changing how Americans are dealing with chronic conditions and acute disease.
It's eliminating the burden of hours-long drives for patients, doctors, or both. And the tools bring experts to facilities that can't afford a full-time specialist.
And Florida’s legislature loves this idea. But it also needs to update the rules and keep up with this high-tech, hands-off approach to health care.
Representative Jason Brodeur says the House telemedicine bill creates a way for health care to be more direct and immediate. For example, patients experiencing a seizure can record it on their smart phone and email a short video to their doctor right away.
“Technology exists to do a whole lot of things much more efficiently and with a whole lot more care than we have currently proposed,” he said.
The House bill (HB 751) and a Senate version (SB7028), sponsored by Sen. Arthenia Joyner, continue to wind their way through pre-session committees, though not without hiccups.
The Senate Health Policy Committee on Tuesday delayed voting on their version, for the second meeting in a row. New, lengthy amendments have been filed and need to be read before a vote happens, said Chairman Aaron Bean, R-Fernandina Beach.
The sticking points are not insignificant. While insurance companies, hospitals and clinics clamor to use the tools, they can't agree about whom exactly and when exactly telemedicine is most appropriate.
Chris Nuland, of the Florida chapter of the American College of Surgeons, said quality care shouldn’t be compromised by a video screen. He says that’s especially true in fields such as dermatology.
“When a rash or a boil appears, more than an image is necessary to examine that particular lesion,” he testified at a Health Policy Committee meeting last week. “You need to know: Are they running a fever? You need to know: Is the lesion is hard, soft? All of those make a difference. And in all of those cases, an in-person physical examination is the only way to look at that stuff.”
Others worry Florida won't be able to hold out-of-state physicians accountable if their remote decisions hurt a patient in the Sunshine State. Several suggested that any doctors practicing telemedicine in Florida should be licensed by the state’s Board of Medicine.
But Joyner said that may be too much of a barrier. Doctors practicing telemedicine from out-of state are needed to help address a growing shortage of primary care physicians, she said.
“If telemedicine is going to serve its purpose of providing quality accessible health care to persons, we are going to need to be able to have the access to doctors out of state,” Joyner said.
And of course there's the issue of money. Should virtual doctors get paid the same as those seeing patients face-to-face? Early versions of the Senate telemedicine bill will let health-care providers negotiate payments with insurance companies. The bill says doctors who treat Floridians who have Medicaid will get equal pay.
The Mayo Clinic in Jacksonville provides telemedicine services all over the country, such as stroke consults for a community hospital in Titusville, hospital official Layne Smith said. The value of telemedicine varies and negotiations should be left to those providing the care, he said.
“We do support the ability to negotiate payment terms with insurers and payers,” Smith told the Senate policy committee. “It may be that we can offer telemedicine services more cheaply for folks. But it may be that in certain cases that we want to charge a premium for telemedicine serves.”
Kim Landry is an emergency physician in Gulf Breeze, in Florida's panhandle. He wants remote doctors to be able to help paramedics in the field assess and treat people who are critically injured. He admits that there will always be times when the best call is to load up the ambulance.
“When you need the services at the hospital, you don’t need telemedicine, you need the services at the hospital,” he said. “So if you are having a heart attack, you’re having a stroke, you need your appendix taken out, you still need those services.”
You can follow Mary Shedden on Twitter @MaryShedden.
