The use of telemedicine services and technology to deliver healthcare at a distances is increasing exponentially, according to the American College of Allergy, Asthma, and Immunology (ACAAI)’s recently published position paper on the use of telemedicine for allergists. Benefits tied to telemedicine include increased access to care, improved health outcomes, reduced costs, better use of resources, more educational opportunities, and improved patient-physician collaboration, write the authors of the paper. However, these benefits should be weighed against potential risks, and the ACAAI recognized a lack of awareness of the telemedicine industry among allergists. “The important first step in supporting practicing allergists was to define telehealth and develop guidelines for the specialty,” says Tania Elliott, MD. To that end, the ACAAI paper defines telemedicine as the use of technology to deliver healthcare, health information, or health education at a distance.
Pros & Cons
While access is not an issue that is unique to those seeking the care of allergists, the specialty is relatively small, with only approximately 3,000 specialists currently practicing in the United States and many concentrated in major cities. With an approximately 3-week average wait time to see an allergist in the US and immunoglobulin E-mediated reactions mostly lasting less than 24 hours, allergic reactions have typically long since past by the time patients are seen. “Telemedicine allows for an immediate interaction with a physician at the time of the need,” says Dr. Elliott.
Additional benefits of telemedicine use by allergists revolve around:
- Asthma management: Studies have shown that patients who undergo a virtual visit with peripheral devices experience similar outcomes as those treated in person, according to Dr. Elliott.
- Atopic dermatitis management: “Asynchronous telemedicine with symptom scores and submission of photographs has been shown in studies to be as effective as in-person care for management,” Dr. Elliott says.
- Environment: The first line of allergy treatment is avoidance of triggers. However, accurate guidance around avoidance is limited if the specialist is unable to visualize someone’s home environment. Traditionally, the recommendations are made upon patient recall and description of the home. A video visit with a trained professional can allow for a view into a patient’s home and has tremendous potential to guide precision allergen avoidance.
- Allergic skin disease. The skin is one of the best organs to be observed remotely, either by video or through high-resolution photography, says Dr. Elliott.
Allergy and immunology practices planning to integrate telemedicine are sure to face some challenges. Many laws and regulations relating to physician reimbursement and the practice of medicine were developed prior to widespread use of telemedicine, presenting legal barriers related to medical licensure, credentialing, and privileging. To that end, physicians must be licensed in the state from which the patient initiates the encounter, explains Dr. Elliott. Telemedicine use also often requires the adoption of new technology—including two-way video software and hardware—and thus both patient and physician must adapt and become familiar and comfortable with this modality. Considerations also include integration with an electronic medical record system and the need to establish a secure network connection to maintain privacy, security, and HIPPA compliance.
A Promising Future
Concluding with a set of position statements supported by the Taskforce on Telemedicine in Allergy (Table), the ACAAI position paper is a major step in embracing the future of healthcare in this country, according to Dr. Elliott. “I envision a hybrid allergist practice in which office visits are reserved for procedures, allergy skin testing, and immunotherapy, while the majority of follow-ups for chronic conditions are conducted remotely,” she adds. “Continued improvements in the peripherals market focused on remote patient monitoring will enable more advanced care to be provided remotely. Remote chronic disease management should decrease healthcare costs and increase compliance, eliminating missed days of work, travel, and time spent going to the doctor. Technology can also be leveraged to meet patients on their terms in a user-friendly way that is frictionless and instruction free—a major improvement from our current complex healthcare landscape.”
Elliott T, Shih J, Dinakar C, Portnoy J, Fineman S. American College of Allergy, Asthma & Immunology Position Paper on the Use of Telemedicine for Allergists. Ann Allergy Asthma Immunol. 2017;119(6):512-517. Available at www.annallergy.org/article/S1081-1206(17)31047-5/fulltext.