RU-N Partnership Seeks to Study, Model Virtual Health Care Delivery in New Jersey

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Experts urge lawmakers to pass legislation needed to establish telemedicine.

With primary care physicians in chronic short supply in New Jersey, leveraging technology may be a key to keeping people healthy, according to experts who gathered at Monday’s second annual Legislative Open House at Rutgers University-Newark (RU-N). The meeting focused on telemedicine, a way for health providers to examine patients and monitor vital signs remotely – and direct significant amounts of their care – without a need for office visits.

Telemedicine was first conceived as a way to care for people in remote rural areas where health professionals are scarce. But now, conference participants said, it is ready for – and in fact needed in – the most densely populated state in the nation, where patients who live even short distances from health facilities have difficulty obtaining the services they need.

“A lot of people aren’t really mobile because of the conditions they have,” said Marc Holzer, dean of the School of Public Affairs and Administration at RU-N and the gathering’s lead presenter. “Or they may be too busy to do it. They may be holding down two jobs. They’re trying to deal with their kids and housing, transportation and everything else.”  

“When you talk about lower income folks, there are not many doctors who take Medicaid, and then there’s a wait list in order to see the provider,” added Assemblywoman Shavonda E. Sumter, one of the elected officials who co-sponsored the event – along with Congressman Donald M. Payne Jr., and Newark Councilwoman Gayle Chaneyfield Jenkins. “So patients end up in the emergency room, which is more expensive care than if you were able to have maintenance services.” For Sumter, telemedicine would be a far superior alternative.

But establishing telemedicine in New Jersey would involve political, technological, logistical, and cultural challenges.

Most obvious is the cost. Holzer estimated an upfront investment by the state of several hundred million dollars, but called that “a bargain, because we will save money downstream.”  

At the same time, he acknowledged, it is imperative to get the details right. “You can’t underestimate the need to make the proper investment,” Holzer noted, “because if you don’t then you wind up with a system that’s set up for failure.” The sheer size of that task is an important reason why RU-N brought together experts in fields ranging from nursing care to public health, to supply chain management and state and local government – all necessary elements for making the numerous moving parts come together.

For telemedicine to work, patients would need special equipment to monitor personal health information and transmit it to their health providers, either from home or from clinics in their immediate neighborhoods. Through Skype, they also would speak virtually with their caregivers. The state would be obligated to pay for most of the hardware. The cost would be huge, though at least more bearable than in the past, said Benjamin Melamed, a professor of supply chain managementat Rutgers Business School.  “This was not financially feasible a few years ago,” Melamed noted. “The sensors used to be extremely expensive – things like thermometers, blood pressure gauges, and so on.”

At the other end of the connection, the provider would need new equipment to keep and store patients’ medical data, and learn how to use it – which many physicians and other caregivers still have not done. “Like anything new or innovative, there’s always this initial reluctance and pushback,” acknowledged Hanaa Hamdi, executive director of the City of Newark’s Office of Health and Community Wellness. “The success of telemedicine will move forward if we can get providers to actually see that telemedicine allows them to become efficient.”

Providers will also need to know they will be paid, which is no small matter. The list of medical encounters for which providers can now be compensated does not include telemedicine sessions. Trenton would need to change that as well.

These and many more complications make the process of adopting telemedicine very hard. But conference participants were unanimous that the rewards will be worth it, including cost savings from telemedicine encounters that are barely 60% as expensive to provide as office visits.

Other advantages would include better deployment of resources. Certain patients will still need in-person contact with their health providers. Data obtained through telemedicine would help to identify those patients. “For example, a nurse who might be going out for home visits can focus on the patients who have the most critical needs,” said Ann Bagchi, a community health nurse and instructor in the Rutgers School of Nursing – who is involved in one of several RU-N pilot programs designed to pave the way for telemedicine. “The patients who actually need to be seen, to change a wound – to dress a wound – those patients can receive the priority visits.”  

According to Hamdi, other states have enjoyed tangible health benefits. She cited findings, for instance, that when a health team used telemedicine to manage weight and diabetes control for patients throughout California, results were “comparable to face to face consultation if not better.” Hamdi said it is now New Jersey’s turn to make similar strides.

“If Alaska can do it and Tennessee can do it and Kentucky can do it,” added Marc Holzer, “why not here?”

Top photo (left to right) of Ann Bagchi, Benjamin Melamed, Marc Holzer, Hanaa Hamdi, and Kevin Lyons by Shelley Kusnetz

Left photo of Marc Holzer by Shelley Kusnetz

Right photo of Benjamin Melamed by Shelley Kusnetz