远程医疗作用_是远程医疗保健的未来

远程医疗作用

Telemedicine is broadly defined as the use of electronic communications and software to monitor and treat patients instead of an inpatient visit. Over the past decade, telehealth, a broader term used to define all medical services and health education delivered digitally, has grown steadily as an industry. According to IBISWorld, the industry’s revenue has grown 34.7% from 2014 to 2019. The market size in 2019 was around $45 billion, but it’s projected to grow to more than $175 billion by 2026. Despite the increase in revenue, Americans have been slow to adopt the practice. According to a 2017 study, 82% of U.S. consumers don’t use it.

远程医疗被广泛定义为使用电子通讯和软件来监视和治疗患者，而不是住院探访。 在过去的十年中，远程医疗(一个用于定义数字化提供的所有医疗服务和健康教育的广义术语)作为一个行业稳步增长。 根据IBISWorld的数据，从2014年到2019年，该行业的收入增长了34.7％。2019年的市场规模约为450亿美元，但预计到2026年将增长到超过1750亿美元。采纳惯例。 根据2017年的一项研究，美国有82％的消费者不使用它。

Like all of American life, that changed with the novel coronavirus. The number of Medicare patients using telehealth has increased from roughly 11,000 a week to more than 650,000 people a week. It’s led to a surge in usage for telemedicine companies such as Teladoc and American Well.

就像整个美国人的生活一样，这种变化随着新型冠状病毒的发生而改变。 使用远程医疗的Medicare患者人数从每周大约11,000人增加到每周超过65万人。 这导致了Teladoc和American Well等远程医疗公司的使用激增。

The stock price of the video conferencing company, Zoom, is up more than 150% since the start of 2020. Shares of Microsoft, which owns the video conferencing software Skype and its Teams platform, are up more than 14% since the start of 2020. Telemedicine visits surged to 50% in March, and are on pace to reach 200 million by the end of 2020.

自2020年初以来，视频会议公司Zoom的股价上涨了150％以上。拥有视频会议软件Skype及其团队平台的微软的股价自2020年初以来上涨了14％以上。3月，远程医疗访问量激增至50％，并有望在2020年底达到2亿。

America’s healthcare system has skipped the test run and jumped to using telemedicine as a primary means of care during the coronavirus pandemic. Here’s how coronavirus could change the future of U.S. healthcare.

美国的医疗保健系统已跳过测试运行，转而使用冠状病毒大流行期间的远程医疗作为主要护理手段。 以下是冠状病毒如何改变美国医疗保健的未来。

The Rise Of Telemedicine

远程医疗的兴起

Telemedicine dates back to the mid 20th century, when radios were used to provide medical advice on ships. In hospitals, the first usage was in the 1950s through a closed-circuit television link for psychiatric consultations.

远程医疗的历史可以追溯到20世纪中叶，当时无线电是用来在船上提供医疗建议的。 在医院中，第一次使用是在1950年代，通过闭路电视链接进行精神病咨询。

In the last 30 years, telemedicine treatment has expanded to mental health, stroke and patients with chronic diseases like asthma, diabetes or heart failure. Several research studies have found it to be an effective alternative and satisfying for both the patient and the provider. Telehealth proponents have sold it as a solution for patients in rural areas. Now they advocate for it as a low cost and convenient option for tech-savvy millennials and busy parents as well.

在过去的30年中，远程医疗已经扩展到心理健康，中风和患有慢性疾病(例如哮喘，糖尿病或心力衰竭)的患者。 几项研究发现，它是一种有效的替代方法，对患者和提供者都很满意。 远程医疗的支持者已将其出售，作为农村地区患者的解决方案。 现在，他们提倡将它作为精通技术的千禧一代和忙碌的父母的低成本便捷的选择。

A 2019 American Well study found that 66% of Americans are willing to use telehealth, but only 8% had already tried it.

2019年《美国健康》的一项研究发现，有66％的美国人愿意使用远程医疗，但只有8％的人已经尝试过。

Dr. Michael Barnett is an assistant professor of health policy and management at the Harvard T.H.Chan School of Public Health and a primary care physician at the Brigham and Women’s Hospital in Boston. He’s published papers about telemedicine adoption in the U.S.There are many different reasons why the use been so low.

迈克尔·巴内特(Michael Barnett)博士是哈佛大学公共卫生学院的卫生政策与管理学助理教授，也是波士顿布莱根妇女医院的初级保健医生。 他发表了有关在美国采用远程医疗的论文。使用率如此之低的原因有很多。

• The first is that insurers are very worried that people would use too much telemedicine if they covered it too easily.
  首先，保险公司非常担心，如果人们太容易覆盖远程医疗，他们会使用太多。

• And so there are lots of restrictions on the kind of telemedicine visit

  因此，远程医疗访问种类受到很多限制

  that insurer will pay for.

  该保险公司将支付。

So, for example, Medicare, which is the big federal government payer that covers older adults and the disabled, they only pay for telemedicine if somebody is a rural resident.

因此，例如，联邦医疗保险(Medicare)是覆盖老年人和残疾人的大型联邦政府付款人，他们仅在有人居住在农村时才为远程医疗付费。

And you also have to go to a specific kind of facility with a specific kind of equipment and has to be a doctor that you’ve already seen. In addition to that, in the U.S., I think people are quite attached to see their doctors in person. Doctors or, also, their business model is very much tied to seeing patients in the office. So they don’t have a lot of incentive to offer telemedicine because there isn’t a whole lot of patient demand. So when the government announced that they would lift telehealth restrictions for Medicare, it was a big deal.

而且，您还必须使用特定类型的设备去特定类型的设施，并且必须是已经看过的医生。 除此之外，在美国，我认为人们非常愿意亲自去看医生。 医生或他们的商业模式很大程度上取决于在办公室看病人。 因此，由于没有太多的患者需求，他们没有太多动力来提供远程医疗。 因此，当政府宣布将取消针对Medicare的远程医疗限制时，这是一件大事。

Trump announced a dramatic expansion of Medicare telehealth services. Medicare patients can now visit any doctor by phone or video conference at no additional cost, including with commonly used services like FaceTime and Skype.

特朗普宣布大幅扩展Medicare远程医疗服务。 Medicare患者现在可以通过电话或视频会议拜访任何医生，而无需支付额外费用，包括使用FaceTime和Skype等常用服务。

The move paved the way for private insurers and others to waive their restrictions. However, the new exceptions didn’t void requirements states might have for telehealth. Telemedicine has been cast as a tool to protect medical professionals from exposure to Covid-19, to help reduce reliance on personal protective equipment and keep vulnerable and healthy at home. Now, coronavirus could boost telehealth interactions to one billion by the end of 2020. Telemedicine companies like Teladoc and American Well have seen a big boost in users during the coronavirus pandemic. They’ve been able to meet demand thanks to most states temporarily modifying their license requirements for doctors, meaning a doctor in a state can diagnose a patient in another state.

此举为私人保险公司和其他公司放弃其限制铺平了道路。 但是，新的例外并未使州对远程医疗的要求无效。 远程医疗已被视为一种工具，可以保护医疗专业人员免受Covid-19的影响，以帮助减少对个人防护设备的依赖，并使脆弱的人在家中保持健康。 现在，冠状病毒可以在2020年底之前将远程医疗互动性提高到10亿个。在冠状病毒大流行期间，像Teladoc和American Well这样的远程医疗公司的用户已大大增加。 由于大多数州都可以临时修改其对医生的执照要求，因此他们能够满足需求，这意味着某个州的医生可以诊断另一州的患者。

• That’s led Credit Suisse listing Teladoc as one of their top 10 investment

  这导致瑞士信贷将Teladoc列为其十大投资之一

  ideas amid Covid-19.

  Covid-19中的一些想法。

• Berenberg Capital Markets predicts the company’s market opportunity can

  Berenberg Capital Markets预测公司的市场机会可以

  only head upwards.

  只能向上。

And William Blair has called it the only clear beneficiary of the Covid-19 an outbreak in our universe. Even tech companies are entering the telemedicine space. So all of the major tech companies out in Silicon Valley have been interested in telemedicine now for years and have been studying ways to incorporate it into their products.

威廉·布莱尔称它为Covid-19的唯一明确受益者，这是我们宇宙中的爆发。 甚至科技公司也正在进入远程医疗领域。 因此，多年来，硅谷的所有主要科技公司都对远程医疗感兴趣，并且一直在研究将其纳入其产品的方法。

Microsoft, for instance, has been developing chatbots, has collaboration software like Teams. They also have video conferencing services. Same with Apple, same Google.

例如，微软一直在开发聊天机器人，并拥有像Teams这样的协作软件。 他们还提供视频会议服务。 与Apple相同，与Google相同。

And increasingly, they’re finding ways to point people to use these sorts of services.

越来越多地，他们正在寻找方法指导人们使用这类服务。

Where Telemedicine Falls short

远程医疗不足之处

While telemedicine on paper looks like a near-perfect solution for policymakers. It isn’t always the best solution for providers or patients. Telehealth is not for all issues. Some medical issues just cannot be resolved over the phone or video and require an in-person visit. Doctors are not always paid the same amount for a virtual visit as they are for an inpatient visit. As of December 2019, only 10 states pay the same amount or have what they call payment parity laws. Many states have passed so-called parity laws that force insurers to pay the same amount of money for a telemedicine visit as an in-person visit. And the fact that telemedicine pays less than in-person visit is another reason why it’s been adopted less because not only are there all these requirements for whether you get paid or not, but also in many situations, doctors may not get paid as much for doing the same service. Additionally, to access telemedicine services, patients need reliable Internet access. And according to a 2020 Broadband Now study, 42 million Americans don’t have access to a wired or wireless broadband connection. Telehealth has a risk of exacerbating pre-existing inequities in health care, in either access to care or health outcomes. We talk about something called the digital divide. So large parts of the country are rural and may not have access to high-speed internet, for instance. They don’t have phones, they don’t have Internet or they might not have a safe place or private place to be for a visit. And so if we leave those folks out of our approach to telehealth, we will just make health inequities worse.

尽管纸上远程医疗对于政策制定者而言似乎是一种近乎完美的解决方案。 对于提供者或患者而言，它并不总是最佳的解决方案。 远程医疗并不能解决所有问题。 有些医疗问题只是无法通过电话或视频解决，需要亲自上门检查。 医生在虚拟访问中的报酬不一定总是与住院时获得的报酬相同。 截至2019年12月，只有10个州支付相同的金额或具有所谓的支付平价法。 许多州已通过所谓的平价法，迫使保险公司为远程医疗访问支付与亲自访问相同的金额。 远程医疗的费用要比面对面拜访少的事实是为什么它被较少采用的另一个原因，因为不仅有关于是否获得报酬的所有这些要求，而且在许多情况下，医生对于做同样的服务。 另外，要访问远程医疗服务，患者需要可靠的Internet访问。 根据2020年宽带现在的研究，有4200万美国人无法使用有线或无线宽带连接。 远程医疗存在加剧医疗保健方面既往不平等的风险，无论是获得医疗服务还是获得健康成果。 我们谈论的是所谓的数字鸿沟。 因此，该国大部分地区都是农村地区，例如可能无法访问高速互联网。 他们没有电话，没有互联网，或者他们可能没有安全的地方或私人场所可供游览。 因此，如果我们不让那些人进入远程医疗方法，那么只会使健康不平等状况恶化。

How Telemedicine Work In Pandemic

远程医疗如何在大流行中发挥作用

While most health systems have been able to quickly adapt, there are still ways to improve. We’re seeing hospitals start to strike these deals with telemedicine companies. Right before the pandemic, Cleveland Clinic, for instance, a big medical institution, sign a deal with American Well, one of the largest telemedicine providers. And that’s true across many of these large hospitals that have gone from having some kind of telemedicine option that’s available, but very few people know about it.

尽管大多数卫生系统已经能够快速适应，但仍有改进的方法。 我们看到医院开始与远程医疗公司达成这些协议。 在大流行之前，例如一家大型医疗机构克利夫兰诊所(Cleveland Clinic)与最大的远程医疗提供商之一American Well签署了一项交易。 对于许多大型医院来说，这都是对的，因为它们已经不再提供某种远程医疗服务，但是很少有人知道。

To now pushing telemedicine front and centre, marketing it, emailing it, putting it right up on their websites for people to use, really trying to make sure that they are aware that the option exists. Massachusetts General Hospital, one of the top hospitals in the United States, has been using a mix of existing and in-house platforms to meet care. Dr Lee Schwamm is the Director of the Center of Telehealth at Massachusetts General Hospital and the Vice President of Virtual Care at Partners HealthCare has mentioned in an interview that

现在要推动远程医疗的发展，将其营销，通过电子邮件发送，然后将其放到他们的网站上供人们使用，这实际上是在确保他们知道该选项的存在。 马萨诸塞州总医院是美国顶级医院之一，一直在使用现有平台和内部平台来满足护理需求。 Lee Schwamm博士是马萨诸塞州总医院远程医疗中心主任，Partners HealthCare虚拟护理副总裁在一次采访中提到：

At the beginning of March, before COVID came to us, maybe four weeks ago, we did about somewhere between 0.7 per cent and 0.8 per cent of all of our ambulatory visits were over telemedicine. This week, we’re doing more than 75 per cent. We also created a program where we mounted an iPad on some specially configured hardware to attach it to an I.V. pole and turned it into an always-on video intercom so that we could reduce the need for providers to put on protective equipment, which is in very short supply. But continue to engage with patients in a way that’s much more compelling than just over the nursing call bell.

3月初，大约在四个星期之前，就来到了COVID，在我们所有非卧床就诊中，大约有0.7％至0.8％是通过远程医疗进行的。 本周，我们的工作量超过75％。 我们还创建了一个程序，将iPad安装在一些经过特殊配置的硬件上，以将其连接到IV杆上，并将其转变为始终在线的可视对讲机，这样我们就可以减少提供商使用防护设备的需要。供应非常短缺。 但是，继续以一种比吸引人的钟声更具吸引力的方式与患者互动。

The University of Washington Hospital offers telemedicine services for specialities. However, like most hospitals, not every service was equipped for telemedicine. The high demand for care has left hospitals and practices to retrain physicians on how to care for patients virtually. In the healthcare system, we have online training that everyone who is credentialed in telehealth needs to complete, and that teaches us how, logistically, how to do telehealth.

华盛顿大学医院提供特殊专业的远程医疗服务。 但是，像大多数医院一样，并非每项服务都配备了远程医疗服务。 对医疗的高需求已经使医院和实践重新培训医生如何虚拟地护理患者。 在医疗保健系统中，我们进行了在线培训，所有具有远程医疗资格的人都需要完成培训，并且从逻辑上教会我们如何进行远程医疗。

Telemedicine has adapted quickly during the time of coronavirus. However, the practice hasn’t been a perfect transition for all forms of care, especially for doctors who are used to seeing patients every day. It’s been disorienting to see so few patients in person. For a lot of doctors, this has been a learning experience, to put it mildly, And now we just don’t have the same mechanism. Another thing that has become very important in this tragic crisis is serious illness conversations with patients.

在冠状病毒时代，远程医疗已Swift适应。 但是，对于所有形式的护理而言，这种实践并不是一个完美的过渡，特别是对于那些习惯于每天看病人的医生而言。 看到这么少的病人真是令人迷惑。 坦率地说，对于很多医生来说，这是一种学习经历，而现在我们没有相同的机制。 在这场悲剧性危机中变得非常重要的另一件事是与患者的严重疾病对话。

Talking with patients and their families about their choices and if they have chronic medical conditions, talking about whether or not they would want to be on a ventilator if their illness progressed rapidly due to COVID and they could not breathe. So, again, many of the things that we used to take for granted would happen in person. We’ve now been forced to reinvent in this video the only environment. Telemedicine has helped maintain some business for the health care industry, but volumes of visits are still down. That could hurt the system financially over the long term.

与患者及其家人讨论他们的选择以及是否患有慢性病，并讨论如果由于COVID而病情Swift发展且无法呼吸时是否愿意使用呼吸机。 因此，同样，我们过去认为理所当然的许多事情都会亲自发生。 现在，我们不得不在此视频中重塑唯一的环境。 远程医疗帮助维持了医疗行业的一些业务，但访问量仍在下降。 从长远来看，这可能会对系统造成经济损失。

And then our telehealth visits, make up, bring us back to our prior levels. So if we had before 100 visits a day, now we have maybe 20 in person and 50 to 60 telehealth visits. Something the federal government, I think, needs to catch up on is that the way they have relaxed telemedicine regulations. They still don’t pay nearly enough for practices to make up for the lost volume that they’re experiencing right now because patients are really either staying home and visit volumes are plummeting across the country for practices everywhere, and it’s especially hitting small and medium practices hard. And doctors aren’t necessarily making up that volume with telemedicine. But also telemedicine visits only pay a third or even less of what a normal in-person visit would pay. So they’re getting hit doubly hard.

然后，我们的远程医疗访问就可以弥补，使我们回到之前的水平。 因此，如果我们每天有100次拜访，那么现在我们可能有20人亲自拜访和50至60次远程医疗拜访。 我认为，联邦政府需要赶上的是他们放宽远程医疗法规的方式。 他们仍然没有为弥补目前所损失的医疗费用支付足够的费用，因为患者实际上要么待在家里，就诊数量在全国各地直线下降，尤其是中小型企业努力练习。 而且，医生不一定需要借助远程医疗来弥补这一不足。 但是，远程医疗访问只需要支付普通亲自访问费用的三分之一甚至更少。 所以他们受到双重打击。

Hospitals and other health care providers are slated to receive about 175 billion dollars to make up for the increased costs and lost revenue as part of the Coronavirus Aid, Relief and Economic Security Act.

作为《冠状病毒援助，救济和经济安全法》的一部分，医院和其他医疗保健提供者预计将获得约1,750亿美元的补偿，以弥补成本的增加和收入的损失。

However, it might not be enough to save them. This crisis has an enormous financial impact on hospitals. We’ve cancelled all of the elective cases that are what help support the mission of the hospital and we are now caring for the sickest of the sick and those patients are staying in the hospital for a very long time. And so without federal and state relief, this is an impossible burden for hospitals to carry financially. And we may be very much at risk of hospital bankruptcies because of the extraordinary concentration of needing to spend more money, acquire more supplies, care for the sickest of patients and at the same time, no longer have the mainstay, the bread and butter of the procedures that largely fund the operations of the hospitals.

但是，仅保存它们可能还不够。 这场危机对医院产生了巨大的财务影响。 我们已经取消了所有有助于支持医院使命的可选病例，我们现在正在照顾最重的病人，而那些病人在医院里待了很长时间。 因此，如果没有联邦和州的救济，这对于医院的财务负担是不可能的。 而且，由于需要花费更多的金钱，获得更多的物资，照顾最病的患者，同时又不再拥有食品的主要Struts，面包和黄油，我们非常有可能面临破产的风险。很大程度上为医院运营提供资金的程序。

The Future Of Virtual Healthcare

虚拟医疗的未来

Cleveland Clinic predicts within five years, half of the outpatient visits in the U.S. will be virtual. After this pandemic is over, telehealth will be here to stay and people will want, they won’t want to go back to only in-person visits. I think people will want the option of telehealth visits as well. Now, they can’t replace our entire healthcare system and people still will need to come in for their pap smears and exams. But I think people will find a preference for this. They won’t have to take off a day from work or take three buses to travel to the doctor’s office or find childcare. The system that we were in before was not particularly efficient. There were just massive costs. And you saw just, you know, that increase every single year. It just it wasn’t sustainable.

克利夫兰诊所(Cleveland Clinic)预测，五年之内，美国一半的门诊就诊将是虚拟的。 大流行结束后，远程医疗将继续存在，人们会想要，他们不想只回到面对面的探访。 我认为人们也希望选择远程医疗访问。 现在，他们无法取代我们的整个医疗保健系统，人们仍然需要参加子宫颈抹片检查和检查。 但是我认为人们会对此有所偏爱。 他们不必下班一天，也不必坐三辆公共汽车去医生的办公室或找孩子。 我们以前使用的系统并不是特别有效。 只是巨大的成本。 而且您知道，这种增长每年都在增加。 只是不可持续。

Telemedicine for a long time has been a way to bring costs down. It makes sense. You should see some of these patients virtually that can be seen that way and then save the physician time for those that need that in-person care.And I think telemedicine offers that and it’s likely where medicine is going. For doctors, the new rules for telemedicine and insurance mean they stand to make more money from the practice if those rules do stick around. Insurers are also going to have a very hard time clawing back this flexibility with telemedicine payments. And so it’s also going to be much easier for physicians to get paid for their time and have a viable business model providing care across the whole spectrum. The coronavirus pandemic created a clear line between the before and after for the wider health care industry. And telemedicine might be a big part of what comes after Covid-19.

长期以来，远程医疗一直是降低成本的一种方法。 这说得通。 您应该看到实际上可以看到的这些患者中的一些，然后为需要亲自护理的患者节省医生时间。我认为远程医疗可以提供这种治疗，而且很可能是药物的发展方向。 对于医生来说，有关远程医疗和保险的新规定意味着，如果这些规定确实存在，他们将从中赚取更多的钱。 保险公司还将很难通过远程医疗支付来获得这种灵活性。 因此，医生也将更容易获得他们的时间报酬，并拥有可行的业务模型来提供整个范围的护理。 冠状病毒大流行为更广泛的医疗保健行业在前后之间建立了清晰的界限。 在Covid-19之后，远程医疗可能会占很大比重。

翻译自: https://medium.com/@tanushprem3/is-telemedicine-the-future-of-healthcare-f09aefea6877

远程医疗作用