Nurse Practitioners and Telemedicine: Same Timeline, Different Outcome

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In February of 1974, Dr. Roger Mark published the first article in the medical literature to reference the term, “Telemedicine.” The article was titled, “Telemedicine system: The missing link between homes and hospitals.”

Dr. Mark worked to connect local nursing homes to Boston City Hospital.[1] The stated goal of the study was to use the technology of the day, which consisted of closed circuit TV, fax and phone, to bridge the access gap in an effort to reduce unnecessary ER visits.[2] To better achieve success, Dr. Mark also employed another novel concept of that time, a “Nurse Practitioner.” Both the term telemedicine and nurse practitioner were so new to Dr. Mark’s audience, much of the article was spent explaining their respective histories, backgrounds and roles in the healthcare delivery spectrum. Now, 44 years later to the month, this article reflects on where the practice of telemedicine stands in relation to the nurse practitioner.

Today, the nurse practitioner is an indispensable part of the US healthcare system. That wasn’t the case in 1974. Nurse practitioners (NP’s) of that time were just beginning to formalize their training programs.[3] Dr. Mark notes that the NP’s involved in his article, “had undergone an intensive full-time, three-month practitioner training program.” Today, 98% of NPs have earned Master’s or PhD degrees.[4] There are almost 250,000 actively practicing NP’s in the US.[5] They are licensed to practice and prescribe in all 50 states.[6] Almost 80% of NP’s practice in the field of primary care, with 50% of NP’s holding hospital privileges.[7] Although the exact number of patients cared for every year by NPs is unknown, the number is likely in the hundreds of millions. Just imagine how care delivery would be if one could wave a magic wand and remove all of the NPs from practice? The impact would likely be catastrophic.

How would that same hypothetical exercise look if all of the telemedicine technologies were now removed from the US healthcare system? The impact would likely be substantially less dramatic. In 2016, there were about 1.25 million telemedicine consultations in a market with over a billion traditional medical visits.[8] The low adoption rate is an effect of poor reimbursement, restrictive rules at both state and federal levels, limited patient adoption, and a lack of physician adoption, education, and training. In a survey conducted by the American Academy of Family Practitioners, only 15% of physicians surveyed used telemedicine in the previous year.[9] The poor utilization cited a lack of training as the number one reason for the poor adoption of telemedicine.[10] The survey results aren’t surprising considering there is no mandated telemedicine curriculum for US medical schools or residencies.

The contrasts between these two fields of medicine could not be any more glaring, especially considering the similarities between their origins and timelines. It is even more surprising considering the rapid advancement of technology and its adoption among the general public. Although the exact reason why the field of nurse practitioners have grown so much more rapidly than the field of telemedicine is unclear, it is likely related to the expansive career adoption among nurses and their state and national governing bodies, that fought for their broader scope of practice. This is in contrast to the practice of telemedicine, which largely remains a part-time job for many physicians. In addition, the field of telemedicine lacks the organizational infrastructure needed for education, lobbying and advocacy that was instrumental in the acceptance of NP’s.

Ultimately, if the field of telemedicine expects to garner greater patient, physician and regulatory adoption, more will have to be done to educate the respective stakeholders in the role and value telemedicine plays in our healthcare system. Organizations like the American Telemedicine Association, Centers for Connected Health Policy and Telehealth Resource Centers are doing an excellent job advocating for the field of telemedicine. However, without a core group of regularly practicing telemedicine physicians and their advocacy for the profession, the full integration of telemedicine will likely still be further down the road.

REFERENCES

[1] Mark, RG. “Telemedicine system: the missing link between homes and hospitals?” Modern Nursing Home, vol. 32, no. 2, Feb. 1974, pp. 39–42.

[2] Mark, RG. “Telemedicine system: the missing link between homes and hospitals?” Modern Nursing Home, vol. 32, no. 2, Feb. 1974, pp. 39–42.

[3] “Home.” AANP, www.aanp.org/about-aanp/historical-timeline#1970-s.

[4] “Home.” AANP, www.aanp.org/all-about-nps/np-fact-sheet.

[5] “Home.” AANP, www.aanp.org/all-about-nps/np-fact-sheet.

[6] “Home.” AANP, www.aanp.org/all-about-nps/np-fact-sheet.

[7] “Home.” AANP, www.aanp.org/all-about-nps/np-fact-sheet.

[8] Guttman, Dave. “29 Statistics You Need To Know About Healthcare & Telemedicine.” Ask A Doctor Online, www.fshealth.com/blog/29-statistics-about-telemedicine-healthcare.

[9] Moore, Miranda A., et al. “Only 15% of FPs Report Using Telehealth; Training and Lack of Reimbursement Are Top Barriers.” American Family Physician, 15 Jan. 2016, www.aafp.org/afp/2016/0115/p101.html.

[10] Moore, Miranda A., et al. “Only 15% of FPs Report Using Telehealth; Training and Lack of Reimbursement Are Top Barriers.” American Family Physician, 15 Jan. 2016, www.aafp.org/afp/2016/0115/p101.html.

ABOUT THE AUTHOR

Darren J. Sommer was awarded his Doctor of Osteopathic Medicine and Master’s of Public Health degrees from Nova Southeastern University College of Osteopathic Medicine in 2003. He completed his Internal Medicine Residency at University Community Hospital in Largo, Fla., in 2006, and is board certified in Internal Medicine by the American College of Osteopathic Internists. He later went on to complete his M.B.A. with Health Sector Management Certification from Duke’s Fuqua School of Business. He is a Health Policy Fellow with the American Osteopathic Association. He can also be reached at www.innovatorhealth.com and at darren@innovatorhealth.com.

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