Growth of Telemedicine in N.H. Has Hopes High, But Questions Remain

Jul 16, 2019

Seeing a doctor by video conference is becoming more and more common. According to one estimate, in just five years more doctor’s visits will happen virtually than in person in the U.S.

In New Hampshire, this explosion of telemedicine is being heralded by some as a solution to health care problems like long wait times, rural access, and workforce shortages.

But questions remain whether telemedicine will be able to deliver.

If you know which hallway to walk down at Dartmouth-Hitchcock Medical Center, one of the state’s largest hospitals, you can enter into a space that’s kind of bizarre --a hospital within the hospital.

NHPR reporter Jason Moon interviews Dr. Keith McAvoy who works in TeleNeurology.
Credit Rick Adams / DHMC

Dartmouth-Hitchcock calls it the Telehealth Center. Inside it has its own emergency department, psychiatry unit, pharmacy – all of them delivering that care remotely.

In one corner Mark Franklin, a critical care doctor, stands at a desk with eight screens.

“Right now on here there’s about 40 patients that I’m monitoring,” says Franklin.

Franklin says he gets all the same info from these screens that he would if he were there at those hospitals in person: patients’ medical histories, their vital signs in real time. He can also use cameras and microphones to speak with the patients and doctors on site.

Credit Courtesy DHMC

“Just before I was talking to you, they had asked me to camera in and talk to family about how the patient’s doing,” explains Franklin. “So, it’s a two-way communication system we have.”

Franklin also works with patients in-person at Dartmouth-Hitchcock’s ICU. He says learning how to do the same work remotely took some getting used to, but he says ultimately he makes the same decisions and delivers the same care.

Telemedicine is become a bigger and bigger part of what Dartmouth-Hitchcock does. When it launched this telemedicine center in 2012, the concept was still something of a novelty. That first year they did less than 100 video encounters with patients. By last year they were doing more than 4,500.

Doctors Jessica Brooks and Daryl Holthoff monitor the TeleEmergency desk.
Credit Jason Moon / NHPR

Dr. Kevin Curtis, who oversees telemedicine at Dartmouth-Hitchcock says telemedicine is vital to their strategy to deliver health care to rural patients.

Credit Courtesy DHMC

Curtis says Dartmouth-Hitchcock is responsible for a huge swath of both New Hampshire and Vermont – hundreds of thousands of lives.

“Most of those lives live rurally and many of them are at a distance,” says Curtis.

Rural clinics across the state have a hard time hiring positions like stroke specialists. Now they can pay Dartmouth-Hitchcock to provide one via video call on demand if a stroke patient comes through the door.

And it’s not only big hospitals in New Hampshire that are moving in this direction.

Exeter pediatrician Kristen Johnson is launching what she believes is New Hampshire’s first-ever telemedicine program for school children.

Starting next school year, students who come in to the school nurse’s office at Newfields Elementary can receive examinations from Johnson remotely. Johnson will set aside an hour each day for these exams as needed.

Using a tablet computer with special attachments, the school nurse can look in kids’ ears, measure their heart rates, and take their blood pressure. The images and audio are livestreamed to Johnson who can diagnose things like ear infections and prescribe for them without ever leaving her office.

Pediatrician Kristen Johnson provides a demo of the telemedicine technology on her daughter, Katie.
Credit Jason Moon / NHPR

“I’m really excited about this,” says Johnson. “I think that this has the opportunity to expand across multiple schools and become a much bigger part of what we do.”

Johnson says the tele-visits will be more efficient and can help families get in the habit of seeing a pediatrician.

But as telemedicine grows, some warn we should be paying attention to how it’s used.

“If it’s something like stroke or a patient with serious mental illness, I am on a chair applauding,” says Doctor Ateev Mehrotra, who researches telemedicine at Harvard Medical School.

“However, if we say more people with bronchitis are getting visits. Then I’m not so sure that’s a good thing.”

Mehrotra’s research has shown that the biggest growth in telemedicine is happening in direct-to-consumer telemedicine -- think face-timing your doctor from home.

What’s more, he says, is that most of those new televisits are from new patients. In other words they aren’t replacing in-person doctor’s appointments, they’re adding to them.

And that undercuts the idea that telemedicine will be able to fix New Hampshire’s shortage of health care workers.

“Telemedicine allows people in urban areas to go take care of rural patients,” says Mehrotra, “but it doesn’t address the issue that there just isn’t enough time of the doctors.”

Then there’s the question of whether these changes are good for patients. Some studies have shown that connecting specialists between different hospitals can lead to health outcomes that are just as good as or even better than if they were there in person.

Other studies of direct-to-consumer telemedicine have suggested that it can lead to over-testing of patients and over-prescribing of antibiotics.

As telemedicine continues to expand in New Hampshire, providers and patients will have to decide when this technology makes people healthier, and when it’s just convenient.