Two stories today highlight the growing momentum behind remote monitoring. Both stories relate to adoption barriers mentioned in Christine Thielst's column I posted on yesterday. First up is a story from the LA Times about moving physicians' diagnostic and interpretive skills off shore.

Hundreds of hospitals around the country are engaging in a new form of
outsourcing — employing physicians abroad to assist doctors on staff —
whether to confirm a preliminary diagnosis or make it themselves.

now, such medical outsourcing is mainly confined to radiology, because
digitized images can be transferred nearly as easily as photos can be
e-mailed. But doctors and experts say the practice will inevitably
spread to other medical fields.

The story is centered on crossing international boundaries to provide night time (and weekend) coverage to U.S. based physicians. Not mentioned are applications like the remote ICU coverage facilitated by systems like VISICU. Given the pending physician shortage (or current shortage if you're talking about intensivists), outsourcing will become a fixture of health care delivery.

Right now, the practice is not so much about saving money as sparing
staff radiologists calls around the clock, Bradley said. However, the
estimated $65 per case that the hospital pays NightHawk is "much, much
less" than it would cost to pay U.S.-based radiologists at those hours,
he added.

Also today, the Contra Costa Times describes how several large insurers have started reimbursing physicians for online consultations. The story also raises the point that many patients will pay extra for convenience.

The online consultation with [Tamara McCartney's] ...physician cost her $40, an
out-of-pocket fee she said was well worth the expense. Her next online
consultation will cost far less, however: Her insurance company now
reimburses doctors in Florida and California for online consultations
with patients.

McCartney's insurance company is Aetna, one of the largest health insurers in
the country. Blue Cross-Blue Shield of Florida, the state's largest
health insurer, began such reimbursements in January 2005. And Cigna,
another big national company, will begin making such payments in

The story also notes that there's much pent up demand with patients for remote consultations.

[Dr. Charles] Batson said Blue Cross pays him $27 for each online consultation.
Though he doesn't view the reimbursements as much of a moneymaker, he
said consultations in particular, and Web messaging in general, have
been a boon to his practice.

The system was relatively inexpensive, boosted office efficiency,
and "every single comment we've had (from patients) has been positive
and thankful," Batson said. "From a business perspective, if you have
happy patients, it will have a positive spin financially in the long

I'm sure employers would rather have employees make virtual visits that take less than an hour, than lose half a days productivity with an actual office visit.

Web-based doctor-patient communication is getting a lot of interest
from employers who provide health benefits for their workers, said
Kenneth Tarkoff, chief operating officer for RelayHealth, which offers
the service in six states through 13 insurance plans. He predicted that
within two years, "this will be a standard benefit for employees."

The story does have a few quotes that don't ring true. For example, there's this from Dr. Charles Cutler, Aetna's national medical director for quality:
"Once physicians become enthusiastic, there will be a tipping point." Another quote that struck me is this one, from Erika Fishman, a senior analyst with Manhattan Research: "A lot of what is going to drive this, is
physician-to-physician cheerleading, from those who enjoy this
technology and are seeing it has a positive effect on their practice."

Despite the enormous investment in innovation and significant opportunities to serve both humanity and stock holders, it seems most health care innovations fail. "Enthusiasm" will not drive physician adoption of online consultations, but fair reimbursement will - doctors will even get enthusiastic at the prospect. Physicians are famously techno-phobic, but "physician-to-physician cheerleading" is a red herring. Systems for online consultations that are reasonably priced (private practice physicians are also notoriously cheap), well designed, and easy to use are what will drive physician adoption.

Pictured right is VISICU's eICU (warning - annoying soundtrack).