What is telemedicine? At some point, we’ll be able to do a noninvasive body scan with a handheld device, have a computer/doctor combo throw out a diagnosis, and robots will perform the necessary adjustments or dispense the proper pills, a la Star Trek. Until then, imaging and communications technology is allowing doctors and patients to step ever closer to that ultra high-tech scenario. The American Telemedicine Association tells us that
The formal definition of telemedicine is when medical infomration is transferred between sites through electronic communications in an effort to improve a patient’s health status. There are many varieties of telemedicine, including many services and applications that use email, wireless tools, smart phones and two way videos.
It began over 40 years ago, with hospitals doing demonstrations of patient care in far reaching parts of the world. Since then, telemedicine has rapidly spread, and it’s now becomeing a standard part of medical treatment in many health care agencies.
It’s common for us now to email our doctors, receive prescriptions and advice over the phone, and to look up general medical information online. However, capabilities for medicine via cyberspace actually far exceed current practices. An article in The Atlantic gives some insight as to why such a technological field is lagging behind in some ways:
Many wonder why there isn’t more electronic access to doctors, but others cite issues such as confidentiality and the lack of technology to support emailing and texting with their patients. Another problem is determining what is billable, what the hours should be and when communication is just too frequent.
Some argue that having the availability to check in when a patient has questions can allow doctors to decide which symptoms require a doctor visit, and which ones do not. They also feel that the many different ways to communicate offer lower cost options to having all patients come in for very minor problems that probably do not require a visit.
Hospitals and practices that are tech-savvy are using more and more remote access systems for their patients to access. This allows them to go online and get results for tests, leave their doctors messages in a secure system. These practices allow doctors and hospitals to stay in compliance with HIPAA, and provide patients with much needed ease of access.
This suggests that the major obstacles to full-reach telemedicine are bureaucratic ones. Confidentiality is a legitimate concern, of course, but there is an incalculably large mass of data that we trust to the internet: financial information, personal information, identification data such as social security numbers, bank accounts, etc. For something as important and potentially beneficial as instant access to medical care from anywhere, that should be considered an acceptable risk. After all, physical files in a doctor’s office are not impregnable, either.
The other problem is that doctors have had to deal with the fact that office visits are billable to insurance companies, while digital communication is frequently not. That is slowly changing, but considering the cost savings, it’s a win-win-win for doctors, insurance companies, and patients alike and the slow-moving machine of regulations is wasting masses of time and money by inhibiting new changes to the rules.
High-level telemedicine is expensive to implement, because it requires new systems. However, once done, the savings in health care can be astonishingly substantial. The Orlando Sentinel outlines some effective programs in Florida. The article notes that there are many hospital visits caused by funneling to emergency care, which exacerbates problems.
Orlando Health is working on an experimental program which will allow many patients to stay home and push a botton on a box to send information that includes blood pressure, and weight to a health care provider that is miles away. The effort is to determine early signs that a patient may have heart failure.
According to Sylvester, there have been 15 percent fewer readmissions in the past two years.
Starting in June, Orlando Health plans to add a “hospital at home” service in which home-health nurses and patients consult with doctors via videoconference to devise treatment plans without a trip to the hospital.
Aside from cost savings, telemedicine can greatly improve the quality of care, because of increased access to specialists for patients and increased access to patients by health-care providers. This was outlined on the site FierceHealthIT, which described a study of Parkinson’s patients. The study showed that teleconferencing was as beneficial to these patients as in-person visits, and saved time and stress.
…telemedicine patients, on average, were saved roughly 100 miles of travel and 3 hours of time.
The study’s authors have determined that there would be more research necessary to determine if telemedicine really had clinical benefits that are comparable to in person medical care. The researchers also have said that using web-based videoconferencing as a way to provide remote speicalty care was valuable to many patients.
“It appears we can use the same technology Grandma uses to chat with her grandson to provide her with valuable medical care in her home,” lead author Ray Dorsey, an associate professor of neurology at the Johns Hopkins University School of Medicine, said in an announcement. “If this proof-of-concept study is affirmed, the findings open the door to a new era where anyone anywhere can receive the care she or he needs.”
Dorsey encourages caution, though, because using more technolgy can have issues that include current rules of Medicare for remote care reimbursements, as well as licensing problems that might cause stumbling blocks to the innovations.
The American Heart Jounal published research this month that highlighted how non-diabetic patients were were underserved in urban communities. When they used telemedicine systems, the study found that they could significantly reduce their blood pressure when compared to patients that were in similar situations and getting traditional care.
Telemedicine has been around for a long time, but it hasn’t yet come of age. There is still a world of potential waiting to be fulfilled.