Telemedicine

As caregivers, staying up on the technological trends is vital to providing our loved ones with the best care possible. Telemedicine, or treating people from a distance, is not a new concept in health care. Since the beginning of the last century, Australians in remote areas used two-way radios to communicate with the Royal Flying Doctor Service. Even in Africa, smoke signals have served as a warning to people of a disease outbreak in a village.

In the United States, a shortage of doctors was addressed in 1954 with the "teledoctor," when the patient dialed for an appointment, then came to the doctor’s office. This replaced the house call model. The current telemedicine trend, however, began with a different population set, when Texas prisons began to overflow in the late 1990s. Physicians were overwhelmed with the number of patients, and finding time to meet with each of them.

The Texas Department of Criminal Justice (TDCJ) was also searching for a way to cut prisoner health care costs and save taxpayer dollars. In collaboration with the University of Texas Medical Branch at Galveston (UTMB), the TDCJ instituted a telemedicine program, using video conferencing as a means of treating the prison population. With the success of the TDCJ’s initiative, UTMB established care clinics for treating uninsured as well as corporate-based patients.

Today, telemedicine has moved into a yet another era. The practice comes in a variety of models, and displays distinct, measurable goals, from increasing a patient’s independence to lessening the cost of health care.

Definitions

First, it’s necessary to understand the difference between telehealth and telemedicine. These words appear in a variety of ways. The Association of Telehealth Service Providers defines the terms this way, explaining that telehealth is a broader term which encompasses telemedicine:

Telehealth: the electronic provision of health care and information services for the direct benefit of individual patients and their families. It includes actual physician-patient interactions via telemedicine, and the provision of education and information services designed to increase awareness of (and where applicable, compliance with) diagnoses and medical conditions, treatments, and good health practices.

Telemedicine: The provision of health care and education over a distance, using telecommunications technology.

The focus of telemedicine thus far has been mainly consultative. The American Telemedicine Association boasts its benefits as improved access to patients, cost efficiency and an answer to consumer demand in today’s busy world. Telemedicine encompasses the following services: specialist and primary care consultations, imaging services, remote patient monitoring, and remote medical education and consumer information.

The ATA states that telemedicine is not a separate medical specialty, with no billing distinction made between services provided on-site and remotely. This is good news for patients who are concerned about insurance issues. A doctor’s visit is a doctor’s visit, whether in-person or a video conference session.

Models

Some experts say there are three, but the majority of professionals agree on two distinct ways telemedicine is used today. The first is a real-time interaction, which is also the most common. Whether a simple phone call or complex as robotic surgery, real-time telemedicine necessitates both parties are present at the same time, with a communications link that allows an immediate interaction. Video conferencing equipment is popular, and today technology is available which allows physicians to perform remote patient evaluations.

A tele-otoscope, seeing inside a patient’s ear, or a tele-stethoscope to hear a heartbeat are just some of the many devices. Specialists such as cardiologists, neurologists, as well as pharmacists are able to consult patients in real time via an immediate network connection.

Surgeons now can operate on a patient miles away with telemedicine. One of the earliest occurred on September 7, 2001, when a remote operation was conducted across the Atlantic Ocean. A surgeon in New York performed a gallbladder operation on a patient in Strasbourg, France. It was completed with the use of a dedicated fiberoptic link, which ensured a digital connection and minimal lag time.

The rapid growth in technology has made these remote surgery rooms very specialized. In Toronto, Canada, the room responds to the surgeon’s voice command to control a variety of equipment on site, including the lighting, position of the operating table and surgical tools themselves. Remote surgery is not a widespread phenomenon, as development of standards and compatibility of equipment are just some issues to be resolved.

The second telemedicine model is the store-and-forward concept. This involves collecting medical data and then transmitting it to the appropriate physician or specialist for assessment. The two people involved do not have to be present at the same time, and the data can be in the form of an email, text dictation, video, and especially the electronic medical record (EMR), which has become a standard in hospitals and doctors’ offices nationwide.

Even teleradiology has seen a boom. The ability to send X-rays from one location to another involves use of an image sending station, transmission network and receiving/image review station. The Internet has made the doctor/patient relationship very different than the house calls of olden days.

Stats

This new movement toward telemedicine has not been without extensive research into its capabilities, rewards and risks.

The Center for Information Technology Leadership (CITL) produced a detailed report reviewing the various levels of telehealth technologies, and their benefits on the economy. The report names six areas, three pre-telehealth and one advanced, including the benefits this technology is offering the health community.

Even though the cost to implement telemedicine nationwide would be astronomical, this report shows us that the cost would be covered by the savings, just in a reduction from transfers of patients via ambulance. "Hybrid (real-time and store-and-forward) technologies would avoid 850,000 transports with a cost savings of $537 million a year," it states. Then, add in the transports within correctional facility settings, nursing homes, etc. and the money available for implementing new technologies increases fast.

Newt Gingrich, Ph.D., along with Doctors Richard Boxer and Bryon Brooks, released a report this year, entitled "Telephone Medical Consults Answer the Call for Accessible, Affordable and Convenient Healthcare." The paper states that more than 1.5 million Americans have access to telemedicine options today, as many employers, health plans and other benefit agencies are recognizing the ability to increase quality care and decrease expenses.

It also explains that more than 25 percent of emergency room visits are for non-urgent or unknown causes, and that access to telemedicine care, especially for rural residents, will help save the hospital rooms for those most in need. Ten percent of physicians practice in rural America, while nearly one-quarter of the population resides in these same areas.

With this research, the need for telemedicine standards to eliminate risk to both practitioner and patient has not gone unnoticed. The American Telemedicine Association has developed what it calls the "Core Standards for Telemedicine Operations," some practice guidelines as well as technical standards for the industry. From quality care and performance management to patient awareness and licensing requirements, the document offers professionals a roadmap in this fairly unchartered territory.

Telemedicine For All Ages

Since January 2007, students at New York’s Onondaga County schools are using telemedicine to monitor their diabetes. Each month, the 23 students have standing appointments with school nurses, who use first-rate technology, including a computer-mounted camera, to speak with doctors, record blood sugar levels, etc. Doctors are able to write prescriptions for the school nurse if insulin or other medication is needed.

In the eastern United States, diabetic monitoring is also a target service for the Central Vermont Home Health and Hospice. The organization received a grant in 2003, which allowed it to buy 25 monitoring units that are stored in high-risk cardiac and diabetic patients’ homes. Patients are prompted each day to take their own vital signs, which are then sent to a nurse who analyzes the data.

The same program is helping patients in the southern part of the country, through Acadian Ambulance’s Telehealth Monitoring. This group has partnered with home health agencies, providing in-home patient monitoring. Decreasing re-hospitalization rates and emergency department visits is the purpose, said Faye Bryant, the Telehealth nurse manager. Patients are then able to heal in their own homes, with less cost, and less stress to patient and families alike.

In Iowa, Colonial Manor, a nursing home in Amana, is serving as a test site for e-TeleHealth, a system developed by the University of Iowa that provides full, interactive, live-video and audio capacity. A nurse, dentist, and physician can be sitting in their offices or homes and access the e-TeleHealth Web site for carrying out a live visit with a patient.

In addition to a computer, monitor on a moveable arm and video-conferencing system, the equipment present at the nursing home site includes an electronic stethoscope, otoscope, dermascope, dentalscope and EKG. These are located on a rollabout, allowing it to be taken to a resident’s bedside if necessary. Another important benefit is the ability of the patient’s family to be involved, even from a distance, through the online video conference.

Tomorrow’s Telemedicine

The ATSP says "The future of telehealth depends less on technology than on politics." The technology is readily available for telemedicine to have a major impact on the country’s health care industry. Now, government programs, telecommunications law and insurance reimbursements, all funding for the industry’s professionals, are sitting on the hill of major decisions.

"The consumer is a key player in the future of telehealth," says the organization. "If people understand what telemedicine is, see it as having value, and insist that they have access to it, governments, employers, and insurance companies will make it feasible."

IBM projects that in five years from now, a computer-generated, three-dimensional image of a patient’s body will be available for the physician to click on a body part and see lab results and other records.

In another future role of telemedicine, a new software will allow a patient’s blood glucose levels or blood pressure, among other readings, to be transmitted to their personal cell phone. The phone acts as a "hub, collecting readings, then transmitting the information in real time to a central server," says an article on www.futurehealthcareus.com.

The patient’s physician has thresholds set, and the person’s phone may give an alert if the readings are high or low. Teenagers may want a text message sent to them while older people a phone call. This technology is an ideal way for monitoring those with chronic conditions who lead active lifestyles.

Whether monitoring vitals at home, on the person themselves, or taking part in real-time video examinations or even surgeries from a distance, the future of telemedicine is a wide, expanding horizon. In the coming years, this technology will impact all of us in some way or another, as caregivers and the people we care for.

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