During the past decade, more and more people have been able to avoid physically going into work by telecommuting from their home computer. Medicine has taken a cue from this growing trend by combining telecommunications technology and medicine to create telemedicine and telehealthcare. While healthcare professionals have always communicated with one another over the telephone, telemedicine kicks things up a notch by utilizing sophisticated satellite technology to broadcast consultations between healthcare professionals who are oceans apart or only a few miles away. Videoconferencing equipment and robotic technology have helped to make doctor’s offices and medical facilities as close to one another as the nearest computer screen.

There are two popular types of technology used for telemedicine applications. The first of these is called “store and forward” which is used for transferring digital images from one location to another. A healthcare professional takes a picture of a subject or an area of concern with a digital camera. The information on the digital camera is “stored” and then “forwarded” by computer to another computer at a different location.  This type of technology is utilized for non-emergent situations, when there’s time for a diagnosis or consultation to be made, usually within 24 to 48 hours, with the findings then sent back. The most common use of store and forward technology is with teleradiology, where x-rays, CT scans, and MRIs can be sent from within the same facility, between two buildings in the same city, or from one location to another anywhere in the world. There are hundreds of medical centers, clinics, and individual physicians who use some form of teleradiology. Many radiologists are even installing appropriate computer technology within their own homes, allowing them access to images sent directly to them for diagnosis, eliminating an unnecessary and possibly time-consuming trip back into to a hospital or clinic. Telepathology is also another common use of this type of technology, with images of pathology slides sent from one location to another for diagnostic consultation. Dermatology is one area that greatly benefits from the store and forward technology, with digital images of different skin conditions taken and sent to a dermatologist for diagnosis.

Utilized when a face-to-face consultation is necessary, the second most widely-used technology is two-way, interactive television (IATV). This is when the patient, along with their healthcare provider (a doctor or a nurse practitioner) and a telemedicine coordinator (or a combination of the three), gather at one site (the originating site), and a specialist is at another site (the referral site) which is usually at a large, metropolitan medical center. Videoconferencing equipment is placed at both locations allowing for a consultation to take place in “real-time”. Videoconferencing technology has decreased in price over the past few years, and many of the computer programs are no longer as complex as they once were, allowing for healthcare professionals to use nothing more than a simple desktop videoconferencing system. Almost all areas of medicine have been able to benefit from videoconferencing, including psychiatry, internal medicine, rehabilitation, cardiology, pediatrics, obstetrics, gynecology and neurology. Also, many different peripheral devices like otoscopes (which help doctors look inside the ear) and stethoscopes (which enable a doctor to listen to a person’s heartbeat) can be attached to computers, aiding with an interactive examination. Many healthcare professionals are becoming more creative with the technology that’s available to them in order to conduct telemedicine. For example, it's not unusual to use store-and-forward, interactive, audio, and video still images in a variety of combinations and applications. Use of the Web to transfer clinical information and data is also becoming more prevalent, and the use of wireless technology is being used to provide ambulances with mobile telemedicine services of all kinds.

Around the world, there are many programs being used in a variety of ways to provide technologically-advanced healthcare. Telemedicine can be used in the remotest parts of the world or in places as close as a correctional facility, helping to eliminate the dangers and costs associated with the transportation of prisoners to a medical center. Also on the horizon for telemedicine is the development of robotics equipment for telesurgery applications which would enable a surgeon in one location to remotely control a robotics arm for surgery in another location. The military has been at the forefront of development for this type of technology because of the obvious advantages it offers for use on the battlefield; however, some academic medical centers and research organizations are also testing and using telesurgery in order to continue the advancements in telemedicine.

As wonderful as the advent of telemedicine is, there are still drawbacks that people need to know about, like the fact that many states will not allow out-of-state physicians to practice medicine unless they are licensed in that particular state. The Centers for Medicare and Medicaid (CMS) have placed restrictions on the amount given in reimbursements for telemedicine procedures, and many private insurance companies will not reimburse at all for this technology, although states such as California and Kentucky have legislated that insurers must reimburse the same amount for a telemedicine procedure as they would for an actual face-to-face consultation. There are also underlying fears of malpractice suits for physicians engaged in telemedicine because there is a lack of hands-on interaction with patients. However, several studies show that most people who have experienced long-distance healthcare via telemedicine have been quite satisfied with the care they received. There are also the technological problems which can hamper the progress of telemedicine, like the fact that regular telephone lines tend to be inadequate in handling many of the telemedical applications. Also, many rural areas still don’t have the cable wiring or other kinds of high bandwidth telecommunications needed to access the equipment required for more sophisticated medical uses. One other obstacle stands in the way of progress, and that’s the issue of funding. During 2005, the Technology Opportunity Program (TOP) will not receive funds for telemedicine/telehealth, and the Office for the Advancement of Telehealth (OAT) will not be able to fund any new programs either. The good news is that some private corporations and telecommunications companies are trying to fill the financial void created by the lack of funding. 

All in all, the advantages of telemedicine definitely outweigh its detractors, with it soon being just another way to see a healthcare professional. The future of telemedicine will not only be advantageous for those in rural communities, but will also offer people who are homebound within metropolitan areas with a way to access specialty care. Eventually, everyone could have a personal diagnosis system through their home computers, and it will monitor our health status on a daily basis, as well as have the ability to automatically notify a medical professional when we become ill. Telemedicine, telehealth, and e-health will continue to combine the best of medicine, technology, and telecommunications, which will help make our lives healthier and safer.

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