Telemedicine
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Perhaps it's not surprising that medicine would follow the two major trends of the information age: high-speed communications and easy, immediate access to a wealth of information. In line with both of these trends is the emerging telemedicine industry. While often broadly defined simply as the transfer of electronic medical data from one location to another, telemedicine really encompasses a broad range of emerging technologies, including telecommunications tools, information systems, and imaging technologies. Telemedicine is primarily intended to supplement the practice of conventional medicine and facilitate the exchange of information needed for diagnosis and treatment of illnesses. It has both palpable and subtle effects on the healthcare industry in general: it ostensibly helps to ease physician shortages as well as reduce overall healthcare costs. One key example is the remote monitoring of homebound patients. Another is teleradiology, which permits remote review and diagnosis by a licensed radiologist from electronically transmitted radiographic images, without the need to retain such expertise on site, "24/7," such as in rural emergency room settings.
Differing opinions as to the breadth and scope of the term "telemedicine" have made it nearly impossible to assess the true economic value of the industry. This has been further complicated by the transitional use of other terms along with telemedicine, such as "e-health" or "telehealth," which have become synonymous in the healthcare industry. "The telemedicine market is a mile wide," said Joe Linkous, executive director of the American Telemedicine Association, in an interview for a 2004 article in For the Record. "He added, "And that makes it difficult to pin down comprehensive spending figures."
However, no one denies that this nascent industry will continue to affect and transform traditional doctor-patient relationships with increasing frequency. But with the inevitable growth of the industry comes growing concern as well. Regulators and legislators are increasingly interested in fostering such innovation while at the same time ensuring competent delivery of medical services. Their main concerns are licensing requirements, malpractice liability, and medical services reimbursement.
Telemedicine typically involves interactive, real time transactions (such as videoconferencing) that may require dedicated networks or even satellite links or "store-and-forward" systems that allow data, images, or patient information to be transmitted from a personal computer (PC) and inspected at the receiver's and sender's convenience. Transmission media include phone lines, coaxial or integrated services digital network lines, satellites, and other peripherals. Although complex dedicated networks provide the infrastructure for many institutional applications, telemedicine is rapidly evolving to encompass software and products for affordable desktop systems that can integrate voice, video, and data.
Applications range in complexity from the relatively simple transfer of digitized images or data via phone lines or the Internet to consultations and videoconferencing to the monitoring of patients at home or the direction of surgery or diagnostic procedures from a distance. Most applications have evolved from government-funded pilot programs, and a substantial proportion of telemedicine's advances were initially developed to meet the needs of military medicine and to improve health care in remote areas. Still in its youth, telemedicine is available primarily to large institutions such as medical centers and prisons, which utilize the technology in products and services for remote consultations, home health, teleradiology, telepathology, patient monitoring, distance education, and research.
The most popular application of telemedicine is the transmission of images in radiology, pathology, and dermatology, which do not require the patient's real time involvement and can circumvent numerous legal problems created by cooperative diagnosis and treatment across state lines. The transmission of still images is also a well-established practice that Medicare and some other third parties will reimburse. Telemedicine in prisons, where the cost of patient transportation is exorbitant, has been highly successful. Interactive conferences for remote consults and distance education for practicing physicians and medical students are also becoming more widespread. Health Care Management pointed out that telemedicine offers a learning perspective that "can enable close observation of medical procedures and facilitate the diffusion of very intensive learning experiences." The publication also asserted that "telemedicine has a difficult relative value calculus." Thus, consideration must be given regarding whether there is economic justification for telemedicine technology.
With the number of U.S. senior citizens growing at a nearly exponential rate, home health spending continues to increase at a steady pace. Telemedical home health applications can range from phone-based call centers to integrated home telemonitoring systems that track the progress of chronically ill or recovering patients. In numerous pilot projects, at-home monitoring has been shown to reduce doctor and emergency visits and enable fewer home health nurses to see more patients more frequently in a shorter time. TeVital, a leading supplier of home-based monitoring equipment, estimated that per cost home health visits can be reduced by one third to one half through the use of sensing and video systems. Although home health telemedicine promised enormous potential savings, it had yet to establish itself as the accepted standard of practice, even in university-based programs in the United States, as of 2005.
An important and promising application for telemedicine technology, both globally and within the United States, has been its potential to reach geographically rural or isolated communities. The Health Resource and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), is tasked with overseeing telemedicine and telehealth concerns related to rural health settings within the United States. The most common applications are for diagnostic consults, data transmissions, and chronic disease management. Physicians in under-served rural areas are eligible for Medicare reimbursement for telemedicine services, with payment shared among practitioners. Although federal Medicaid law does not recognize telemedicine as a distinct service, services administered via telemedicine applications may be reimbursed at the state's option, according to a U.S. Department of Health and Human Services' Health Care Financing Administration Web page.
The HRSA's Office for the Advancement of Telehealth (OAT) is primarily a grants-based entity that provides funds and informational resources to eligible applicants. In its approval of grant awards, it focuses on rural health care or persons otherwise limited in access to proper care (e.g., the Alaskan Federal Health Care Access Network Telemedicine Project); under-represented populations (e.g., forty telemedicine programs and partnerships within the Indian Health Service); innovative technology; and educational initiatives (such as instructional nursing guidelines for new mothers).
As important as rural applications are those that involve limited accessibility to needed care. In 2004, the Veterans Affairs Medical Center in Salem, Virginia installed a telemedicine system at its Crossroads substance abuse shelter in Wytheville. A videophone with a small camera operated through one of the shelter's business telephone lines and connected homeless veterans at the shelter with medical personnel at the main operation in Salem. According to an article appearing in the Wytheville Enterprise, the distance, cost and time involved in traveling to the VA center in Salem had often prevented veterans from following through with necessary care after being hospitalized. Many of them did not have a driver's license or a vehicle. This meant that a representative from the Salem office had to physically travel to the shelter to assess a person, then take him back to Salem for treatment.
Although interest in telemedicine was revived by the technological advances of the late 1990s, the use of communications technology to improve information sharing and to connect patients with doctors located elsewhere is not new. One of the first applications in the United States was a closed-circuit television system devised for a Nebraska state psychiatric institute in the 1950s. The National Aeronautics and Space Administration (NASA) began using telemetric devices to monitor the condition of astronauts in space in the 1960s and later to deliver health care to...
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