What is telemedicine?

Development and Applications

With the development of health information technology (HIT),
American telemedicine has expanded rapidly and is widely used in a variety of
forms. Most applications of telemedicine fall under the categories of “real time,”
such as when face-to-face consultations are necessary, or “store and forward,”
which is one of the most widely used technologies. Electronic transmissions of
computed
tomography (CT) scans, x-rays, and test results can be stored
and sent to another department, another city, or anywhere in the world.
Videoconferencing in real time, on the other hand, allows all parties
involved—doctor, patient, specialist, and others—to consult together as if they
were in the same room. These applications have been found useful to most medical
specialties and particularly in the delivery of services in remote areas. The
prefix “tele-” is generally applied to specialties using the technology
(telecardiology, teleradiology, telepediatrics).

Services are generally delivered through the Internet, although mobile
applications have become increasingly more common. Other modes of delivery include
private networks for specialty needs, used directly or contracted out to private
agencies. Home connections for clinical consultation may use single-line
phone/video systems and the web.

Some major advantages of telemedicine include lower costs, greater efficiency, remote delivery of care, better clinical outcomes, immediate returns on investment for agencies, minimization of health care disparities in populations, and easier and more efficient billing procedures.

Use in Treatment and Therapy

Since the mid-1990s, tens of thousands of patients have been served by various forms of telemedicine. Physicians may consult with specialists, and patients can be monitored at a distance for better diagnosis and treatment. Vital signs can be taken and instantly transmitted to another site for analysis. Wireless technology is now used in ambulances to transmit vital information en route to the hospital.

Doctors and patients can communicate through telemedicine programs, as well as through the Internet. Consumers can access specialized health information and engage in online discussions with groups providing peer support. Telemedicine has been used primarily for patient care services, although it is also being used for administration and continuing education. There are also a number of developing and innovative potential applications.

The US Department of Veterans Affairs has studied the use of telemedicine for the
treatment of posttraumatic stress disorder (PTSD), giving veterans broader access
to services and group treatment interventions. Such telemental health programs
have broad applications for mental health patients and can offer more immediate
access, security, and reassurance.

Teletrauma programs allow doctors, especially in rural areas, to talk to trauma
specialists through live video hookups. Such programs have already saved a number
of lives and have tremendous potential. Teletrauma technology is projected
eventually to link most hospitals with top trauma centers.

Health e-stations are off-hour clinics where patients with minor ailments can be
treated by a doctor over a plasma television hookup. Patients can also be
monitored at home through home telehealth applications adopted by home health
agencies. Such services can empower patients, increase access, and reduce costs
and time and can result in less burden on physicians and on emergency room care.
Telehospice programs are relatively new, and in the process of development. They
may provide pain control, anxiety relief, and comfort measures.

The use of telemedicine in screening can also be extremely valuable in preventing
more serious illness or future problems in a population. Dental screening,
especially in underserved populations for early childhood conditions, for example,
can detect possible serious future problems from infection, malnutrition, and loss
of teeth. Retinal screening of diabetics can also provide early detection of loss
of sight, allowing early intervention.

Perspective and Prospects

The early roots of telemedicine date from the late 1920s with the development of
telephones. Since then, technological development has culminated in capacities for
highly advanced interactive communications enhanced by improved data
compression and available bandwidths, setting the stage for
future expansion, deployment, and application.

New applications for telemedicine and telehealth are constantly being proposed,
researched, and developed. In the case of natural disaster or terrorist attack,
for example, a broad telehealth system could provide a rapid and effective
response through linking existing networks to form a national medical response
grid. The US military is researching the extended use of telemedicine to deliver
care on the battlefield involving robotic telesurgery, which enables a surgeon in
one location to perform surgery remotely through control of a
robotic arm in another location. Improved technology has allowed for the
development of wearable devices that can relay important diagnostic information to
health care specialists in real time via cellular networks.

Some of the barriers faced in developing e-health systems include exploring ways
to institute billing and incorporate insurance payments. Information must also be
secure and protected in order to comply with the Health Insurance Portability
and Accountability Act (HIPAA). Medicare and
Medicaid reimbursement has a number of restrictions. There is
also a lack of appropriate technology and infrastructure. A question of licensure
of physicians involved in out-of-state consultations, as well as fears of
malpractice, makes some physicians hesitant to participate.
There are also considerable initial costs for training and equipment. Federal
funding is provided through grant programs, reimbursement under Medicare, and
services for the military, veterans, American Indians, and correctional
populations. A number of companies and health care organizations are interested or
involved in research and development in the corporate sector, and telemedicine is
expected to have a significant impact on how health care is delivered in the
future.

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