Telemedicine uses a variety of electronic communications media, ranging from teleconferencing to image-sharing to remote patient monitoring, to provide clinical services to a patient. As the American Telemedicine Association points out, telemedicine is associated with, but not the same as, telehealth, which also refers to nonclinical services such as research, training and administration.
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The use of telemedicine technology dates back to the late 1960s, when physicians ran a microwave line under Boston Harbor to connect Massachusetts General Hospital with Logan International Airport in order to examine patients at the airport clinic while avoiding Boston traffic.
Today, telemedicine is used in medical fields such as dermatology, behavioral health and cardiology as a way to provide better care to communities underserved by physicians, hospitals or both; it is also considered a way to significantly reduce the cost of treating health conditions, including hypertension, diabetes and sleep apnea, which benefit from continued monitoring of a patient's condition.
Dr. Jason Knight remotely examines an ER patient using a robot during a clinical validation process at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif.
Here's a look at 10 ways that telemedicine technology is changing the delivery of healthcare-along with a note of caution for organizations that are taking advantage of relaxed regulations to expand their use of telemedicine services.
1. Diagnose and Treat Strokes Faster
The sooner a stroke victim receives treatment, the better the chance of survival. In many cases, treatment hinges on the capability to identify key symptoms and administer medicine known as tissue plasminogen activator (tPA) within three to five hours of suffering a stroke. Unfortunately, emergency room physicians don't always have the expertise to make these decisions, and small or rural hospitals don't always have a neurologist on call.
Enter telestroke services, which have been shown to improve stroke treatment in several ways:
- Patients treated in hospitals that were part of a telestroke network in Georgia received tPA approximately 20 minutes faster than patients in hospitals outside the network.
- Telestroke helped facilities in remote parts of Alberta reduce ER transfers to the University Hospital in Edmonton by up to 92 percent. Such ambulance or helicopter transports are costly, time-consuming and sometimes dangerous.
- Videoconferencing led to more accurate diagnoses and treatments than telephone conversations in the Imperial Valley of California and in Boston.
- Neurologists and radiologists in Arizona were able to use smartphone image-sharing applications that proved to be as accurate as desktop-based picture archiving and communication systems 92 percent of the time.
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2. Provide ICU Physicians, Nurses a Second Set of Eyes
Telemedicine technology is increasingly making its way into the intensive care unit. Rather than replace the physical ICU outright, the tele-ICU, as it's called, provides a "second set of eyes" for nurses or physicians who must treat several patients at once amid alarms and other distractions that may make them miss a medication dose, sudden change in blood pressure or other important signal.
Wall-mounted cameras let tele-ICU staff assess patients and communicate with bedside physicians. (Image courtesy of Critical Care Nurse.)
Staff of the tele-ICU have the same access to patient data such as vital signs, lab results and physician's notes as on-site critical care staff, and they use one- or two-way cameras to perform bedside assessments or confer with physicians. Because the remote physicians don't face the same distractions as those in the hospital, they can more closely monitor a patient's progress and suggest new treatment or drug options. As one patient at a Phoenix hospital told the Arizona Republic in 2011, his remote physician provided better care than hospital staff despite being based in Israel.
3. Let Patients Undergo Rehab at Home
When patients are discharged from the ER or the ICU, the care process is often just beginning. This is especially true for patients who are recovering from a stroke or suffering from other neurological disease such as multiple sclerosis, Parkinson's or dementia. In many cases, these patients find it difficult to travel to a health care facility regardless of whether they are in an urban or rural setting.
The use of telemedicine technology in rehabilitation addresses these issues in several ways- conducting cognitive or psychiatric assessment, leading group therapy sessions (hosted at a clinic or senior citizens' center, for example), providing patients with online resources and remotely monitoring a patients' pedometer readings to ensure that an exercise regimen is up to par.
Telemedicine can also assist in recovering from lung disease, as it lets patients participate in online education sessions and attend supervised physical rehabilitation at a nearby satellite location.
4. Help Patients Reduce Their Risk of Heart Disease
Cardiovascular diseases are the leading cause of death around the world. Drug treatments or social/lifestyle changes can help prevent many cases. However, patients must work closely with their doctors to quit smoking, lose weight, change their diet or begin an exercise program, and making frequent office visits can be difficult for both parties. Here, telemedicine technology may be the answer-for example, researchers in Philadelphia found that patients were nearly twice as likely to participate in cardiovascular disease management programs if they could send/receive information to/from a healthcare provider online (as opposed to traditional paper- or office-based information sharing.)
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5. Encourage Diabetics to Embrace Healthier Behavior
In the United States, healthcare costs related to diabetes-multiple inpatient and outpatient visits, for example-are close to $100 billion a year. Research from the eHealth Initiative suggests that telemedicine improves the health of diabetics, especially older adults.
To succeed, two things need to happen. First, a physician's interaction with a patient must boost self-efficacy, or the belief that the patient can, in fact, engage in activities that improve glycemic control.
Second, treatment plans must set goals for successfully changing patient behavior-which is becoming increasingly easier thanks to mobile health technology that helps patients count calories, keep an eye on vital signs, log workouts and monitor medication doses and schedules-and nurses and dieticians must check in with patients regularly to monitor their progress.
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6. Empower Patients to Manage Chronic Conditions
This diagram shows how information would flow in a home-based system for managing a patient with inflammatory bowel syndrome. (Image courtesy of InTech.)
In the former case, something as simple as routine three-minute phone calls with a health care provider will encourage patients to take blood pressure medication, refill prescriptions and remember their appointments-all of which reduces the number of inpatient and ER visits they must make.
In the latter case, patients can describe symptoms to physicians over email, perform a number of self-tests and participate in step-by-step educational programs related to their particular disease. In both cases, mobile health technology eases chronic disease management by literally putting care management applications and devices in patients' hands.
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7. Improve Oral Health With Store-and-Forward Telemedicine
Teledentistry typically makes use of store-and-forward telemedicine, which lets a doctor (or dentist) acquire medical images or other relevant data, assess it and send it to another physician for review. (Of the main types of telemedicine technology, store-and-forward is the least interactive, as it does not require two or more parties, nor does it involve a physical examination.)
The main benefit of telemedicine in dentistry, then, is sharing records among dentists and dental specialists to determine if a certain procedure is necessary and, if so, how soon it must take place. Specialists can also help dentists spot problem areas and suggest preventive measures to a patient so that costly, complicated procedures can be avoided. As with other uses of telemedicine, this collaboration helps patients in rural or other underserved communities who don't otherwise have access to medical specialists.
8. Link Patients, General Practitioners to Dermatologists
Dermatology is a prime candidate for the use of store-and-forward telemedicine technology. The information that is shared is often an image-and applications that help people share images are not in short supply. The images tend not to contain any of the personal health information (PHI) or personal identifiable information (PII) that raises HIPAA security and privacy red flags.
Teledermatology is being used in two ways:
- Direct Dermatology, a company founded by a Stanford dermatologist, has introduced technology that lets patients take a picture of a skin problem and send that to Direct Dermatology along with their medical history; within two days, the patient will receive a report back from the company, along with any necessary prescriptions. This use of teledermatology targets rural patients without easy access to a medical lab or clinic and builds on the findings of a 2010 study suggesting that online dermatology visits are as effective as in-person appointments.
- Dermatologists in the Netherlands, meanwhile, have been using telemedicine technology to confer with general practitioners since 2005. In this time, studies have shown that daily consultations prevent unnecessary patient referrals in 74 percent of cases and reduce the cost of care by 18 percent.
9. Provide Mental Health Consultations to Children
Traumatic events can have a dramatic effect on children, especially if they already suffer from mental health disorders such as depression, anxiety or hyperactivity. That's why the Robert Wood John Foundation and the University of Texas Medical Branch established a Telemedicine for School-Based Mental Health program in Galveston, where the aftermath of hurricanes Katrina and Rita in 2005 and Ike in 2008 left many children in emotional distress.
A report prepared at the conclusion of the six-year project showed that the teleconferencing counseling sessions were the first consultations with a mental health professional for many students. (Sixty percent of participants did not have health insurance.) Overall, nearly 70 percent of parents and guardians said the sessions helped their children perform better in school, and the telemedicine program as a whole helped Galveston County fill a need to treat students with severe mental health challenges, the report says.
10. Improve Rural Healthcare Around the World
As stated, telemedicine technology offers much promise for patients in the rural United States. Its biggest impact, though, may be felt in Africa and other parts of the developing world where healthcare services are equal parts scarce and inaccessible. Remote consultations can help address relatively minor conditions before they become major-treating cataracts before they cause blindness, for example, or ensuring that new mothers receive the educational resources they need to raise a child and take care of their own medical needs.
However, there remains a tremendous need for equipment such as computers, printers and scanners at hospitals in rural areas that rely heavily on subsistence farming and lack business and community development. That said, mobile health applications, including a bar code scanner that can determine if a drug is counterfeit, may be the answer, as people in the developing world are more likely to own cell phones than PCs.
Don't Neglect Telemedicine's Risk Management Needs
The use of telemedicine technology is not without its risks. Both patients and physicians must have appropriate hardware and software security in place to ensure the safe transmission of PHI and PII such as a Social Security Numbers and detailed medical records. Your organization's telemedicine risk management strategies, then, need to address numerous issues.
First off is the federal government's telemedicine conditions for participation. This outlines what facilities must do to provide and receive telemedicine services, especially as it pertains to the credentials of participating physicians, the privileges they have and the licenses they (and other caregivers) need. Remember that different states have different licensing rules.
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In addition, your organization should draft a detailed set of telemedicine guidelines that lists all partner facilities, addresses which types of healthcare providers (nurses, radiology techs and physician assistants, to name three) can participate and clearly states how the information gathered during telemedicine treatment will enter a patient's electronic health record.
Rising healthcare costs and the demand for improved care are driving many facilities to explore the benefits of telemedicine. While technological barriers and skeptics remain, many studies have shown that telemedicine can complement, and in some cases improve, the overall patient experience. Expect more even use cases for telemedicine technology to emerge.
Brian Eastwood is a senior editor for CIO.com. You can reach him on Twitter @Brian_Eastwood or via email. Follow everything from CIO.com on Twitter @CIOonline, on FacebookGoogle +.
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