• Telemedicine: The Next Medical Frontier

    IMAGEThe old way: You develop a mysterious rash. You call your doctor's office for an appointment, leave work early, sit in traffic, and then sit some more in the waiting room. After examining your rash, your doctor decides you need to see a dermatologist. You obtain a referral, make another appointment (which may not be immediately available), rearrange your schedule, sit in more traffic, and finally arrive at the dermatologist's office for diagnosis and treatment.
    The new way: Right there in the exam room, your doctor photographs your rash with a digital camera and sends it, along with her examination findings, via computer to the dermatologist. He reviews the information, asks additional questions if necessary, makes a diagnosis, and recommends a course of treatment. Or perhaps your doctor establishes a video link to the specialist, allowing you to receive an immediate consultation, diagnosis, and treatment plan.
    It will be some time before such scenarios become commonplace because a number of legal, financial, and ethical issues need to be worked out first. But telemedicine—the use of telecommunication lines to transmit medical information—is one of the fastest growing and most quickly evolving US industries, according to Jon Linkous, former executive director of the American Telemedicine Association.

    Benefits for Patients

    "Telemedicine expands the potential for patient choice," says Linkous. Not long ago, telemedicine was used mainly to facilitate the exchange of information between doctors and medical institutions. As the technology improves and becomes more accessible, new avenues of diagnosis, monitoring, and treatment are opening up. In fact, Medicare does reimburse for telemedicine services, Linkous says, and government grants are available for the establishment of telemedicine networks.
    Here are the highlights of how people are benefiting from telemedicine:
    • Patients in rural and underserved communities gain access to quality healthcare.
    • Technological advancements enable emergency responders to transmit more and better information from emergency vehicles to emergency room personnel.
    • Video links between medical institutions and nursing homes or patients' homes provide caregivers and patients with immediate access to doctors.
    • Monitoring devices allow homebound patients to transmit their heart rates, blood pressure, glucose levels, and other important data from their homes to their doctor.
    • Correctional facilities can also use telemedicine to avoid transporting a prisoner to a doctor's office.

    Helping People at Home

    Woodrow Kessler, MD, PhD, has been involved in the development of telemedicine for more than two decades. Kessler opened an office, staffed by a nurse, in a suburban Philadelphia shopping mall where he would see his patients via a two-way video/audio link from his primary office several miles away.
    Kessler has been involved in developing telemedicine programs in underserved areas, as well. He relates the story of a rural Kentucky man with diabetes who suffered repeated hospitalizations. The staff sent him home with a televideo unit to monitor him at mealtimes. Upon seeing his meals, medical personnel discovered that the man was not eating right. After receiving training in managing his diet, the frequency of his hospital visits dropped.
    Kessler also cites the case of a South Carolina mother whose child was born with a cleft palate, a condition that requires special feeding techniques. By establishing a video/audio link in the mother's home over which she received training in these techniques, the baby was able to leave the hospital earlier than would have been possible otherwise.

    Helping People Abroad

    Telemedicine has also rescued travelers who have become ill far from home.
    Daniel J. Carlin, MD, is the founder of World Clinic, a global telemedicine practice based in Massachusetts. A patient of Carlin's was vacationing in the Azores when she developed a yeast infection. She did not speak Portuguese, nor did she know where to go for help. She contacted Carlin by satellite phone. He reviewed her record, interviewed her about her symptoms, and told her to check her e-mail in half an hour. In the meantime, he went to his database, located a pharmacy in her area with the appropriate medicine in stock, prescribed it, and obtained directions from her hotel to the pharmacy, which he then e-mailed to her.
    In another instance, Carlin downloaded from the Internet and e-mailed an anatomical drawing of the ear, along with instructions, to help a ship's captain do a procedure on a crew member whose ear was badly infected.
    "The trick is to identify the resources available and connect patients to those resources," adds Carlin.

    Understanding the Risks

    As patients use the Internet to find health and medical information, both Carlin and Linkous warn that consumers should be careful. "You don't always know what you are getting," Linkous says. "Stick with information from trusted sources that are known entities." And share any information with your doctor before acting on it.
    On the Internet, you can get prescriptions filled and even visit virtual doctors' offices. But Linkous warns, "There is not enough being done yet to create standards and guidelines. This is an international issue that is still very much in the 'buyer beware' category. I personally wouldn't do it right now."
    Carlin warns that consumers should not view Internet medicine as a way to avoid the hassle of medical appointments. For now, doctor's visits—no matter how inconvenient—are still a more established method of treatment than Internet medicine. "Healthcare is not always convenient," he says. "You have to make the time."

    Looking Forward

    "Telemedicine is going to fundamentally change the way medical care is delivered," says Linkous. "Patients love it, the cost savings have been significant, and its efficacy has been proven." But doctors, he says, are somewhat reluctant.
    "Physicians who are late responders to the technology will start to be won over after they see just one benefit," says John A. Coller, MD, director of the Ambulatory Surgical Research Center and Telemedicine Initiative at the Lahey Clinic in Burlington, Massachusetts.
    Conferences and seminars addressing telemedicine are offered, and some medical schools cover the subject in classes. As insurance companies see documented efficiencies, they too will hop on the bandwagon.
    As time goes on and the financial, legal, regulatory, and ethical wrinkles facing telemedicine are ironed out, Coller predicts that it will open up access to medical care and improve efficiency.


    American Telemedicine Association http://www.americantelemed.org/

    National Rural Health Resource Center http://www.ruralcenter.org/


    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    Ontario Telemedicine Network http://www.otn.ca/


    Frequently asked questions (FAQs). Telemedicine.com website. Available at: http://www.telemedicine.com/faqs.html#Q4 . Accessed September 14, 2011.

    Medicare payment of telemedicine and telehealth services. American Telemedicine Assocation. Available at: http://www.americantelemed.org/files/public/policy/Medicare%5FPayment%5FOf%5FServices.pdf. Published 2008. Accessed September 14, 2011.

    Telemedicine 101. Telemedicine Information Exchange website. Available at: http://tie.telemed.org/default.asp . Updated January 2005. Accessed July 21, 2009.

    Telemedicine defined. American Telemedicine Association website. Available at: http://www.americantelemed.org/i4a/pages/index.cfm?pageid=3333 . Accessed September 14, 2011.

    World Clinic website. Available at: http://www.worldclinic.com/ . Accessed September 14, 2011.

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