However, long before modern telecommunications, African villagers used smoke signals to warn people away from villages where diseases were present. A century ago, Australians living in remote areas used two-way radios powered by bicycle pedals to communicate with the Royal Flying Doctor Service of Australia. In other words, telemedicine has been around much longer than most people realize.
Today, telemedicine uses information technology and telecommunications technology to provide clinical healthcare from long distances. Patient consultations can be done using video conferencing, transmission of still images, and wireless devices and applications. Telemedicine eliminates physical distance barriers and provides services to people who may not otherwise have access to them due to lack of specialty care or living in a rural area. Delivery of telemedicine primarily uses the following technologies:
- High speed network lines linking outlying clinics to centralized providers of general and specialist medical care
- Point-to-point high speed connections for delivery of remote services or outsourcing of specialty services like radiology and mental health services.
- Landline or wireless monitoring center links for cardiac, pulmonary, and fetal monitoring
- Online e-health patient service sites that provide direct patient care
Services Telemedicine Can Provide
Primary and specialist medical care and referral can be delivered by telemedicine through live interactive video, or transmission of diagnostic images, recorded video, or vital signs collected remotely. Patients can be remotely monitored as well, sometimes in their own homes, using devices that collect and send data to home health agencies or remote diagnostic test facilities. Data collected may include vital signs, EKG data, or blood glucose levels. Data collected remotely supplements the services delivered by visiting nurses.
Consumer health information can be delivered via internet or wireless devices in the form of peer-to-peer support groups and online discussions. Continuing medical education credits can also be provided through web portals for healthcare professionals and for those undergoing specialist medical education in remote areas.
What Is Telenursing?
Telenursing is a type of telemedicine that delivers nursing services at long distances. It is becoming more prevalent because of interest in reducing costs of healthcare, as well as increases in aging and chronically ill populations. It is one way that communities cope with nursing shortages, and such services can help keep patients from having to be hospitalized.
Telenursing can also be used in home healthcare. Patients who live in remote areas who are immobilized or have chronic illnesses can remain at home and videoconference with nurses over the internet. Telenursing can be used to deliver after-care after patients return home from having had surgery, and allows nurses to visit more patients per day compared to home health nurses who have to drive to individual patient homes.
What Is Telerehabilitation?
Telerehabilitation is telemedicine that delivers rehabilitation services at a distance using telecommunications devices or the internet. Types of telerehabilitation include:
- Speech-language pathology
- Occupational therapy
- Physical therapy
Typically, webcams and video conferencing are used in telerehabilitation delivery, though some telerehabilitation modalities can be delivered using wireless or online apps. Telerehabilitation allows for things like fitting patients for braces, wheelchairs, and artificial limbs. Teletherapy for cognitive skills enhancement can also be delivered remotely to school children in need of these services. Some telerehabilitation programs are federally funded through the Veterans Administration, the Department of Health and Human Services, and the Health Services Research Administration.
Benefits of Telemedicine
The American Telemedicine Association (ATA) lists four main benefits of telemedicine:
- Better access to healthcare for those in remote locations
- Containment or reduction in healthcare costs for managing chronic diseases by reducing staffing needs, cutting travel necessity, and shortening hospital stays
- Quality of care equal to that given in traditional in-person consultations. In some cases, like mental health and intensive health, telemedicine has shown even better patient outcomes than traditional care.
- Addressing consumer demand for healthcare delivery with less travel time and associated stress.
Other benefits include reduction of need for outpatient visits through remote patient monitoring, and better medical education for professionals in remote areas, who can more easily observe experts and learn best practices without having to leave their community for training. A practical benefit of telemedicine is reduction or elimination of transmission of certain infectious diseases, particularly drug resistant staph infections.Disadvantages of Telemedicine
Perhaps the main disadvantage of telemedicine is the high up-front cost of telecommunications and IT equipment, as well as the cost of training the medical professionals who use the technology. Telemedicine also carries the risk of compromise of protected health information through mistakes with electronic storage management and data transmission.
In some cases, telemedicine interactions take longer than an in-person consultation. For example, dermatologists can diagnose some skin conditions in around 15 minutes in person, whereas performing a diagnosis remotely can require longer, due to the limitations of video image resolution. Telemedicine can also mean patients cannot start treatment immediately, as they might in an outpatient or hospital setting, due to lack of specialty medications or supplies.
The Future of Telemedicine
Federal legislation concerning telemedicine has mostly been cobbled together rather than being passed in bolder legislative moves. The 2014 National Defense Authorization Act, which was signed by President Obama in January, expands telemedicine services for military members coming off deployment and specifically focuses on mental health services to soldiers suffering from post-traumatic stress disorder. Another bill was introduced in the House of Representatives requiring Medicare to cover telemedicine services, but it has not been passed. Some states, however, have passed laws requiring Medicaid to cover telemedicine consultations.
More than 36 million Americans have already made use of telemedicine in some form, and as many as 70% of doctor visits could be handled over the phone, according to a study by the Affiliated Workers Association. New applications for telemedicine are expected as technology continues to evolve rapidly.
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