During the past 40 years, experts in technology, telecommunications, and medicine have collaborated on numerous demonstration projects that have documented the efficacy and efficiency of telemedicine. Today, this research is paying dividends in the form of a variety of telemedicine projects and applications that are enabling physicians to provide healthcare services to patients located anywhere from 100 feet to 10,000 miles away. Telemedicine has moved beyond the demonstration stage, with many applications starting to be integrated into daily practice in a variety of settings from large hospitals to private physician offices to direct use by consumers.
It’s easy to describe the benefi ts of this new technology in broad, sweeping terms. However, examples of specifi c applications and their results can best demonstrate how telemedicine is beginning to transform the delivery of healthcare.Medical Imaging
Teleradiology is a means of electronically transmitting radiographic patient images and consultative text from one location to another. Teleradiology represents, by far, the most widespread use of telemedicine today, and for good reason; due to an ongoing shortage of radiologists and increased use of medical imaging, a critical need exists to use such effi cient applications as teleradiology to meet demand. Once considered merely an interesting demonstration of the technology, today several hundred US hospitals use teleradiology services, allowing radiologists to work from home or the hospital to outsource certain imaging services.
One growing element of remote radiology services is the use of internationally based companies to provide after-hours (sometimes
called “nighthawk”) services. Th e companies employ radiologists in such locations as India, Switzerland, Australia, France, and Israel to provide US hospitals with needed services.Children’s Services
According to a report published by the Agency for Health Care Research and Quality and the Harvard School of Public Health
, in 2000, 37% of hospital stays for children across the US were paid by Medicaid, with respiratory conditions the most frequent
diagnosis for one to nine year-olds. Remote monitoring can significantly reduce this problem, as the following example illustrates.
Researchers from the Army Medical Department
demonstrated that home telemonitoring of children afflicted with asthma can
significantly improve outcomes over traditional offi ce-based care. A group of “virtual patients” recorded vital sign data online (such as pulmonary functions) and submitted it online to their case managers weekly. These were compared to a control group receiving traditional care.
The one-year trial showed that children who accessed care through the Web-based case management system had better MDI/S scores, were more likely to keep a journal of daily asthma symptoms, and demonstrated a greater increase in asthma knowledge. The “virtual patients” achieved excellent asthma care, revealing that store-andforward technology combined with case management can provide an important tool to assist in disease management. The benefits of pediatric telemedicine were also explored by the University of Iowa College of Medicine, which conducted a study of specialized interdisciplinary team consultations for children with health and developmental disorders.
The study included four groups of children: those with severe behavior disorders, with swallowing disorders, needing assistive technology, and with unmet health needs—primarily traumatic brain injury (TBI). The results indicated a high degree of satisfaction between parents, children, healthcare providers, caregivers, and teachers. The telemedicine network provided access to high-quality healthcare and was a timesaver for both the providers and the family. The cost savings to the local school district equaled $971 per session. Th e travel and time costs to parents for out-of-pocket expenses equaled $125. As a result of the study, the telemedicine clinic for children with special needs was adopted as part of the regular clinical venue at University of Iowa Hospitals and Clinics and participating schools (Harper D, Journal of Telemedicine and e-Health
, June 2001).
Employer-Sponsored Health Plans
Incorporating workplace telemedicine for employer-sponsored health plans can yield a number of benefits, including:
• Increased patient convenience
• Increased employee productivity
• New employee peace of mind
• Increased efficiencies due to less actual patients in waiting room