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Telemedicine Bringing Doctors and Patients Together

Medicine will never be the same again. And it's all thanks to communications technology.

A big distance between a doctor and patient is becoming less of a barrier to the delivery of medical care. Telemedicine is the reason.

Telemedicine is the use of telecommunications equipment by medical professionals who are located some distance away from their patients. Doctors can examine patients electronically, and transfer X-rays and other medical files.

Telemedicine started with doctors simply consulting and advising each other over the telephone. Advances in technology now allow doctors to virtually enter an examination room anywhere in the world through live, interactive systems.

There are many benefits of telemedicine. Patients with unusual ailments can get the advice of distant specialists. Patients in remote areas can get medical advice without traveling.

Such "telediagnosis" can save time and money. It can also save physical and emotional stress for patients. People who aren't able to move around easily, such as the elderly, can be monitored without leaving their homes.

"Telemedicine has been around for about 40 years, but in the last five years it's been exponentially growing in all sectors," says Jonathan Linkous. He's head of the American Telemedicine Association.

"And this has been growing for a number of reasons," Linkous says. "One, the cost of telecommunications and the cost of technology have plummeted in the last few years. [High-speed Internet] has started to be available to a much larger area of people, not just in the United States, but across the world.

"And some of the applications have become [much smaller] and made cheaper," he adds. "We have the high end, which are the applications, for example, for remote intensive care unit monitoring or robotic surgery. But then you have some very simple applications for the cell phone that you can download."

Decreasing costs aren't the only factor behind telemedicine's growth.

"The other aspect is certainly the understanding of how to do this -- how to provide health care remotely and how this integrates with the regular health-care system," says Linkous. "[This understanding] has matured as time goes by."

New uses for telemedicine are constantly being developed. We've only seen the tip of the telemedicine iceberg. The potential is huge.

"We're not even at 50 percent," says Linkous. "We're not even at 10 percent, I would say. We're really at the beginning stages."

"I don't think it's widespread near as much as it needs to be," says Debbie Voyles. She's director of telemedicine at Texas Tech University's Health Sciences Center.

"At the Health Sciences Center here, we actually started doing telemedicine in 1990, which was when we saw our very first patient. And it really hasn't grown very much until the last couple years," she says.

"Other than the military, the other biggest users of telemedicine over the years have always been from academic medical centers," says Voyles. "But in the last two years, I've seen a lot of growth in private hospitals [and] private practice physician groups seeing the benefits of being able to reach their patients through telemedicine... so they can expand their coverage area, basically, without having to set up satellite offices in different places.

"So, over the last few years, it has grown. But I don't think we've even begun to tap the full potential of what telemedicine can do," Voyles adds. "And as we've run into more and more need for physician coverage with the physician shortages that we're having, I think it's going to become just that much more important to figure out how to incorporate the telemedicine technology to be able to reach people, especially those that are out in rural communities or in inner cities."

"It still feels like it's early days -- days full of opportunity if you happen to be a student," says Dr. Edward Brown. He's head of a telemedicine network. "Certainly we've come a long way, and there's enormous growth in the area, but we just feel like there's so much more that we could do to improve health care.

"There's a whole bunch of reasons that [telemedicine] is becoming more used," he says. "Number one is distance and access to care. A lot of rural areas have long distance travel to see a health provider, particularly a specialized type of health provider.

"There's also [an uneven distribution] of health providers, so you may live in a city or town that has enough health providers but not a particular specialty that you need, and telemedicine is a way to get there," he says.

"It also is a great way to access scarce resources -- those sub-specialists who are expert in a specific area," he adds. "This is a way for them to reach out and spread their expertise in a greater geographic area."

Telemedicine is not just about convenience. It can mean the difference between life and death.

"There are a lot of emergency services that you simply wouldn't be able to get if you didn't have access to telemedicine," says Dr. Brown. "One of the big ones for us is called Telestroke, where a stroke specialist can provide advice to a patient in an emergency department within three hours of that stroke. They can advise on whether to give a client a clot-busting drug or not, which can be life saving. You just wouldn't get services like that without telemedicine."

"Telehealth" is closely related to telemedicine. It's a broader term. While telemedicine is focused on diagnosis and management of patients, telehealth is also about prevention, education and health promotion. Telehealth includes continuing education for medical professionals on the web and information for the public.

The Cost of Telemedicine

At first, telemedicine can be expensive. All of that telecommunications equipment doesn't come cheap. And every month a facility or government network must pay for its telecom connection.

However, once the investment is made, telemedicine can save money because it can make things more efficient. Most importantly, it helps doctors and other medical professionals to more effectively treat patients, no matter where they are.

"At its core, it's a technology, so if you can't afford it, you can't do it," says Brown. "With the advent of better technology, with cheaper computers, with the Internet [and] cheaper telecom, certainly that's been a [motivator] to get people to use it, and it keeps getting less expensive."

Certain areas of medicine have started using telemedicine sooner, and more widely, than others.

"Some specialty areas of medicine are more aware [of telemedicine] than others, for example in radiology," says Linkous. "Remote reading of images in radiology has been around for many years. They call it teleradiology or just off-site imaging. And the majority of hospitals in the U.S. use some form of remote imaging services on a regular basis."

The Creation of New Jobs

Telemedicine doesn't just help medical professionals do their jobs. It is also creating new jobs.

"It's an interesting field because it's sort of a convergence of operations, technology and health care," says Brown. "And we need skill sets in all three of those areas to make a telemedicine network work.

"First of all, you need some technology folks to make it work, to set it up, to run it, manage it, figure out how to develop it. You need health providers who are trained and know how to do it. And... a lot of sites have what are called telemedicine coordinators, which are often nurses or other health professionals who have learned a special skill in how to manage telemedicine and how to manage patients who are presenting for telemedicine."

Voyles agrees that telemedicine is creating new jobs. "With the advent of electronic medical records and telemedicine, you've got to have people that have good computer be able to run the equipment, to do the electronic medical records [and] for data entry," she says.

There are also technology experts making external devices used for telemedicine, such as otoscopes (devices for looking into ears), stethoscopes, and general exam cameras.

"There are just not a lot of companies out there that are developing those, so they're pretty expensive," says Voyles. "We need more and more people to develop some of those so that we can bring the costs down. Because the biggest cost component of our telemedicine equipment is in those [external] devices."

There's no question that if you're considering a medical career, you can expect telemedicine to play a big role.

"Any new health-care professionals who are getting into the field need to be aware of [telemedicine] because it's going to become a part of medicine," says Linkous.

"Just like you needed to know how to use a stethoscope, or you needed to know how to use a heart monitor or an EKG, you're going to need to know how to use certain types of telemedicine, because it's going to be integrated in to almost every aspect of care."


Telemedicine Defined
A great overview from the American Telemedicine Association

Texas Tech University Health Sciences Center -- Center for Telemedicine
Texas Tech is recognized as a leader in telemedicine

Telemedicine Today Magazine
An online magazine about developments in the field of telemedicine

Telemedicine & Advanced Technology Research Center
An office of the headquarters of the U.S. Army Medical Research and Material Command

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