Sarah Neller, PhD Student
College of Nursing | University of Utah
Imagine living in a place where it was difficult to access
healthcare, where specialty healthcare providers refused to practice, and where
it was more than 50 miles to the nearest hospital. This may seem like a remote
possibility, but it’s the reality for many Americans who live in rural areas.
Access to care continues to be a challenge that divides socioeconomic strata
and creates disparities that could be reduced with appropriate access.
Telemedicine is one avenue that can bridge the gap to reach those around the
world who otherwise would not receive appropriate care.
What is telemedicine
and how is it different from telehealth?
You may be asking yourself, “What’s thedifference in telehealth vs. telemedicine?” A
lot of entities use these terms interchangeably, so if you’re researching the
topic, it’s important to determine how the article or entity defines their
terms. Telehealth is really an overarching term
that encompasses all parts of health or anything related to healthcare that is
mediated through technology – this can include non-clinical services including
training, continuing education, even health advice, like talking to a health
coach online through your insurance company.
rmmagazine.com
Telemedicine on the
other hand, is a subset of telemedicine that involves clinical services
mediated through technology – think anything that would involve the EHR or
seeing a provider – physical assessment, diagnosis, and ordering of labs,
tests, and treatments.
History
of telemedicine
The history of
telemedicine trackswith the development of communication over time. In ancient
times, signals like smoke and light were used to communicate plague outbreaks.
Inventions of the telegraph and telephone were early mediums of telemedicine.
In the 1950s, specialties like radiology and cardiology began to use telemedicine
as we know it today to transmit medical data such as x-rays and
electrocardiograms (EKGs). The growth of the internet has allowed for continued
development of telemedicine capabilities including virtual office visits, like
those projected by this Jetsons cartoon from 1962, because it allowed for
easier and cheaper applications.
How is telemedicine
delivered?
There are many different modalities of telemedicine. It can
involve a patient to provider interaction or provider to provider interactions.
Note that these interactions can go both ways (though it’s important to note
that the patient’s primary provider does need to obtain consent from the
patient before sharing information with the consulted provider to comply with
HIPAA laws). These interactions can occur synchronously, which is in real time
or asynchronously, which does not occur in real time. Examples of synchronous
interactions can include “office” visits, which are mediated through technology
like video conferencing, and asynchronous interactions could involve messaging
through an electronic health record (EHR) portal or even communication with
wearable patient monitors like pacemakers, Holter monitors, etc.
Benefits and uses of
telemedicine
Uses: There are multiple uses for telemedicine including telestroke,
teleresuscitation,
and telehealth emergency
care. Additionally, specialties like stroke, cardiology, dermatology,
psychiatry are well suited for telemedicine. New York Presbyterian Hospital offers virtual OnDemand urgent care visits,
so you can access a provider from the comfort of your living room.
Benefits: There are so many benefits to telemedicine
including increased access to high quality health care from primary care and
specialty providers, increased patient engagement with the healthcare system
(largely because they now have increased access to it), and fewer costs related
to transportation and time off work. It also offers convenience which can
improve patient’s ability to initiate care and maintain ability for follow-up
care if needed. Multiple
studies have shown that telemedicine aids to lower
hospital readmission rates for certain conditions. Through telemedicine
consultations, patients in rural areas are able to stay in their communities
for treatment rather than be transferred to a larger medical center for a
higher level of care. This is beneficial to the patient because it prevents
transfer to the big city and keeps them close to their family support system,
and it’s beneficial to the community because it can help keep the rural
hospital open, which preserves access to care and maintains jobs. In short, it
makes healthcare easier for the patient!
Challenges: What’s
the hold up?
So why isn’t telemedicine an option everywhere? What’s the
hold up? First of all, not all
specialties are suited for telemedicine. Telemedicine should not be used when
an in-person exam is required due to high acuity, when there is a language
barrier without available interpreter, or when the health care worker on the
patient side does not have enough training or experience to aid the remote
provider. It is frequently not implemented due to perceived high cost of
implementation, provider hesitancy, or state policy.
A changing trend in
healthcare
Telemedicine has opened the doors to the ability to deliver
healthcare in new and innovative ways around the world. Mobile health units are
a way that telemedicine has been able to be utilized in remote areas around the
globe, during disasters,
and in the fight against opioid
abuse. Patients are now able to connect to their health care provider from
the comfort of their own home or own community. In the 115th
Congress, there have been 1 Senate bill and 2 House bills related to
telemedicine that have been passed since December 2017. There are 15 Senate
bills and 28 House bills related to telemedicine that are pending for this
congressional session. As funding increases and regulation improves,
telemedicine will quickly become a recognized standard of care that will improve
affordability and accessibility for patients across the globe.
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Telemedicine Association. (2017). Telemedicine/telehealth bills in the 115th
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