What is Telemedicine?
What is Telemedicine?
Telemedicine generally refers to the provision of clinical services from a distance. The Institute of Medicine of the National Academy of Science defines telemedicine as “the use of electronic information and communication technologies to provide and support health care when distance separates the participants.”
Telemedicine uses video conferencing technologies and electronic communications to allow patients at one site to have a visit with a provider at a different site. Sometimes the distance is a few miles - other times telemedicine connects patients and providers that are 1000's of miles apart.
The videoconferencing technologies used by telemedicine allows patients to see clinicians that are not at the same location. Videoconferencing allows the patient and doctor to see and talk to each other like a live television broadcast. The tools used by clinicians to observe and collect vital information, such as otoscopes and stethoscopes, have been adapted so the clinician and patient can see and hear as if they were in the same room.
What is the Difference Between Telemedicine and Telehealth?
Telehealth refers to a broader scope of services that includes telemedicine, but also includes other services that can be provided remotely using communication technologies. The federal Office for the Advancement of Telehealth, describes telehealth as including telemedicine and a variety of other services.
What are Some Telehealth Applications?
The applications for telehealth can be categorized into three types: clinical services, educational services and administrative support. Clinical service applications include primary and specialty care, support to ICU's, and chronic care monitoring. The second category, educational services, includes a variety of services that can be provided to both patients and clinical staff. The third category, administrative support, primarily consists of video conferencing applications that allow collaboration and meetings with multiple sites.
There are two basic approaches to providing telemedicine services. The first approach is live interactive where both the patient and provider site are available in real time and can communicate as though in the same room. Live interactive telemedicine is most like a regular on-site patient visit. Live interactive telemedicine is appropriate when the clinician needs to talk with the patient or when the clinician needs to observe motion or other characteristics of the patient. There are many telemedicine applications that can use live interactive telemedicine. In California, live interactive telemedicine has been used for over 50 specialty services. The most commonly provided specialties are dermatology, psychiatry, neurology, ENT, orthopedics, pain management, endocrinology, urology and rheumatology.
The second technology approach, store and forward, is used when a face to face visit is not necessary. Store and forward systems allow a provider or technician at the patient site to capture diagnostic information using clinical instruments and send the digital image of the information to a clinician at a remote site. The remote site clinician retrieves the digital images, reviews them and sends a report back to the patient site. It is commonly used for dermatology, diabetic retinopathy screenings, radiology, and pathology. Store and forward allows specialists to review patient findings at convenient times without depending on the presence of the patient. Since there is no requirement to meet face to face with the patient, store and forward maximizes the time a clinician spends reviewing and reporting on findings.
Why are Telemedicine and Telehealth so Important in Our Healthcare System?
Telemedicine is emerging as a critical component of the healthcare crisis solution. Telemedicine holds the promise to significantly impact some of the most challenging problems of our current healthcare system: access to care, cost effective delivery, and distribution of limited providers. Telemedicine can change the current paradigm of care and allow for improved access and improved health outcomes in cost effective ways.
- Telemedicine increases access to healthcare:
- Remote patients can more easily obtain clinical services.
- Remote hospitals can provide emergency and intensive care services.
- Telemedicine improves health outcomes:
- Patients diagnosed and treated earlier often have improved outcomes and less costly treatments.
- Patients with telemedicine supported ICU's have substantially reduced mortality rates, reduced complications, and reduced hospital stays.
- Telemedicine reduces healthcare costs:
- Home monitoring programs can reduce high cost hospital visits.
- High cost patient transfers for stroke and other emergencies are reduced.
- Telemedicine assists in addressing shortages and misdistribution of healthcare providers:
- Specialists can serve more patients using telemedicine.
- Nursing shortages can be addressed using telemedicine.
- Telemedicine supports clinical education programs:
- Rural clinicians can more easily obtain continuing education.
- Rural clinicians can more easily consult with specialists.
- Telemedicine improves support for patients and families:
- Patients can stay in their local communities and, when hospitalized away from home, can keep in contact with family and friends.
- Many telehealth applications empower patients to play an active role in their healthcare.
- Telemedicine helps the environment:
- Reducing extended travel to obtain necessary care reduces the related carbon footprint.
- Telemedicine improves organizational productivity:
- Employees can avoid absences from work when telehealth services are available on site or when employees can remotely participate in consultations about family members.
- These examples illustrate the some improved outcomes and cost savings being achieved by telemedicine and telehealth programs:
- Home monitoring of chronic diseases is reducing hospital visits by as much as 50% by keeping patients stable through daily monitoring.
- The national average for re-admission to hospitals within 30 days following a heart failure episode is 20%. Telehealth monitoring programs have reduced that level to less than 4%.
- Timely provision of treatments that effectively reverse the consequences of a stroke have risen from 15% to 85% due to the availability of telestroke programs.
- Telemedicine support to Intensive Care Units (often called eICUs) is reducing mortality rates by 15 - 30% and substantially reducing complications and length of stay.
- Telemedicine retinopathy screening programs support early identification of serious eye disease and reduce the incidence of blindness in diabetic patients.