What is Telemedicine?
In the early 1960s, clinicians, health service researchers, and others began investigating
the use of advanced telecommunications and information technologies to improve
the delivery of health care. Today, telemedicine is a combination of advances
in medical technologies; the use of computers; the use of databases to store and
retrieve information ("Informatics"); high-speed telecommunication facilities; and mainstream
medical procedures. Telemedicine is the use of electronic information and communications technologies
to provide and support health care delivery by connecting patients and health
care providers who are separated by long distances.
Telemedicine Has Many Uses
Telemedicine can serve patients in many ways, from interacting with dermatologists
or psychiatrists over a video conference call to monitoring chronic diseases
in a patient's home, such as diabetes or congestive heart failure.
Many hospitals offer public health awareness information through hospital-based
medical web sites. And many health providers have partnered with cable television
to offer extensive public service programming on health care issues. Hospitals and outreach clinics routinely use their in-house telecommunications
networks to provide routine consultation services and continuing education training
on new medical procedures for their staff, and to improve administrative processes.
In some hospitals, patient medical information is now instantly available through
laptop computers and other electronic devices that have a wireless connection
to hospital networks and the Internet. Emergency vehicles are often enhanced by onboard computer systems that use Geographic
Information Services Technologies to direct ambulances to the patient by using
satellite coordination, software programs, and wireless technologies. These
state-of-the-art ambulances can instantly access patient information and allow
emergency personnel to talk directly with physicians while the patient is en
route to the hospital.
Delivering health care services through telecommunications technologies is far
from routine in everyday medical practice. However, hospital administrators
are embracing telemedicine services as a way to improve health care services
within their service area and to expand services beyond their traditional service
area. Using telecommunication services to provide health care to geographically
hard-to-serve areas can improve hospitals' financial stability, especially
in a time of budget cuts and constraints.
Best Potential Uses for Telemedicine Services
The Appalachian Region does not have many health networks in which hospitals
are affiliated with clinics, primary care centers, nursing care facilities that
provide comprehensive health care services. As a result, the Region's
health care system is fragmented and hospitals often do not communicate with
one other about patient care issues.
Access to specialty care, database information services, and continuing education
for health service providers could greatly improve the quality of health care
in Appalachia. The overall quality of health care has been significantly improved
in rural parts of the United States where telemedicine services have been integrated
into the health care delivery system.
Four
Issues for Administrators and Health Service Providers to Consider Before Establishing
Telemedicine Services
1. Standards of practice in the use of telemedicine.
Thirty years of evaluation and research have led to specific standards of practice
in place across the country that outline how, when, where, and under what circumstances
patient care can be delivered through telecommunications technology. Standards
of practice include the type of equipment to be used in the consultation and
how the equipment is to be maintained to ensure that it works properly. Standards
of practice also include the proper procedure(s) for clinicians to use during
a telemedicine consultation.
2. Telemedicine services are generally limited to the state in which the service
provider is licensed to practice.
Telemedicine challenges the traditional practice of face-to-face patient care.
Because the service provider can be located anywhere, the issue of public licensure
directly affects the delivery of health care services. That is, a doctor licensed
to practice in one state cannot participate in a telemedicine consultation with
a patient located in another state.
Many large medical practices that operate across state boundaries or across
the nation, such as the Mayo Clinic, require that certain members of their clinical
staff have licenses in all states in which they provide service. Additionally,
numerous states across the country have changed their medical licensing criteria
to include services that are facilitated by telemedicine.
3. Privacy, confidentiality, and patient information security are critical issues.
Hospitals wanting to offer telemedicine services need to establish clear internal
guidelines for medical procedures to ensure patient confidentiality. Important
security and privacy issues to consider for a telemedicine consultation include:
who presents the patient and the patient's medical information; how and
if the consultation is recorded and how is it stored; and who can see and use
recorded information. To increase the adoption of telemedicine services throughout
the country, many hospitals are sharing internal procedures with one another.
4. Physician consultations, telemedicine equipment, and the cost of telecommunication
services are still not fully reimbursed.
Over 35 states have enacted laws that enable health care providers to be reimbursed
for certain types of telemedicine consultations that are billed to the state
Medicaid program. Many insurance providers routinely reimburse for specific
types of telemedicine services, while other companies are considering reimbursement
only for demonstration programs. The federal government's Medicare program
is also reimbursing health care providers for some services on a demonstration
basis.
Physicians can often use their patient visit charts to indicate to certain
service providers or reimbursement companies (for example, Blue Cross, Kaiser
Permanente, Medicaid, Medicare, etc.) that the patient visit was conducted through
telecommunication services.
However, telemedicine equipment can be costly to purchase and maintain, and
the monthly costs to operate a system can be expensive. In many instances, a
hospital budget simply cannot accommodate a program where reimbursement for
services may not be possible.
ARC's Telemedicine Programs Over the last 13 years, ARC has funded a number of telemedicine programs that
include traditional service delivery from hospitals, improvements in emergency
services, criminal justice telemedicine services, and in-home care services.
These telemedicine projects are usually part of a community's overall
program for improving telecommunications and serve a number of areas of the
community, such as education, government, and the private and health sectors.
Emergency Services in Pickens County, Alabama, Get State-of-the-Art Technology
In Pickens County, Alabama, emergency services, including fire, police, and
emergency health services, are now state-of-the-art, thanks to the installation
of wireless telecommunications equipment in 25 emergency vehicles. Nearly 5,000
calls a month are routed through the county's communication center, which
sends the appropriate vehicle to the exact location using Geographic Information
Services software and wireless technology. It is estimated that the new dispatch
system will increase response time by 25 percent and reduce the number of deaths
by 10 percent. The system will also help to coordinate fire, police, and emergency
services throughout the county. Additionally, the FCC will certify the new emergency
service as compliant with industry standards. Creating a Virtual Pediatric Center in Binghamton, New York
In northeastern New York State, 11 medical sites are being equipped with telemedicine
technology to create a virtual pediatric center that will serve Broome, Chenango,
and Delaware counties. Most of the families in these counties face extreme poverty,
poor or nonexistent transportation, and insufficient health care. The telemedicine
equipment will enable 46 physicians, physician assistants, and nurse practitioners
to deliver health services to an estimated 132 children, who can thus receive
better medical care, including better diagnosis and improved access to specialists.
The telecommunications network that will support the 11 sites will also be used
for continuing education for medical staff and to retain medical professionals
in the area.
ARC and the Federal Communications Commission To Offer Telemedicine Workshops
in 2004
Beginning in early 2004, ARC, in conjunction with the FCC and other federal
agencies, will offer a series of workshops throughout the Region on how telemedicine
programs can be funded, how the FCC's Universal Service Health Care program
can underwrite the telecommunications monthly line costs, and how to file applications
for federal support.
ARC will publish information on these workshops as soon as it is available.
Check Telecommunications News and Events for updates.
Related information:
Telecommunications
Sources of Funding
Best Practices
Examples of ARC Telecommunications Projects
Research and Data
News and Events
Frequently Asked Questions
Spotlight on Telecom Issues
Directory of Telecom Resources
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