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Healthcare - Telemedicine

Telemedicine is a growing field made possible by improved, more widely available, and affordable telecommunications services. Once narrowly defined as direct provision of medical services using telecommunications technology, the term telemedicine is now being supplanted by "Telehealth", and covers "use of electronic information and communications technologies to provide and support health care when distance separates the participants" (US Veterans Administration) or "use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration" (Office for the Advancement of Telehealth, US Health Resources and Services Administration).

These definitions include activities providing direct and indirect clinical services such as teledermatology, but also include educational and administrative uses of these technologies to support health care, such as for continuing education or administrative videoconferencing. As convergence of video, voice and data networks occurs in the marketplace, it is not surprising that services previously offered on multiple media are now migrating to converged Internet, providing opportunities for convergence of a number of health care activities occurring at a distance.

Brief history of Telemedicine/Telehealth
The earliest recorded use of telemedicine was a 1950's Nebraska demonstration project using closed circuit television to provide mental health services from a university medical center to a state hospital 100 miles away. Forty years ago the NASA space flight telemedicine program began so that medical personnel on the ground could monitor astronauts' biomedical responses to space flight and to provide any necessary medical care. NASA's "Telemedicine Space Bridge to Armenia" Project provided medical assistance in response to a severe earthquake in Armenia in 1988. Using a live, two-way satellite link medical personnel at hospitals in Salt Lake City, Houston Texas, and Maryland conducted many sessions with Armenia physicians for a variety of medical consultations. Due to the enormous expense of these pioneering efforts it is only within the last ten years that the practice of telemedicine has begun to move from pilots to public availability.

Current Practice of Telemedicine
Remote clinical diagnosis via videoconferencing is currently used in some rural areas. A rural doctor or nurse practitioner consults with a physician based at a metropolitan or university hospital. Using videoconferencing technology and specially adapted medical tools, the remote doctor can see the patient, talk with the local health care practitioner, hear a heartbeat through a remote stethoscope, see images from ear/nose/throat exams, or examine skin conditions. This application has typically required leased T-1 telephone or ISDN lines, which can be quite expensive. Due to a number of issues (cost effectiveness, patient/physician acceptance of the technology, licensing and payment issues), the most common use of such facilities has been to provide health care to prisoner populations. Prisoners have a legal right to receive needed medical treatment, but the cost of transporting a prisoner to a medical facility is extremely high since at least two guards and possibly and ambulance are required for transport during trips requiring an entire day. This high transport expense has provided cost-justification for telemedicine in states such as Virginia and Texas.

A notable pioneer in broader acceptance of telemedicine can be found at the East Carolina University's Telemedicine Center. Their telemedicine program employs an array of interactive video and audio technologies to deliver clinical care and education to the rural population of eastern North Carolina. Since 1992, the Center has supported over 7,500 telemedicine consultations in over 35 different medical specialties, and over 10,000 distance learning and continuing medical education activities. ECU's Telemedicine Center includes an operational communications hub providing connections between points of need and global medical resources utilizing POTS, ISDN, T-1, Microwave, Satellite, and IP technologies.

The US Veterans' Administration (VA) has had a number of clinical telemedicine programs, including teleradiology/filmless digital imaging, telepathology, telenuclear medicine (MRI), home telephone monitoring of cardiac pacemakers, telephone liaison care programs, and more.

NORTH Network in Ontario Canada runs an extensive H.323-based telehealth service for remote hospitals and clinics in the northern parts of the province. They use a private IP network (dedicated to health care applications) to link over 60 sites in the north to large urban teaching hospitals. They currently facilitate hundreds of videoconference enabled consultations per week as well as running an extensive educational "broadcasts" using the same technologies. They've avoided the typical billing problems for remote consultations by getting a special government grant that allows them to directly pay consulting physicians.

NASA is designing a highly portable Telemedicine Instrumentation Pack (TIP) to collect medical audio, video and data from the patient in space.

In an effort to push the field of telemedicine forward significantly, the National Library of Medicine in 1996 awarded 19 multi-year telemedicine projects intended to serve as models for evaluating the impact of telemedicine, assessing various approaches to confidentiality in telemedicine, and testing emerging health data standards. A symposium summarizing activities in and results from this program was held in March 2001, and proceedings are available on-line.

Any type of medicine to any rural area and to any entity that had participated in a Federal telemedicine demonstration project (for example, Veterans Administration Hospitals, even in urban areas). The practice of medicine across state lines is severely restricted by current laws.

Source: © 2004-5, Video Development Initiative.

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