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Who would have ever imagined that a doctor’s visit could be conducted through a phone-line, video, or the use of a computer 1000 plus miles away? Medical records can be view by another medical professional for a second opinion three counties away before you arrive. A radiologist in Singapore has diagnosis your femur fracture here in the United States. Medical diagnosis, treatment and consultations are being performed from miles away because of technology. It seems as if there is no limitation to the well being of a patient through a wide range of telemedicine services.
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What is telemedicine?
According to the American Telemedicine Association “telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status. Emails, videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telemedicine”.(http://www.americantelemed.org) This interactive form of medical services has provided healthcare to individuals many miles away or minutes away in the comfort of their homes, physician offices and hospitals.
Ways to communicate services
Store-and -forward is a means of transmission of medical information to other medical professionals and facilities that will provide the recipient pertinent medical history, vital signs, medical records, lab results and images. “Store-and-forward telemedicine systems have the ability to capture and store digital still or moving images of patients, as well as audio and text data. A store-and-forward system eliminates the need for the patient and the clinician to be available at the same time and place. Store-and-forward is therefore an asynchronous, no interactive form of telemedicine. It is usually employed as a clinical consultation (as opposed to an office or hospital visit)”. (http://www.ahrq.gov) One of the major concerns with store and forward is whether it is as effective as face to face medical visits, does it have comparable outcomes, is it appropriate for appropriate medical management, is the patient truly satisfied with the outcome and level of services and is it cost effective? There are several benefits of store-and-forward technology. Patients in rural areas are able to be seen by specialty physician miles away when there is limited access to the services in the area. The store-and-forward of medical information is also being used with emergency response teams to communicate the information to the emergency room staff for an efficient transfer of vitals and medical status. The store and forward technology is said to be the least expensive way to communicate and the most accurate in real time for patients at a distance needing medical consultation. Another type of store and forward technology is videoconferencing technology. The two way television allows two doctors in two different areas to communicate to provide treatment, a diagnosis, or telesurgery. There are several healthcare areas that benefit from telemedicine
Some of the common teleservices
Telemedicine includes several medical disciplines that benefit from the services. Services like radiology, dermatology, nursing, pharmacy, pathology, neurology and psychiatry. The need for a second opinion in healthcare has seen a demand, and the shortage of specialty doctors in rural areas increased. The development of telemedicine has benefited the patient in many ways because of technology.
Teleradiology- is the transmission of x-ray, CT, MRI, PET, and SPEC images that can be read by radiologist in another facility or country. The information is sent via the store and forward process of telemedicine. Large and small hospitals have began to use teleradiolgist to cut down on expense and having access to immediate diagnosis.
Teledermatology- is the use of video conferencing and store and forward images to provide a consultation for an individual that requires a dermatologist. There have been concerns with the consistency of this tyoe of visit for patients due to unclear images of the skin and the possibility of not having that face to face visual from the dermatologist to make an adequate diagnosis.
Telenurse- the use of phone, electronic email, videoconferencing, and computers to provide healthcare services or consultation to a patient. Telenusring has continued to grow in the areas of telephone triage for health insurance carriers. Telenursing has grown with interactive patient training related to changing wound dressings, insulin administering, self management of a patient’s health.
Many of the healthcare providers must follow certain guidelines to receive payment for telemedicine. According to Medicare “it’s condition for payment must include an interactive audio and video telecommunications system that is used and must permit real-time communication between the physician or practitioner at the distant site and the beneficiary at the originating site. The medical providers that are covered under this fee for payment are services rendered by a physician, nurse, physician assistant, midwife, clinical nurse specialist, or clinical psychologist.
The current list of Medicare telehealth services includes:
Office or other outpatient visits
Psychiatric diagnostic interview examination
End-Stage Renal Disease (ESRD)-related services
Neurobehavioral status examination
For ESRD-related services, at least one face-to-face, “hands on” visit (not telehealth) must be furnished each month to examine the vascular access site by a physician, NP, PA, or CNS. (http://www.cms.hhs.gov)
New Trends in telemedicine
Trends observed nationally include:
using telemedicine in correctional facilities and home health care settings, can significantly reduce the time and costs of patient transportation;
providing additional services to rural area
linking physicians together more efficiently
linking hospitals and schools together to improve care and widespread
With a growing population and healthcare on the rise many public and private medical providers have seen a cost reduction with the use of telemedicine and patients have benefited from the technology in telemedicine. Insurance providers are paying for less hospital in patient days because the patient can be monitored from a distance. The patients are able to communicate with a nurse or physician at home through phone, video, or Bluetooth monitoring. Telemedicine allows more freedom to the patient to feel less restricted to home visits, they have access to some providers 24 hours a day and it cuts down on their travel time to medical visits. The patient’s family has also displayed satisfaction from the use of telemedicine because it’s less strenuous on their travel time and loss of work days. Another benefit of telemedicine provides an outreach to rural areas to be included in clinical trial studies and procedures. The providers have also benefited because they are able to receive real time feedback from other professionals that are able to transmitted medical information quickly, decreased travel time, and continued patient education and communication.
Issues that need to be addressed
Education regarding telemedicine and it’s usage. There are concerns that many do not know that he services exist.
Cost and evaluation of the services. Will the cost for reimbursement be lower because there is no face to face contact? How will the affects of technology increase cost?
Liability and malpractice issues.
Out of state practices of medical professionals crossing their licensed boundaries. How will they be regulated and which state laws and rules will they be governed under?
Security is always a concern regarding information sent via phone and internet lines. Can medical information be protected properly and the doctors will be held liable for the misappropriation of a patient’s medical information. Although there are HIPPA laws regarding patients privacy according to ORTCC “it’s much more difficult to guarantee confidentiality because several individuals outside the traditional medical team. The transmission procedure requires technical staff at both ends. In small communities, it is possible that the patient knows the nonmedical personnel socially, compounding the sense of loss of privacy. Thus, the nature of the doctor patient relationship changes dramatically with telemedicine, challenging traditional concepts of privacy and confidentiality”. (http://www.ortcc.org)
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With technology making waves telemedicine has been able to grow through leaps and bounds allowing those that are limited and restricted to receive the medical attention of medical professionals. Physician has gain quicker access to other professionals without sitting face to face, digital images, and audio files of heartbeats and fetal movements. The privacy, protection, reimbursement, malpractice, and governing laws are still a concern but the efficiency of communication to provide medical care is needed.
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