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What is Telemedicine?


The up-and-coming method of healthcare delivery is telemedicine. Also called eHealth, telehealth, and online medical consultation, telemedicine is the use of information technology and telecommunication to provide health care from a distance. This practice does away with the location barriers, improves access to clinical services, and saves lives.
 
Early forms of electronic and computer healthcare involved the use of radio and telephone technologies. In the 21st century, providers can offer several services by way of web cameras (webcams) and the Internet. Doctors now have advanced diagnostic methods delivered through patient-server applications, videotelephony, and telemedical devices. The various telehealth technologies allow for adequate communication between a patient and clinical staff, offering affordable, convenient, and confidential care methods (Sachpazidis, 2008).
 
Researchers find that Telemedicine is Cost-Effective and Beneficial
 
A recent report published in the Journal of Diabetes Science Technology found that an increasing number of patients with diabetes have difficulty obtaining health care. Lead researcher Dr. Levin (2013) found that telemedicine is a feasible, cost-effective service for diabetes treatment.
 
Over the course of five years, this team of investigators followed a group of patients with diabetes who resided on the island of Aeroe. Electronic patient record keeping and web-based monitoring was used to evaluate telemedicine for these patients. The doctors found that after teleconsultation, improvements were seen in areas such as blood pressure, lipid values, and glucose levels. The researchers concluded that interdisciplinary interventions could achieve superior results for diabetes treatment.
 
Advantages of Telemedicine
 
Other than provide immediate health services to patients in need, telehealth has many advantages. These include:
 
Cuts Down on Travel – This form of healthcare delivery is optimal for those who live in remote communities and rural regions of the world. Many specialists do not have offices in small towns and rural areas, so patients can receive care without having to travel extreme distances just to see a doctor for a few minutes. With devices such as hand-hand mobile units that allow healthcare providers to view and assess patients from afar, a doctor can evaluate someone as if they were right there in the same room with them. This remote form of monitoring reduces prescription medication costs by approximately 15 percent. This is done by cutting down on the number of outpatient visits, making patient drug administration easy to monitor, and ease of prescription verification (Vant-Haaff, 2009; Saylor, 2012).
 
Educates Healthcare Workers – Another advantage is that telemedicine is a useful educational tool, allowing experienced healthcare providers the ability to show and instruct medical students and healthcare staff in a distance location on efficient evaluation measures (ATA, 2012).
 
Patients Like It – Studies show that telemedicine is well-received by patients. This form of healthcare delivery is a better way to manage chronic diseases like diabetes mellitus, hypertension, hypothyroidism, erectile dysfunction, male pattern baldness, and shingles (ATA, 2012).
 
Permits Interactive Telemonitoring – In 1989, the MedPhone Corporation introduced the first interactive telemedicine system that operated over the standard land-line telephone. This allowed patients to who required cardiac care to be connected to providers who could diagnose and treat them. This practice was focused on the patient’s comfort and health, with subjective history being obtained by telephone. Additionally, the telemonitoring devices could organize diagnostic values such as heart rate, blood glucose, and blood pressure (Blyth, 1990).
 
Cost Effective – According to the American Telemedicine Association (ATA), telehealth reduces and contains the cost of medical services by better management of both acute and chronic forms of illness. This leads to less staff, reduced travel time, and fewer hospital admissions (2012).
 
Provides Better Care – Many studies on the ATA’s (2012) website show that telemedicine allows for improved quality of clinical services delivered. Most reports, particularly mental health and intensive care, telehealth delivers better outcomes and a superior product.
 
Categories of Telemedicine
 
There are numerous types of telehealth, but there are just three main categories:  remote monitoring, store-and-forward, and real-time interactive services. According to the ATA, these services are described as:
 
Remote Monitoring – This is also called self-testing or self-monitoring. Remote monitoring allows healthcare professionals to evaluate and follow a patient from a distance using various forms of technology. This system is mainly used for monitoring chronic conditions, such as heart disease, asthma, or diabetes mellitus. 
 
Store-and-Forward – The store-and-forward delivery system involves the obtainment of certain clinical data (diagnostic images, biosignals, hemodynamic values) and transmission of this information to the specialist or provider. Both parties do not need to be present for store-and-forward service, and this is used for dermatology, pathology, and radiology areas of telehealth. 
 
Real-Time Interactive – This delivery service provides real-time interactions between the doctor and patient, and involves telephone or webcam conversations, online communication via email or chat, and home visits. The provider can bypass the traditional face-to-face office visit and collect patient history and examination data using doctor-interactive methods (ATA, 2012).
 
Types of Telehealth
 
Nursing – Nursing services can be provided by way of telenursing, similar to telemedicine. This is a type of telehealth where the nurse uses the various technologies to diagnose, consult, and monitor a patient. This saves travel time, keeps patients out of the hospital, and provides care to those living in rural areas. Many believe that this could be the solution to the nursing shortage problem (eHealth Insider, 2005).
 
Rehabilitation – Called telerehabilitation, this is a form of delivering rehab services to patients. Areas of practice include speech-language pathology, occupational therapy, physical therapy, and neuropsychology. With online rehabilitation, patients do not have to travel to an outpatient care center, making this an optimal choice for those with disabilities and chronic illnesses. Therapists use webcams, telephones, videophones, the Internet, and videoconferencing to provide services. At present, there are only a few health insurances in the U.S. that reimburse for these services (Keaton, 2006).
 
Emergency Care – When you think of emergency care, you automatically think of a doctor administering cardiac defibrillation right after shouting, “Clear!” However, telemedicine is useful for provision of emergency care services. For trauma triage, telehealth providers can interact with the personnel at the scene of an accident via mobile devices or the Internet. Remote trauma physicians can assess the patient and develop a plan of care using this method. As for operating room services, trauma surgeons can consult on cases in remote locations using video or teleconferencing. The hands-on surgeon can receive directions from the distant provider, allowing for assistance and expertise advice for operative purposes.
 
Pharmacy – Telepharmacy is a growing field, where pharmaceutical services are provided to patients in rural locations where there is no local pharmacist. This service involves patient counseling, drug therapy monitoring, prior authorization with insurance companies, monitoring compliance. All this is done by videoconferencing and online medical consultation. Patients are able to receive online prescriptions without having to jump through hoops to obtain them. The way this works is that once a prescription is sent from the doctor to the base pharmacy, the pharmacist verifies it and enters the order into the computer system. The label is transmitted to the remote site, where it is added to the bottle via a “ADDS” worker. This is an authorized person who can access the medicine from a dispensing cabinet called ADDS. After this, the worker consults the pharmacist via videoconferencing for patient counseling (Clifton, 2003).
 
Radiology – One of the most useful forms of telehealth is teleradiology. This allows healthcare workers to send diagnostic images form one site to another. These include x-rays, MRI, CT, ultrasound, and PET scans, just to name a few. There must be an image sending station, a receiving area, and a transmission network system. Most radiologists now use this form of image transfer, and it allows for quick diagnosis and treatment. The computer on the receiving end must have a display screen of superior quality, and the Internet is used for communication between the two parties. No particular software is needed, only a digital subscriber line (DSL) and a functioning personal computer (Kontaxakis, 2006).
 
Cardiology – As mentioned previously, healthcare providers are using telecardiology methods to assess patients with heart problems and diseases. A system developed in 1975 allowed patients to send electrocardiogram (ECG) information from home to a central station in the intensive care unit of a hospital. This was done via telephone transmission, where the ECG output data was connected to the phone input using a modulator. This converted the rhythm into a high frequency sound. On the other end of the line, a demodulator reconverted this sound into a rhythm strip for interpretation (Indian Heart Journal, 1982). Now, doctors use electronic stethoscopes to record cardiac sounds (ATA, 2012).
 
Dermatology – The use of telehealth in the field of dermatology is now common practice. With teledermatology, doctors can assess skin conditions and lumps using visual, audio, and data communication systems. This allows for a fast diagnosis and speedy treatment option for the patient. People who live in underserved areas greatly benefit from these services, avoiding excessive travel to see a specialist for proper care (ATA, 2012).
 
Mental Health and Counseling – Called telepsychiatry, this form of telemedicine allows for patients who live remotely to utilize videoconferencing for mental health and counseling services. The University of Colorado Health Sciences Center (UCHSC) conducted a study that supports the use of these programs for both Alaskan Native Americans and American Indians. A growing number of technologies are now available, including computerized cognitive behavior therapy (CCBT) and other telespychiatry services (ATA, 2012).
 
Pathology – Telepathology involves the use of telecommunications technology to transfer data from a remote location to a pathologist. Using high-quality imaging, doctors can use television microscopy to analyze specimens, eliminating the hands-on involvement. This field is successful for diagnosing histopathological samples, research, and education. The first sustainable clinical service of this kind was developed in Norway in 1989 and is still in existence today (Nordrum, 1991).
 
Reasons to Consult a Virtual Doctor
 
There are many reasons why you may need the services of an online physician. First of all, these healthcare providers treat a variety of conditions, such as diabetes, shingles, sinus infections, hypertension, male pattern baldness, and erectile dysfunction. If you do not want to discuss your condition in person, now you have the ability to do this from the privacy of your own home!
 
If you do not want to risk buying medication from an overseas company, use QuickRxRefills.com, an online prescription service you can trust. These virtual doctors consult with you online and diagnose your problem remotely. Using telehealth technology, patients can now receive health care if they lost of forgot medication while on vacation or traveling for business, or if their office based doctor is out of town or on vacation.
 
Researchers Hilty and colleagues (2013) of the University of California-Davis Department of Psychiatry found that telehealth increases access to health care and is extremely effective. They reviewed a number of published studies that documented research done on telemedicine. These studies included the areas of mental health, eHealth, videoconferencing, and international telehealth. They concluded that telemedicine is applicable for the assessment and diagnoses of many populations, including geriatrics, children, adults, and ethnic groups. Also, they found that many settings were acceptable, like home health, emergency care, and dermatology. 
 
In a recent review of Partners Online Specialty Consultations (POSC) of the Center for Connected Health, researchers found that consulting specialists recommended a complete change in treatment for most patients. The POSC provides virtual access specialty care to patients at many hospitals in Massachusetts. For remote areas, a specialist can evaluate the patient via videoconferencing. This programs works because it allows the patient to consult an online doctor who collaborates with the healthcare team at the hospital where care is being provided. These findings support the use of telemedicine for the provision of specialty care (ATA, 2012).
 
Final Thoughts
 
Because we now live in an electronic world, where computer use is commonplace, telemedicine makes perfect sense. If you find yourself in need of medical care, consult an online doctor and side-step the hassle of locating and driving to the office.
 
References
 
American Telemedicine Association (ATA) (2012). Telemedicine case studies. Retrieved from: http://www.americantelemed.org/learn/telemedicine-case-studies
 
Blyth WJ (1990). Telecommunications, concepts, development, and management. Second Ed., Glencoe/McCgraw-Hill, 280 – 282. 
 
Clifton D et al. (2003). Provision of pharmacy services to underserved populations via remote dispensing and two-way videoconferencing. American Journal of Health-System Pharmacy, 60: 2577-2582.
 
eHealth Insider (2005). Nurses happier using telecare, says international survey.
 
Hilty DM (2013). The effectiveness of telemental health: a 2013 review. Telemedicine, 19(6): 444-454. doi: 10.1089/tmj.2013.0075
Indian Heart Journal (1982). Teletransmission of ECG waveform: an ingenious low priced technique. Indian Heart Journal, 34(6).
 
Keaton L et al. (2006). An e-rehabilitation team helps caregivers deal with stroke. The Internet Journal of Allied Health Sciences.
 
Kontaxakis G et al. (2006). Integrated telemedicine applications and services for oncological positron emission tomography. Oncology Reports, 15: 1091-1100.
 
Levin K (2013). Telemedicine diabetes consultations are cost-effective, and effects on essential diabetes treatment parameters are similar to conventional treatment: 7-year results from the svendborg telemedicine diabetes project. Journal of Diabetes Science Technology, 7(3): 587-595.
 
Nordrum I (1991). Remote frozen section service: a telepathology project to northern Norway, Human Pathology, 514-518.
 
Sachpazidis I (2008). Image and medical data communication protocols for telemedicine and teleradiology. Dept. of Computer Science, Technical University of Darmstadt, Germany.
 
Saylor M (2012). The mobile wave: how mobile intelligence will change everything. Perseus Books.
 
Vant-Haaft C (2009). Virtually on-sight. Just for Canadian Doctors.

 

Mitchell Cohen
Mitchell Cohen, M.D. is Board Certified doctor specializing in Orthopedic Medicine and Spinal Surgery. Graduated from Hahnemann University in Philadelphia, PA with a degree in Human Physiology (1983) and subsequently achieved his medical degree in 1987 from Case Western Reserve University School of Medicine. Dr Cohen did his Surgical Residency at the University of New Mexico in 1992 as well as a Spine Fellowship in 1993. Dr. Cohen has published the following medical journals: "Biomechanical Efficiency of Spinal Systems in Thorocolumbar Fractures" (1993), "Kaneda Anterior Spinal Instrumentation" and "Spinal Fusion Stabilization amongst many others. View Dr Cohen's Twitter Page.

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