Health reform initiatives at the federal and state level have drawn attention to the challenges our country faces in making cost-effective health care available to all. Telemedicine is an innovation that has probably not received sufficient attention in the public media, although health policy experts have been interested in its implications for several years.
Telemedicine, or telehealth, has various definitions. The American Telemedicine Association offers the following:
Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status. Closely associated with telemedicine is the term "telehealth," which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. 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 and telehealth. (ref. 1).
Under this definition, telemedicine includes forms of telecommunications-facilitated clinical practice that are becoming increasingly common (such as teleradiology), home monitoring of chronic health conditions, and networks established to make specialized care available to rural and isolated populations.
In the popular media, the term "telemedicine" is sometimes erroneously used to describe internet prescribing for patients never seen by the physician, frequently in connection with internet pharmacies. Such activities are not truly telemedicine, and are the subject of state and federal enforcement measures, as described below.
Evaluation of telemedicine
The federal Agency for Healthcare Research and Quality (AHRQ) has collected information on various telemedicine initiatives. The following examples were presented at the 2007 AHRQ annual meeting:
- A telemedicine link at a child care center that allows a telehealth assistant to send information obtained by computer-driven digital sensors directly to the child’s regular physician, allowing quick assessment of minor health issues by the regular provider – a good alternative to a parent taking time off from work to take the child to an ER or retail clinic (ref. 2).
- An internet communication system that allows a patient at home to report regularly on several indicators for chronic hypertension, heart failure, diabetes, and COPD/asthma, improving frequency of monitoring and enhancing patient education (ref. 3).
- A university’s telehealth network that connects providers in rural areas with specialists in oncology, hematology and other specialties, using a distributed electronic health record for online management of cancer treatment protocols (ref. 4).
These and similar initiatives have caused public health administrators and payors to take interest in the potential of telemedicine to improve health outcomes and contain costs.
AHRQ has surveyed peer-reviewed studies of telemedicine for the Medicare population (originally in 2001, updated in 2006 [ref. 5]), and the pediatrics and obstetrics populations (ref. 6). In both reviews, AHRQ found that studies have demonstrated that telemedicine can be made operational, but experience with telemedicine is still too limited to establish its efficacy and cost-effectiveness. AHRQ categorized telemedicine activities into "store-and-forward" telemedicine (where clinical data are collected, stored and forwarded to be interpreted at a later time), home-based telemedicine (where physiologic measurements, test results, images and sounds were collected in the patient’s residence or care facility), and office/hospital-based telemedicine (real-time clinician-patient interactions substituting for face-to-face encounters).
While scientific demonstration of the value of telemedicine awaits further study, telemedicine also dovetails with developments in health information technology that are widely expected to yield quality and cost-saving benefits. Government initiatives to encourage adoption of interoperable electronic health records may aid development of telemedicine, by establishing standards for health information exchange. Some personal health record (PHR) applications seek to make use of home-based telemedicine applications. Microsoft HealthVault connects with certain heart rate monitors, glucometers, blood pressure monitors and other devices, so that the consumer can record his/her data and monitor key clinical indicators. Ultimately, such information may also be shared with the clinician, as in the projects funded by Project HealthDesign. Many of the Project HealthDesign studies combine a PHR used by the patient with transmission of data to the clinician; an example is a study in 2008 of a system allowing diabetic patients to transmit blood glucose levels, blood pressure, food intake and exercise via a cellphone to their physicians (ref. 7).
1. American Telemedicine Association, "Telemedicine Defined", available at http://www.americantelemed.org/i4a/pages/index.cfm?pageid=3333
2. NcConnochie, Herendeen and Wood presentation at 2007 annual meeting of the Agency for Healthcare Research and Quality (AHRQ). Presentations at the 2007 AHRQ annual meeting are linked at http://www.ahrq.gov/about/annualmtg07/.
3. Bove presentation at 2007 AHRQ forum.
4. Waters presentation at 2007 AHRQ annual conference.
5. Telemedicine for the Medicare Population: Update, AHRQ Publ. No. 06-E007, Feb. 2006.
6. Supplement. Telemedicine for the Medicare Population: Pediatric, Obstetric, and Clinician-Indirect Home Interventions in Telemedicine, Evidence Report/Technology Assessment No. 24, Supplement (Aug. 2001).
7. Chronic Disease Medication Management Between Office Visits, University of Washington, summary available at http://www.projecthealthdesign.org/projects/overview-2006_2008/405516.
About the Author
Patricia King is a health care attorney in Illinois, and principal of the web-based business Digital Age Healthcare LLC (http://www.digitalagemd.com/).