Definition: Defining the Meaning of Telemedicine
The use of medical information exchanged from one site to another through electronic communications with the goal of improving a person's health status. 'Telemedicine,' and, 'telehealth,' are many times considered to be interchangeable terms which encompass a wide definition of remote health care.
Definitions of Telemedicine Fields - Ian Langtree - (2015-01-23)
'Telemedicine,' is the use of medical information exchanged from one site to another through electronic communications with the goal of improving a person's health status.
It was the story heard around the world when Dr. Rafael Grossmann became the first surgeon to use Google Glass in the operating room this past June, allowing a group of medical students to virtually view the procedure through his experienced eyes remotely and in real time.
Today, telemedicine includes a growing number of applications and services using two-way video, smart phones, email, wireless tools and additional forms of telecommunications technologies. More than 40 years ago, with demonstrations of hospitals extending care to people in remote areas, the use of telemedicine spread quickly and is now becoming integrated into the ongoing operations of hospitals, home health agencies, specialty departments, private doctors offices, and people's workplaces and homes.
Telemedicine is not a separate medical specialty. Services and products related to telemedicine are many times part of a larger investment by health care institutions in either information technology or the deliver of care. Even in the reimbursement fee structure there is usually no distinction made between services provided on site and services provided through telemedicine and often no separate coding required for billing related to remote services. 'Telemedicine,' and, 'telehealth,' are many times considered to be interchangeable terms which encompass a wide definition of remote health care. Consultations through:
- Nursing call centers
- Transmission of images
- Continuing medical education
- Remote monitoring of vital signs
- e-health including patient portals
- Consumer-focused wireless applications
Services Provided by Telemedicine
Perhaps telemedicine is best understood in terms of the services provided and the mechanisms used to provide those services. For example:
Primary care and specialist referral services might involve a primary care or allied health professional providing a consultation with a person, or a specialist assisting a primary care doctor in rendering a diagnosis. It may involve the use of live interactive video, or the use of store and forward transmission of diagnostic images, video clips, or vital signs along with patient information for later review.
Remote patient monitoring, to include home telehealth, uses devices to remotely collect and send information to a home health agency or a remote diagnostic testing facility for interpretation. The applications might include a particular vital sign such as a heart ECG or blood glucose, or a number of indicators for people who are at home. The services may be used to supplement activities by a visiting nurse.
Consumer health and medical information includes the use of the Internet and wireless devices for people to obtain specialized health information, as well as on-line discussion groups, to provide peer-to-peer support. Medical education provides continuing education credits for health care professionals and special medical education seminars for groups located in remote areas.
Telemedicine Delivery Systems
Networked programs link hospitals and clinics with community health centers and clinics in suburban or rural areas. The links might use dedicated high-speed lines, or use the Internet for telecommunication links between the sites. An estimate of the number of existing telemedicine networks in America is roughly 200; they provide connectivity to more than 3,000 sites. Point-to-point connections using private high-speed networks are used by hospitals and clinics that deliver services directly or outsource specialty services to independent medical services providers. Outsourced services may include:
- Mental health
- Stroke assessment
- Intensive care services
Monitoring center links are used for pulmonary, cardiac, or fetal monitoring, home care and related services that provide care to people in their own homes. Many times, usual land-line or wireless connections are used to communicate directly between the patient and the center, although some systems use the Internet. Web-based e-health patient services sites provide direct consumer services and outreach over the Internet. With telemedicine, these sites provide direct patient care.The Benefits of Telemedicine
Telemedicine has been growing at a rapid rate because it offers 4 fundamental benefits.
These benefits include the following:
Improved Quality: Studies have consistently revealed that the quality of health care services delivered through telemedicine are as good as those provided in traditional in-person consultations. In some specialties, especially in mental health and ICU care, telemedicine delivers a better product with greater outcomes and patient satisfaction.
Cost Efficiencies: Reducing or containing the cost of health care is one of the most important reasons for funding and using telehealth technologies. Telemedicine has been shown to cut the costs of health care while increasing efficiency through improved management of chronic diseases, reduced travel times, shared health professional staffing, and fewer and shorter hospital stays.
Improved Access: For more than 40 years, telemedicine has been used to bring health care services to people in distant areas. Not only does telemedicine improve access to people, it also permits doctors and health facilities to expand their reach beyond their own locations. Considering the provider shortages around the world, in not only rural but urban areas, telemedicine has an incredible capacity to increase services to millions of people.
Patient Demand: People want telemedicine. The largest impact of telemedicine is on the person, their family members and their community. Using telemedicine technologies reduces stress on the person and cuts travel time. Over the past 15 years, study after study has documented patient satisfaction and support for telemedical services. The services offer people access to providers that might not otherwise be available, as well as medical services without needing to travel over long distances.
Telemedicine Fields Include:
Teletrauma care - Telemedicine for trauma triage: using telemedicine, trauma specialists can interact with personnel on the scene of a mass casualty or disaster situation, via the internet using mobile devices, to determine the severity of injuries. They can provide clinical assessments and determine whether those injured must be evacuated for necessary care. Remote trauma specialists can provide the same quality of clinical assessment and plan of care as a trauma specialist located physically with the patient.
Emergency telemedicine - Common daily emergency telemedicine is performed by SAMU Regulator Physicians in France, Spain, Chile and Brazil. Aircraft and maritime emergencies are also handled by SAMU centers in Paris, Lisbon and Toulouse.
Teleaudiology - The utilization of telehealth to provide audiological services and may include the full scope of audiological practice.
Telesurgery - Remote surgery - Performance of surgical procedures where the surgeon is not physically in the same location as the patient, using a robotic teleoperator system controlled by the surgeon. The remote operator may give tactile feedback to the user. Remote surgery combines elements of robotics and high-speed data connections.
Teleophthalmology - A branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning.
Teledermatology - A sub-specialty in the medical field of dermatology and one of the more common applications of telemedicine and e-health. In teledermatology, telecommunication technologies are used to exchange medical information (concerning skin conditions and tumors of the skin) over a distance using audio, visual and data communication.
General health care delivery - The first interactive telemedicine system, operating over standard telephone lines, designed to remotely diagnose and treat patients requiring cardiac resuscitation (defibrillation) was developed and launched by an American company, MedPhone Corporation, in 1989.
Telerehabilitation - The delivery of rehabilitation services over telecommunication networks and the Internet. Most types of services fall into two categories: clinical assessment (the patient's functional abilities in his or her environment), and clinical therapy. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology, speech-language pathology, audiology, occupational therapy, and physical therapy.
Telepathology - The practice of pathology at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis, education, and research.
Teleneuropsychology - The application of telehealth-based communications (i.e., video teleconferencing) to neuropsychological services. This includes remote neuropsychological consultation and assessment, wherein patients with known or suspected cognitive disorders are evaluated using standard neuropsychological assessment procedures administered via video teleconference (VTC) technology.
Telecardiology - ECGs, or electrocardiographs, can be transmitted using telephone and wireless.
Teledentistry - The use of information technology and telecommunications for dental care, consultation, education, and public awareness in the same manner as telehealth and telemedicine.
Teleradiology - The ability to send radiographic images (x-rays, CT, MR, PET/CT, SPECT/CT, MG) from one location to another. For this process to be implemented, three essential components are required, an image sending station, a transmission network, and a receiving-image review station.
Telepharmacy - The delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist. It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing.
Telenursing - Refers to the use of telecommunications and information technology in the provision of nursing services whenever a large physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telehealth, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, telemonitoring, etc.
Telepsychiatry - Utilizes videoconferencing for patients residing in underserved areas to access psychiatric services. It offers wide range of services to the patients and providers, such as consultation between the psychiatrists, educational clinical programs, diagnosis and assessment, medication therapy management, and routine follow-up meetings.
Quick Facts: Telemedicine
- The American Telemedicine Association, ATA, defines telemedicine as "the use of medical information exchanged from one site to another via electronic communications to improve patients' health."
- Studies have consistently shown that the quality of healthcare services delivered via telemedicine are as good those given in traditional in-person consultations.
- The CDC reports that 84 percent of seniors have at least one chronic condition. Using the latest communications technology empowers healthcare providers in treating these patients and helps educate patients about their care.
- Mortality rate dropped from 13.6% to 11.8% after tele-ICU was implemented, and length of stay in the ICU fell from 13.3 days of 9.8.
- The U.S. Veterans Administration reports reductions in utilization of between 20% and 56% when care coordination and home monitoring are employed.
- Products and services related to telemedicine are often part of a larger investment by health care institutions in either information technology or the delivery of clinical care.
- California prison officials provided roughly 9,000 telehealth consultations in 2004, saving taxpayers more than $4 million in transportation and escort costs.
- For over 40 years, telemedicine has been used to bring healthcare services to patients in distant locations.
- 55 percent of urban and rural physicians reported that cost of telemedicine equipment is the main barrier to accessing this technology.
- Barriers to telehealth use include concerns about costs and return on investment, clinician resistance, lack of broadband connectivity, and interstate practice issues.
- 21 percent of physicians reported that broadband capability was a barrier in their use of telemedicine. In addition, about 60 percent of rural areas have broadband compared to 70 percent of urban areas.