Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred via telephone, the Internet or other networks for the purpose of consulting, and sometimes remote medical procedures or examinations.

Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care.

Care at a distance (also called in absentia care), is an old practice which was often conducted via post; there has been a long and successful history of iin absentia health care, which - thanks to modern communication technology - has metamorphosed into what we know as modern telemedicine.

The terms e-health and telehealth are at times wrongly interchanged with telemedicine. Like the terms “medicine” and “health care”, telemedicine often refers only to the provision of clinical services while the term telehealth can refer to clinical and non-clinical services such as medical education, administration, and research. The term e-health is often, particularly in the UK and Europe, used as an umbrella term that includes telehealth, electronic medical records, and other components of health IT.

Telemedicine is practiced on the basis of two concepts: real time (synchronous) and store-and-forward and Home Health(asynchronous).

Real time telemedicine could be as simple as a telephone call or as complex as robotic surgery. It requires the presence of both parties at the same time and a communications link between them that allows a real-time interaction to take place. Video-conferencing equipment is one of the most common forms of technologies used in synchronous telemedicine. There are also peripheral devices which can be attached to computers or the video-conferencing equipment which can aid in an interactive examination. For instance, a tele-otoscope allows a remote physician to ’see’ inside a patient’s ear; a tele-stethoscope allows the consulting remote physician to hear the patient’s heartbeat. Medical specialties conducive to this kind of consultation include psychiatry, family practice, internal medicine, rehabilitation, cardiology, pediatrics, obstetrics, gynecology, neurology, speech-language pathology and pharmacy.

Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. It does not require the presence of both parties at the same time. Dermatology (cf: teledermatology), radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured Medical Record preferably in electronic form should be a component of this transfer.

Home Health Telemedicine When a patient is in the hospital and he is placed under general observation after a surgery or other medical procedure, the hospital is usually losing a valuable bed and the patient would rather not be there as well. Home health allows the remote observation and care of a patient. Home health equipment consists of vital signs capture, video conferencing capabilities, and patient stats can be reviewed and alarms can be set from the hospital nurse’s station, depending on the specific home health device. Usually low bandwidth analog Plain Old Telephone System (POTS). Some newer systems do support higher bandwidth capabilities. Disease management, post-hospital care, assisted living, etc.

Telemedicine is most beneficial for populations living in isolated communities and remote regions and is currently being applied in virtually all medical domains. Specialties that use telemedicine often use a “tele-” prefix; for example, telemedicine as applied by radiologists is called Teleradiology. Similarly telemedicine as applied by cardiologists is termed as telecardiology, etc.

Telemedicine is also useful as a communication tool between a general practitioner and a specialist available at a remote location.

The first interactive Telemedicine system, operating over standard telephone lines, for remotely diagnosing and treating patients requiring cardiac resuscitation (defibrillation) was developed and marketed by MedPhone Corporation in 1989. A year latter the company introduced a mobile cellular version, the MDphone. Twelve hospitals in the U.S. served as receiving and treatment centers. (See: Telecommunications, Concepts, Development, and Management, Second Edition, pages 280-282, W. John Blyth, Glencoe/McCgraw-Hill Company,1990)

Monitoring a patient at home using known devices like blood pressure monitors and transferring the information to a caregiver is a fast growing emerging service. These remote monitoring solutions have a focus on current high morbidity chronic diseases and are mainly deployed for the First World. In developing countries a new way of practicing telemedicine is emerging better known as Primary Remote Diagnostic Visits whereby a doctor uses devices to remotely examine and treat a patient. Consultations monitors an already diagnosed chronic disease, AND has the promise to diagnosing and managing the diseases a patient will typically visit a general practitioner for.

Examining the feasibility and effectiveness of doctor-patient interaction through videoconferencing, a study has shown that such virtual doctor visits are similar to face-to-face visits on most measures. 

“There is growing evidence that the use of videoconferencing in the medical environment is useful for a variety of acute and chronic issues.

Videoconferencing between a provider and patients allows for the evaluation of many issues that may not require an office visit and can be achieved in a shorter time,” says Dr. Ronald F. Dixon, an internist at Massachusetts General Hospital and the study’s senior author.

In America, telemedicine projects are being examined to evaluate their capacity to improve patient access to care and lower healthcare costs.

During the current study, the researchers randomised patients to one of two arms.

In the first arm, the patients completed a visit-either virtual or face-to-face-with a physician, and later completed a second visit via the other modality with another physician.

In the second arm of the study, the subjects had both visits face-to-face with two different physicians.

All of the doctors and patients involved completed evaluation questionnaires after each visit.

The researchers observed that the patients found virtual visits similar to face-to-face meetings on most measures, including time spent with the physician, ease of interaction and personal aspects of the interaction.

The doctors in the study were also found to score virtual visits similar to face-to-face visits on measures like history taking and medication dispensing.

Though the physicians appeared less satisfied on measures of clinical skill and overall satisfaction, the ratings they gave to virtual visits were still in the good to excellent range.

The diagnostic agreement between physicians was 84 percent between face-to-face and virtual visits; it was 80 percent between the two face-to-face visits.

“The tradition of medicine is to lay hands on the patients, which has always been considered paramount to patient care in the minds of physicians. However, these findings suggest that virtual visits could be a viable option in circumstances where patients need to be monitored routinely for chronic conditions like diabetes , hypertension, obesity or depression, and where self-management strategies are not working. Virtual visits may also be effective for triage of acute, non-urgent issues like back pain or respiratory infections,” says Dixon.

Based on their observations, the researchers came to the conclusion that both patients and physicians could benefit if virtual visits were used as an alternative method of accessing primary care.

The study has been reported in the Journal of Telemedicine and Telecare. (ANI)

The eloquent By Joe Mullich has some great info on web conferencing in the medical field: It’s no surprise that businesspeople view web conferencing as a cost-effective alternative to in-person meetings and trade shows. But who would imagine online meetings offer a better way to treat obesity or expand the use of new surgical techniques that can save countless lives?

“Web 2.0 technologies are beginning to change the practice of medicine,” says Lynne A. Dunbrack, program director for Health Industry Insights, a market research and advisory firm in Framingham, MA. “We now have a significant number of doctors who grew up with the Internet, and they want to use online collaboration technology to keep up with the relentless demands for ever-greater speed and efficiency.”

The rise of online video and web conferencing for medicine is part of an overall embrace of information technology by the healthcare industry. Although critics say the healthcare industry has been slow to change paper-based record keeping and other manual medical processes, the use of online video via the web by physicians, technicians and their patients has increased dramatically.

The technology, experts say, offers doctors a means to keep up with exploding volumes of information and attend to patients who live far away or have other issues that make them difficult to treat in conventional ways.

Online Training

Randy Marc Lasnick, director of marketing for Lumedx Corp., a maker of cardiovascular information and imaging systems, is at the nexus of virtual medicine. Among other products, the Oakland, CA, company offers “physician portals,” aimed at helping doctors enhance patient care and improve efficiency by providing a single location for information about each patient’s procedures, prescriptions and medical procedures.

But as useful as the new technology was, doctors – who lose income every moment they are away from their practice – didn’t have time to attend presentations to learn it. So Lumedx set up a series of web conferences using Cisco WebEx Meeting Center to offer training – and participation soared.

“When we did in-person conferences, about 25 to 50 people would come,” Lasnick says. “With the online presentations, the attendance runs from 50 to 200 for an event.”

Expanding Use of Online Information

The use of web conferencing has the potential to indirectly benefit patients by providing them with more time with their doctors. A 2008 study by Manhattan Research found that physicians who conduct web conferences with pharmaceutical sales representatives were able to see nearly 24 percent more patients than those who didn’t.

“This isn’t necessarily a case of cause-and-effect, where the video is freeing up more time for the doctors,” Levy says. “However, these results suggest that doctors who immerse themselves in online media and open themselves to new channels for gathering information are much more efficient overall.”

A key finding was that doctors expressed satisfaction with the web-conferencing technology. “That is quite unusual for a new or re-emerging technology,” Levy says. “It marks both improvements in the technology itself and in the doctors having a greater sense of what information they need and how they can use online mechanisms to get it.”

Drive for Efficiency

The growing acceptance of online technology may provide a way for physicians to keep up with the explosion of medical knowledge, which doubles every 18 months, as well overcome the industry’s fragmented system for dispersing that information.

“Healthcare is really a cottage industry, with the approximately 5,000 hospitals across the United States each its own operation, largely isolated from the others,” says Jonathan Small, vice president of communications for the Institute for Healthcare Improvement (IHI), a not-for-profit organization based in Cambridge, MA. “Studies indicate that when a more effective clinical procedure is identified through research, it takes 17 years to spread across the whole industry.”

IHI is using Cisco WebEx web conferencing to dramatically shorten these time frames. The organization is launching programs called “Sprints” aimed at promoting adoption of new techniques in less than 90 days. Because of the convenience of online meetings using Cisco WebEx Training Center and Event Center, IHI is able to gain greater participation from key individuals at hospitals across many geographies.

IHI is encouraging all US hospitals to try the World Health Organization (WHO) Surgical Safety Checklist – a process similar to how pilots check off items before a flight to ensure safety. A study in the New England Journal of Medicine found that hospitals that used the checklist reduced the number of complication following major operations by 40 percent. So far, more than 900 hospitals have signed on.

“There would simply have been no way to get a significant number of people to travel to meetings to learn about this initiative,” Small says. “This effort simply wouldn’t have been possible without virtual technology.”

WebEx for Patient Care

The drive for efficiency may extend web conferencing to treatment as well. As Dunbrack notes, hospitals are just now turning to web conferencing for clinical uses such as allowing specialists to do remote consultations in emergency settings. “This is a very promising way to address a lot of pressing industry problems, like treatment in rural areas, but the reimbursement issues remain a major stumbling block,” she says.

Initially, web conferencing for treatment has primarily focused on support groups. A pioneer in this area is Cardiometabolic Support Network (CMSN), a web-based obesity treatment program developed by Dr. Louis J. Aronne, Director of the Comprehensive Weight Control Program at New York Presbyterian Weill-Cornell Medical Center, and key leaders in the treatment and management of obesity and cardiometabolic risk. CMSN’s innovative model provides expert advice and support to patients through an expert assessment and uses WebEx to deliver live online group meetings moderated by registered dietitians.

As a core feature of the program, the virtual meetings go far beyond chat rooms, using WebEx web-conferencing technology to deliver the program using slides, videos or documents during group discussions. The patients in the pilot program, who have continued to work with their primary healthcare providers to manage obesity-related conditions like diabetes, “have seen an average weight loss of 18 lbs,” says Dr. Aronne.

Extending New Services to New Patients

Participants in the New York-based pilot program log in from across the country. “Without web conferencing, it would be impossible to create a large-scale program that can be used to cost-effectively reach thousands,” he says. “We can deliver our expertise over a broader geographic area and the patients save time and travel expenses.”

Web conferencing may also allow the medical community to reach patients who are reticent to seek treatment in person. The online venture is modeled after scientifically proven programs and effective in-person clinical programs, where 90 percent of the participants are typically women. Online, where people’s identities remain confidential, the enrollment has been split equally between men and women. “It is a safe place for men to share,” Dr. Aronne says. “They can talk about their experiences, challenges and even share recipes in a safe place without revealing their identities to the group.”

Studies have shown that online medicine can be as effective as in-person treatment, but as Dr. Aronne points out, “a key thing the studies also indicate is the online experience can’t be automated. People want to know that a real person is on the other end, ready to help them. They want the sensation of a human touch.”

That bodes well for the future of web conferencing, he notes, since it makes a live interaction with a skilled professional only a mouse click away.