Is Telemedicine the Answer to Rural Health Care?
更新： 2020/11/22 18:51:53
What Is Telemedicine?
Telemedicine is a way of eliminating distance barriers in providing health care. Interpreted loosely, telemedicine has been around for a long time, with the use of the telephone and radio communications. Today’s telemedicine relies on numerous telecommunications devices, as well as information technology, to provide health care at a distance.
Technology can be used to provide better access to medical services, particularly in remote rural areas. It can also be used in emergency care situations where specialized emergency help is needed but not readily available. In a world where we can Skype with friends in other countries and share information with others around the world, it is only natural that telemedicine is advancing too.
Telemedicine may involve acquisition of diagnostic data, such as medical imagery, and transmission to a specialist who evaluates the information offline and shares his or her expertise with the on-site medical provider. Dermatology and radiology make use of this type of telemedicine. Remote monitoring is a type of telemedicine that lets health care providers monitor patients with chronic conditions using electronic devices instead of in-person patient evaluation. Interactive telemedicine is real-time interaction between patient and provider or between one provider and a specialist located elsewhere.
Rural Health Care and Telemedicine
Perhaps the most revolutionary aspect of telemedicine is that it helps compensate for serious shortages of specialists in rural areas that do not have enough of a patient base to make it worthwhile for specialists to set up practices. Heart surgeons, rheumatologists, neurologists, and other specialists can serve rural patients with telemedicine. In cases where a patient is required to utilize a $20,000 emergency helicopter service simply because a local doctor does not have access to a specialist’s consultation, telemedicine can fix the breach and help patients avoid this type of expense.
In regions with difficult terrain, or where there are long distances between hospitals, medical helicopter transport is essential. However, telemedicine can prevent some of these helicopter trips, potentially saving hundreds of millions of dollars a year. When a general practitioner in a rural area can consult with specialists, specialists can talk practitioners through the exam process and suggest specific tests tailored to the patient’s situation. This cuts down on unnecessary medical testing and improves rural practitioner skills, saving time and money, and helping rural residents get the care they require.
Telemedicine on Native American Reservations
Health care on Native American reservations is often very basic, and patients sometimes live in very remote regions. On Arizona reservations, for example, turnaround time for routine radiology interpretation could take up to a week before adoption of telemedicine techniques. With a telecommunications network in place, patients can be connected with radiologists throughout the state. Radiology departments in major hospitals can interpret radiology tests conducted at remote medical clinics. Under a program called the Arizona Telemedicine Program, or ATP, over a million patient cases have benefited from telemedicine connections to radiologists throughout Arizona.
Native Americans living on reservations can also be linked with specialists, such as psychiatrists, who connect to HIPAA-compliant clinics through a secure videoconference link, providing real-time interaction between patients and distantly located physicians. In cases of possible neonatal heart defects, cardiologists in major cities in Arizona can oversee tests like echocardiograms performed in rural hospitals to determine if an infant needs to be transported to one of the state’s larger regional hospitals.
The Current State of Telemedicine
Telemedicine is poised to revolutionize medicine at HealthLineRX in rural areas. Some rural health facilities are staffed by nurse practitioners rather than physicians, and telemedicine can help these health care providers by sharing the expertise of distant specialists who have seen a broader range of conditions from working in more densely populated areas. A case that may show up once every couple of years in a rural clinic may be seen routinely in a city, and now rural practitioners can draw on the expertise of those with much more experience dealing with unusual medical situations.
In some rural emergency rooms, a practitioner can literally access long distance medical expertise by pressing a button. When such a call is answered, a high-definition video feed starts on an emergency bay video monitor. Nurses or other practitioners can remotely control cameras, zooming in on patients as well as their monitoring equipment or IV pumps.
Emergency Department telemedicine is the next best thing to having a specialist right there in the room with a patient. Not only do these telemedicine facilities save lives, they can also drastically cut down on unnecessary transfers to larger hospitals. Furthermore, some telemedicine providers can support rural intensive care units, improving patient outcomes and allowing more patients to be treated near their homes.
HIPAA and Telemedicine
Public policy sometimes lags behind when technologies advance rapidly, and that is true with telemedicine. One challenge has been adherence to the Health Insurance Portability and Accountability Act (HIPAA). This law was designed to protect patient privacy and set standards for security. Physicians must have informed consent from patients before transmitting information about them to distant specialists. This is problematic with patients who are non-responsive or otherwise not able to give consent.
While not all eventualities involving HIPAA and telemedicine have been worked out, providers are able to protect patient confidentiality by creation of secured log-in barriers for images and other information collected at one location and transmitted via smart phone or tablet to specialists elsewhere. Data can be sent and stored on a secure server, and any images taken by a physician for transmission are not stored on mobile devices. That way, even if the mobile device is lost, patient confidentiality is preserved.
The Future of Telemedicine
Telemedicine services will probably be the standard in specialized rural health care within the next decade. The increase in access to specialists as well as huge savings on patient transportation costs will continue to fuel growth in this exciting technological sector. Recruiting medical specialists to rural areas can be difficult, but increasing reliance on telemedicine can help make up for the shortages.
In underserved populations, transportation is the biggest barrier faced by patients who need specialist care. Many of these rural patients are poor and they often do not have transportation to a city where they can get the care they need. Telemedicine provides an alternative for them. And in some cases, expensive, specialized equipment is becoming unnecessary as smart phones and tablets become widely used. Skype plus an iPhone can mean the difference in a patient being treated close to home or having to travel long distances to see specialists in person.
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