A 53 year old woman was examined by a Cardiologist and diagnosed as having atrial fibrillation (irregular heart rhythm). The episodes increased in frequency and duration causing shortness of breath, fatigue, and at times lightheadedness and dizziness. She eventually had a small (the size of a finger nail) cardiac loop recorder implanted just under the skin into the left side her chest. When she experiences an episode, she presses a button, and places the Medtronic device against the left side of her chest. A cardiogram is recorded and transmitted to her Cardiologist for evaluation.
I reviewed a CT scan of the sinus (an image study) with a Radiologist who is originally from Australia. The left maxillary sinus, (cheek sinus) was involved and one needed to determine whether it was cancerous or fungal in nature. While discussing this case, he received a message from a Radiologist colleague who lives in Melbourne who requested a second opinion concerning a patient who suffered head trauma. Welcome to “Medicine Without Borders” and “Doctors Without Waiting Rooms.”
Telemedicine is the use of telecommunication systems to diagnose and treat medical conditions of patients in remote areas. It’s also used as a consulting tool with other physicians and healthcare workers. Patients can consult specialists from Alaska to Miami, Boston to Hawaii and beyond. Physicians, patients and health care workers can communicate anywhere and at any time. With the use of Telemedicine, distance and disabilities are no longer limiting factors in accessing patient care.
Telecommunications technologies are not new. In the 1960’s NASA put men into space and monitored the astronauts’ vital signs plus other parameters. Alaska, Australia and Canada have Telemedicine programs in place that appear to be cost effective and reliable. Dr. Ray Dorsey, Director of Neurology Telemedicine and the Movement Disorders Division at Johns Hopkins has used Telemedicine to monitor Parkinson patients. California has used Telemedicine to provide care for the HIV infected patient in the prison population. (1) The VA TeleHealth Services aim to ensure veterans get “the right care in the right place at the right time.” The airline industry has used information technology to treat passengers with in flight medical emergencies. The symptoms can be downloaded and video conferencing (VC) initiated to assist in the care of this emergency and decide, for example, if this flight should be diverted or not. (2)
In 2010, there were 129.8 million Emergency Department (E.D.) visits. (3) A significant number of the patients required non-urgent treatment and were sent home. The majority of these patents attributed their E.D. visits to lack of availability to other providers. In some cases, the average cost of an E.D. visit (more commonly referred to as E.R – Emergency Room visits) was equal to, or exceeded the cost of a month’s rent. (4)
Tired of waiting in a Doctor’s office? Many visits to the PCP (Primary Care Physician) can be reduced with efficient use of Telemedicine. With the focus on patient access to reliable medical care and recognizing that many medical conditions are chronic in nature, Telemedicine can be an effective avenue to drive down waiting time and the cost of health care.
What will be the future of Telemedicine? Only time will tell. Looking through the retroscope, in the 19th century anesthesiology, antisepsis, bacteriology and the germ theory (where one organism was the cause of a specific disease) were significant milestones. 1n the 20th century, antibiotics and pharmacotherapy, radiology-image studies, vaccines, DNA, computers were just a few innovations that have impacted medicine. In the first decade of the 21St century, the human genome project was completed, stem cell research continues, and targeted cancer therapies are becoming more widespread. Minimally invasive surgery is now more commonplace. But the trend that may revolutionize the delivery of medical care is the interface of information technology with patients and doctors.
With computers, smartphones, telephones, email, and texting you can access medical information as well as medical consultants 24/7. Telemedicine has arrived and it can be a win-win game.
- Providing Care for the HIV Infected Patient in a Correctional Setting.
- NPR 5/14/2013.
- National Ambulatory Medical Care Survey… CDC; E.D. Visits; 2012.
- Washington Post; Sarah Kliff; 2013.