Imagine this: On a Saturday night, a 70 year-old man who is vacationing in a small resort town feels weakness in his leg and starts slurring his speech. An ambulance rushes him to the nearest community hospital, where an emergency room doctor examines the man and concludes that he is probably suffering a stroke.
An hour has passed since the man's symptoms began, so the doctor must find out quickly whether the symptoms are due to a blood clot that is starving the brain of blood ischemic stroke) or bleeding into or around the brain (hemorrhagic stroke). If a blood clot is to blame, the man must receive medication within three hours to dissolve the clot to prevent brain damage. But the very same drug could be deadly if there's a hemorrhage in the man's brain.
Since this is a small community hospital, there is no neurologist on staff who specializes in stroke care nor is there a radiologist on site to read a computed tomography (CT) scan of the man's brain. At one time, the doctor would have been forced to transfer the man to a facility where such specialists were available—a delay that would dramatically increase the patient's risk for irreversible brain damage or death.
Now: New technologies allow even the most remotely located patients to get state-of-the-art diagnoses, and perhaps even treatments, in hospitals that are not staffed by the types of specialists who ordinarily administer such care.
What Is Telemedicine?
Telemedicine is an innovation in health care that allows doctors to exchange a patient's medical information, as well as X-rays, CT scans and magnetic resonance imaging (MRI) scans, through the use of advanced technologies, including broadband communication networks and high-speed Internet lines. With telemedicine, medical care and/or second opinions can be provided for people who live in areas where medical specialists such as ophthalmologists (eye doctors)...endocrinologists (doctors who treat hormone-related disorders, such as diabetes)...cardiologists (heart doctors)... infectious disease specialists and dermatologists (skin doctors are not always available.
Telemedicine can be lifesaving in cases such as that of the stroke victim described previously--the ER physician at the community hospital can quickly obtain a CT scan and transmit it via broadband communication services to specialists at another location, who can consult with the referring hospital to determine whether the patient should receive a clot-dissolving drug.
Get Better Care
Approximately 3,500 medical centers throughout the US offer telemedicine services, such as...
- Live, interactive videoconferencing. This technology allows a patient, while at a hospital or doctor's office, to communicate live over a video monitor with a medical specialist in another location. Medical equipment, such as a digital stethoscope or dermatology camera, is operated by on-site medical staff so that the off-site specialist can "examine the patient and talk to him/her via videoconferencing. The offsite doctor's recommendations are then implemented by the on-site doctor.
- "Store-and-forward" technology. A doctor can transmit medical records and diagnostic images to a specialist of the patient's choice for later viewing, interpretation and recommendations, using broadband networks or other communication services.
Telemedicine At Home
People with chronic diseases, such as diabetes, heart disease, lung disease, kidney disease and high blood pressure, usually require regular monitoring. Rather than go to doctors' offices for routine tests, these patients often can benefit from home-monitoring technology, known as home "telehealth." An estimated 200,000 Americans now use telehealth services.
This technology allows patients to transmit their blood pressure, electrocardiogram (ECG) results, blood oxygen or blood sugar levels, for example, to a home-health agency or their own physicians. Home monitoring can help doctors identify subtle problems, such as elevations in blood sugar or blood pressure, allowing for prompt treatment. This may eliminate the need for hospitalization
Can Telemedicine Help You?
Telemedicine is available to diagnose and monitor more than 50 different medical condi tions, including…
- Cancer. Telemedicine not only allows cancer patients to obtain timely consultations and/ or second opinions with physicians who are not located nearby, but also facilitates access to clinical trials, which may be located in distant academic and/or research centers.
In these cases, telemedicine can be used to transmit medical information, including diagnostic images and patient data, to screen the patient for eligibility in a particular clinical trial. For more on clinical trials, go to the National Institutes of Health Web site (www.clinicaltrials.gov).
- Diabetes. People with diabetes are at increased risk for complications, such as diabetic retinopathy (a vision-robbing disorder of the retina). Every person with diabetes should have a regular retinal exam to look for signs of retinopathy, which often can be treated with surgery or medication to prevent or slow vision loss. With appropriate training and equipment, a health professional at a hospital or clinic can acquire images and transmit them to a retinal specialist for review.
- Heart disease. Home telehealth can be especially helpful for people with heart disease or heart failure-conditions that require monitoring of blood pressure and devices, such as pacemakers. This data can be sent to a home health care monitoring agency and shared with a cardiologist.
- Mental disorders. Mental health professionals, such as psychiatrists, psychologists and social workers, are in short supply in many rural areas of the US. With telemedicine, people who have mental disorders, such as depression and anxiety, can receive diagnostic evaluations, ongoing therapy and medication management via videoconferencing.
- Skin conditions. Nationwide, and particularly in rural areas, there is a shortage of dermatologists. Telemedicine can give patients access to a dermatologist, either through live, interactive consultations or store-and-forward technologies.
Research shows that primary care physicians cannot adequately treat all types of skin problems. For example, a patient who was mistakenly being treated for shingles was recently diagnosed via telemedicine with necrotizing fasciitis, or "flesh-eating strep," a potentially deadly skin infection that requires prompt, aggressive treatment with surgery and antibiotics. A remotely based skin cancer patient also can benefit from frequent telemedicine exams by a dermatologist.
Fees For Telemedicine
Some health insurance plans cover certain fees associated with telemedicine. For example, Medicare pays for some telemedicine services, such as remote cardiac monitoring services and remote screening for diabetic retinopathy, if the patient lives in a federally designated underserved rural area or inner city. For more information contact the Medicare Rights Center, (800-333-4114, www.medicarerights.org).
If you have some other form of insurance and your primary care provider or a specialist has suggested that you get a medical service via telemedicine, check with your health plan provider to see whether the fees will be covered.
Some telemedicine providers have received grants from private foundations and the federal government to help offset the cost to patients, while others offer reduced fees for some patients who do not have insurance coverage for telemedicine services.