Telemedicine's depth now going beyond rural areas

Initially used to transcend problems of distance and location, telemedicine employs cameras, microphones and other medical monitoring devices, which are connected via a telecommunications network in the evaluation, diagnosis and treatment of patients from remote locations. The observational devices can be anywhere, which allows for the technology to be used in diverse settings or to treat prisoners, soldiers and the homeless.

"That doesn't mean that people don't need to go into hospital," says Adam Darkins, MD, MPH, FRCS, chief consultant for care coordination at the U.S. Department of Veterans Affairs (VA), which has spent $20 million for a program to install telehealth monitors in the homes of more than 16,000 patients across the country. "But if you get someone in for two days, stabilize them and get them home, rather than two weeks in an intensive care unit, it's a win on both sides."

Since its nascent days, telemedicine has expanded in structure and form.

"Most of the applications early on were to people who were geographically isolated, both from the standpoint of the general public in rural communities as well as those people who were incarcerated in correctional facilities," says Jay Sanders, MD, FACP, FACAAI, president and CEO of the Global Telemedicine Group, based in McLean, Va. "In the beginning, we wanted to provide a means to bring the patient to the physician, but what has happened is the realization that the exam room probably always needs to be predominantly where the patient is and not where the doctor is."

"That began the movement, both from an academic standpoint and from a commercial standpoint, in the whole area of bringing this enabling technology into the patient's home. If you can keep a patient out of the hospital, which is the highest cost, you improve quality and decrease cost," Dr. Sanders says.

In addition to keeping down costs, telemedicine's entrance into patient's homes can reduce white-coat syndrome-increased patient anxiety when visiting the doctor's office, which could affect blood pressure and other measurements.

"It's estimated that one-third of patients who are diagnosed as having resistant hypertension simply have 'white-coat hypertension,' and that if we took their blood pressure at their place of work or we took their blood pressure at home, it would be totally normal," Dr. Sanders says. "The whole question of where the exam room should be and where the best evaluations of the patients should be are now totally changing the course of telemedicine."

CARE AT SCHOOL, WORK

The exam room has been expanding beyond the home into school and into the workplace thanks to telemedicine.

University of Kansas Medical Center's (KUMC) TeleKidCare program allows school nurses or even the parents of students to confer with emergency room doctors to treat students.