Saturday, January 2, 2010

My Favorite Myths About Telemedicine

Last year I asked the ATA staff to come up with a list of the top myths about telemedicine. With years of fielding questions from the public, from ATA members and the press I figure they were in a good position to come up with some of the leading examples.

Yes, I admit that these are pet peeves of mine as well, so this is partly a cathartic exercise and a good way to start the new year. Anyway, here are a few of the most popular myths, in no particular order, and a brief explanation why the statement is a myth:

Telemedicine is a new, emerging field. This has been repeated in a number of articles and blogs by newcomers to telemedicine who haven’t heard of it before and, thus, believe it must be new. In fact, telemedicine has been around in various forms for about fifty years. Know it or not millions of Americans directly benefit from telemedicine every year. Be it from an MRI viewed by a radiologist using teleradiology, a pacemaker checked on via telephone or a specialist remotely checking on a patient in intensive care telemedicine is becoming pervasive. Yes, there are many parts of telemedicine that are emerging just like there are a lot of new applications related to the telecommunications industry that are emerging.

Telemedicine is only about providing health care to remote, rural areas. Certainly the early, government-funded demonstrations of remote health services targeted remote areas. Most of the 200 or so telemedicine networks in the United States were formed in order to connect tertiary care facilities in urban cores with rural clinics. While there remains a great need to provide health care to residents located outside of metropolitan areas, many telemedicine applications are being used in urban areas. Linking suburban and inner city hospitals in a network providing intensive care services and other specialty care is a fast growing phenomenon. Outsourcing radiology and other imaging services is used by hospitals throughout the nation regardless of their location. Remote monitoring, mHealth applications and telemedicine for emergency response are being deployed in every metropolitan area.

Telemedicine is all about video conferencing and, therefore, requires broadband. There are many critical needs and uses of video conferencing in telemedicine. But a live image is not always needed. Two of the most common applications in telemedicine: remote monitoring and teleradiology rely primarily on sending still images and data and don’t require live video. Medical images may need high speed lines but typically not two way and not at the same speed as high-quality video. Furthermore, the required quality of the video image also varies. Sometimes, a simple video image from a video-phone may be enough depending on the use. Broadband is important but not for every telemedicine application.

Telemedicine can be a significant threat to patient privacy. Enough already with the privacy fears. Just like in the use of networks for banking, the use of telemedicine can provide a secure, efficient way to transmit medical information without compromising privacy. With the use of data encryption, information flowing over telecommunications lines can be just as private, or even more private, that paper-based records kept in doctors’ offices and hospitals.

Telemedicine needs far more research before it can be used or reimbursed. Oh, how this one burns so many in telemedicine! Over 40 years of research has yielded a wealth of data about the cost effectiveness and efficacy of many telemedicine applications. PubMed a bibliographic database of medical research that is maintained by the National Library of Medicine includes over 10,000 citations of published works related to telemedicine or telehealth. Over 2,000 evaluative studies related to telemedicine have been published in two journals devoted to telemedicine alone. There are areas where more research can be helpful but this massive body of evidence has proven the effectiveness, safety, cost effectiveness and patient acceptance of many applications of telemedicine years ago.

Telemedicine, telehealth, eHealth, mHealth and telecare are all different. Huge amounts of time have been spent arguing about the differences in meanings about these various terms. At ATA, we take a very broad definition of telemedicine, encompassing a continuum of applications from cell phone based-wellness products to remote, robotic surgery. ATA defines telemedicine as the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

Telemedicine is a subset of health information technology (HIT). OK, I saved one of the best for last. There are many reasons why telemedicine and HIT are critically important and should work together. However, each operates in a different world with different objectives. Generally, HIT describes the design, development, creation, use and maintenance of information systems for the healthcare industry. Some would claim that HIT is a broad term encompassing everything touching on electronic data in health care. However, in reality there are significant current differences in the world of HIT and telemedicine. HIT is primarily focused on the electronic medical record and associated management and clinical information systems that improve the efficiency of administrative systems and back-end support for patient services. Telemedicine, on the other hand, is the use of applications to directly provide health care services. Within a hospital, HIT is mostly driven and managed by the CIO (Chief Information Officer). Telemedicine in a hospital is mostly driven and managed by the medical staff but a large part of telemedicine is not even hospital based but part of an independent monitoring service, an outsources specialty service or a stand-alone service. Telemedicine is also entirely focused on providing health services outside of the walls of a health institution, whereas HIT is primarily focused on hospital systems and, sometimes, linking hospital systems across a region. There are notable exceptions where the HIT world and telemedicine world are one in the same and there are huge opportunities for collaboration but it is a big mistake to assume that telemedicine and HIT are one in the same. They are not.