Telemedicine

Overview

An elderly female patient presents at a rural hospital with cardiac problems and depression. The medical staff at this hospital prescribes a course of therapy for her heart troubles, and the patient is seen for regular, routine follow-up visits with a cardiologist. However, there is no psychiatrist on staff at this small facility. To ensure that the patient's depression, a serious comorbidity which can exacerbate the heart problems, is properly treated, the physicians connect her with a home-monitoring service. Every quarter, the service rings the patient and administers a telephone-based, interactive voice recording (IVR) screening using a health questionnaire as a way to monitor the patient's mental status.

A study by Carolyn Turvey and colleagues at the University of Iowa, whose parameters were outlined above, indicated that 90% of patients completed this telemedicine screening. The researchers found that a regular telephone IVR screen for depression could be used in a standard illness protocol. This program could potentially serve as a model for incorporating technology in the management of chronic illness with comorbid depression.

Chronic illnesses, like depression, account for most of the healthcare expenses in the United [Page 1120]States. Cutting-edge telemedicine projects like the one described above are increasingly being developed to decrease the burden of these illnesses on the medical system, to treat comorbidities, and to improve patient care and outcomes.

The term telemedicine appears frequently in news media reports and is often mentioned at medical conferences. Although telemedicine is not yet recognized as a separate medical specialty, technologies used for telemedicine are often part of a larger investment by healthcare institutions in either information technology or the delivery of clinical care. The new technologies involved in the practice of telemedicine include IVR, videoconferencing, transmission of still images over the Internet, online patient portals, remote monitoring of vital signs, and continuing medical education delivered online.

For clinical care, there are several applications of telemedicine that are becoming well established. Some of the applications include referral to a specialist, consultation with a patient, remote monitoring, networking hospitals, continuing education, and consumer education.

Referral to a specialist typically occurs when a specialist assists a general practitioner in arriving at a diagnosis. This often involves a patient seeing a specialist over a live network. But it can also happen with transmission of diagnostic images and/or video along with patient data, for later viewing by the specialist. Radiologists make the greatest use of telemedicine, with thousands of images read by remote providers each year. Other major specialties that rely on telemedicine include dermatology, ophthalmology, psychiatry, cardiology, and pathology. According to reports and studies, almost 50 different medical subspecialties have successfully used telemedicine.

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