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.
In addition, telemedicine, also known as telehealth or e-health, presents a chance to recognize and possibly prevent chronic
conditions from worsening in patients, cutting healthcare costs through a reduction in hospital stays and outpatient clinic
visits and providing better quality outcomes.
"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."
GOING TO THE PATIENTSince 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."
In the early 1990s, telemedicine applications began an expansion into patients' homes. With funding from a federal grant and
technology provided by Georgia Tech University, Dr. Sanders, also past president of the American Telemedicine Assn., extended
the application of telemedicine to electronic housecalls, a precursor to remote monitoring techniques used today by disease
management programs.
"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.
