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Telemedicine: all hype, or new hope for the underserved?

Some say telemedicine distances health providers from patients. Jonathan Linkous says it draws them close.

Speaking at U.S. News & World Report’s “Hospital of Tomorrow” forum, the American Telemedicine Association CEO spoke of telemedicine’s growing reach, making a persuasive case for its power to improve access to care and lower co­sts.

Telemedicine has been around for 20 to 30 years depending on how you define it. It started as a means to bring health care to most remote, rural areas.

“Today there are about 100 to 200 networks across country providing such services to about 1 million patients,” Linkous said. “But that’s just the tip of the iceberg.”

A lot of hype about mobile health is just that. But remote radiology is so prevalent it’s not even called tele-radiology any more, and many other specialties are going remote, from webcam visits with psychiatrists, neurologists and dermatologists to remote monitoring of ICU’s.

Verizon, as part of its health benefits package, offers its 700,000 employees 24/7 online access to urgent care providers. “More than 100,000 stroke patients were seen remotely by neurologists this year,” Linkous said.

There remain barriers to telehealth’s broader application, including inadequate bandwidth, privacy laws, refusal of insurers to pay for it and licensing restrictions. “It’s a big area. It’s somewhat controversial. A lot of state medical boards are looking into it. But the truth is, consumers want it,” Linkous said.

Perhaps the most tremendous growth in telehealth has been in remote monitoring of ICU’s. Sentara Healthcare built the nation’s first eICU in 2000. Today, about 13 percent of intensive care beds in the U.S. are remotely staffed in some way, shape or form, said Sentara’s eICU medical director, Steven A. Fuhrman.

Fourteen years ago, the motivating factor was a projected shortage in critical care personnel, chiefly due to an aging baby boom population. Intensive care patients are at their most vulnerable, arguably requiring the most intimate level of care, and trained intensivists are well-documented to improve outcomes, Fuhrman said.

In the early days the novelty of caring for a critically ill patient from 50 miles away “was often met with question marks,” Fuhrman acknowledged. But he said, telehealth’s refined care standards and advances in computerized alerts have measurably improved ICU outcomes.

ICU’s are a natural environment for telehealth because they provide acute, episodic care with lots of electronic monitoring. They’re data rich.

But telemedicine is proving to be useful even with management of complex, chronic diseases.

Robert L. Satcher Jr., assistant professor of orthopedic oncology at University of Texas’ MD Anderson Cancer Center said in the coming decades, cancer will become the most common cause of death in the U.S. and globally. A shortage of oncologists, especially in rural areas and developing countries, he said, virtually guarantees growth of tele-oncology, from online patient counseling and virtual “tumor boards” to remote diagnostics and robotic surgeries.

“Tele-oncology is not an all-encompassing panacea,” cautioned Satcher, noting that it can streamline and improve care or exacerbate inefficiencies and lead to suboptimal care. “Implementation of the technology should be controlled centrally and guided by local needs.

By: Kirsten Stewart

Kirsten Stewart is a senior writer for University of Utah Health Sciences