Health Information Technology (HIT) is a growing and changing field in today’s hi-tech world. Numerous advances in technology have led to improved systems and devices for patient care. Telemedicine allows for medical information to be transmitted from one location to another via electronic communications to assist with the treatment of patients. This enables patients to be treated at distant locations.
According to ICUcare LLC (2010), “Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve, maintain, or assist patient’s health status. Closely associated with telemedicine is the term ‘telehealth’, which is often used to encompass a broader definition of remote health care that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, and nursing call centers, are all considered part of telemedicine and telehealth” (para. 1).
Telemedicine can be a simple as two doctors talking on the phone about the treatment of a shared patient, or as complex as a two-way interactive videoconference. Either method allows greater access to health-care providers, particularly specialists, that would otherwise be available in some areas. There are a variety of peripheral devices that can be directly linked to the computer to add in a patient examination, from a stethoscope to an MRI. Development is currently ongoing in developing robotic technology to perform telesurgery by allowing a surgeon to control a robotic arm to perform surgery in another location. Closed-circuit television systems can provide for around the clock patient monitoring, and existing ICU patient monitoring systems can easily be configured to allow physiological vital signs to be read from a remote location. (Wagner, Lee, & Glaser, 2009).
The types of telemedicine can be broken down to two main categories: asynchronous and real time. Asynchronous, often called store and forward simple acquires the data at a location, and then transmits the data to another location whenever it is convenient. Real-time communication can be fully interactive or simply monitoring the patient via the use of closed-circuit cameras or other systems. (Wikipedia, 2010).
Store and forward telemedicine does carry risks due to its asynchronous nature. An event may occur at 1am, be transmitted to the doctor at 5am, read and responded to by the doctor at 8am, and received by the patient at 8am, at which point the original issue may have progressed. Store and forward may be convenient, but it also carries an increased risk of misdiagnoses and error, especially when the data is being collected and reported by the patient. It is difficult for the doctor to get the full picture when he or she is not physically present or otherwise able to monitor the tests being administered.
In Sands’ (2007) pod cast, he discussed using telemedicine to improve the clarity of communication between doctor and patient while simultaneously cutting down on the number of office visits required. Instead of being required to take a day off work to come into the clinic, a patient can instead teleconference with the doctor to exchange information or even use online methods such as instant messaging programs and online video chats.
Previously, in absentia care was occasionally conducted via post. Smoke signals warned people to stay away from an area or risk contagious disease. These days, high speed Internet and satellite communications allow for quality real-time transmissions that nearly render the distance involved to be a moot point.
In 1989, the Medphone Corporation developed the first interactive Telemedicine system operating over standard phone lines. This system allowed for the remote diagnosing and treating of patients that required cardiac resuscitation. Shortly after, the same company introduced a mobile phone version of this system. Prior to this, Dr. Ajai Shanker and Dr. S. Makhija of Gawlior, India transmitted the first teletransmission of an electrocardiograph reading in 1975. The system allowed wireless transmission of ECH readings from an ambulance or the patient’s home to the central ICU, and could also monitor patients with pacemakers in remote areas. Perhaps one of the earliest purveyors of telemedicine was the physician Galen, born in 129AD. He offered consultation and prescribed patients via post, often without ever seeing or even questioning the patients. (Wikipedia, 2010).
One of the most famous portals of telemedicine is WebMD, a site which has symptom checkers, quizzes, and health assessments. Additionally, it provides a personal health manager that can enable one to track progress on various treatments and print off an emergency health card to carry. (WebMD, 2010).
There are specialized consent forms to participate in a telemedicine consultation. (American Telemedical Association, 2010). HIPAA concerns for telemedicine include a heightened level of concern for patient privacy in real-time consultations, the existence of non-clinical staff such as the IT staff handling the telecommunication system, clinical personnel who may be present for the consultation but not visible or audible to the patient, the transmission of patient information across organizations and political boundaries, and the storing of patient information on all sides of the consultation. (US Department of Health and Human Services, 2001)
Another concern of telemedicine is that the health care professional should be fully licensed and registered with their respective licensing/regulatory bodies as well as the respective bodies of the site where the patient is located. They should also be aware of credentialing and accountability requirements in both locations. (ICUcare LLC, 2010).
Methods of complying with HIPAA regulations include transmitting all email communication in encrypted form, installing and monitoring a firewall on the computer network, maintaining an audit system for the computer network, and ensuring all access to the point of service computers is user-authenticated. Additional security systems can include facial recognition systems and digital identity cards. (Gaya, 2010).
Patient records can be maintained at both ends of the communication, allowing for the information to be available as needed by both doctors and patients. The information on both sides of the communication is covered by HIPAA and care should be taken to ensure it is maintained and disposed of properly. CVS pharmacy was recently fined for disposing of patient information in trash containers that could be accessed by the public. (Federal Telemedicine News, 2009).
Telemedicine does offer many benefits to patient care, but it does not come without risk. Telemedicine allows a doctor to expand his or her expertise to a variety of locations and always manage to be where his or her skills are most needed. As technology improves, the services that can be offered through telemedicine will also increase, perhaps to the point where a surgeon can simultaneously be standing in Iowa and performing brain surgery on the moon.
American Telemedical Association. (2010). About Telemedicine. Retrieved from http://www.americantelemed.org/i4a/pages/index.cfm?pageID=3308
Federal Telemedicine News. (2009). HIPAA Case Settled. Retrieved from http://telemedicinenews.blogspot.com/2009/02/hipaa-case-settled.html
Gaya, J. (2010). Telemedicine – Enhancing Network Security to Achieve HIPAA Compliance. EZine Articles. Retrieved from http://ezinearticles.com/?Telemedicine—Enhancing-Network-Security-to-Achieve-HIPAA-Compliance&id=3950233
ICUcare LLC. (2010). What is Telemedicine?. Retrieved from http://www.icucare.com/PageFiles/Telemedicine.pdf
Sands, D. (Speaker). (2007, March 30). Stanford Clinical Informatics Seminar Series [Audio podcast]. Stanford University. Retrieved from http://deimos3.apple.com/WebObjects/Core.woa/Feed/itunes.stanford.edu.1291767037.01291767042
US Department of Health and Human Services. (2001). HRSA Telehealth – Final HIPAA Privacy Rules. Retrieved from http://www.hrsa.gov/telehealth/pubs/hippa.htm
Wagner, K.A., Lee, F.W., & Glaser, J.P. (2009). Health Care Information Systems. A Practical Approach for Health Care Management (2nd ed.). San Francisco, CA: Jossey-Bass.
WebMD. (2010). WebMD. Retrieved from http://www.webmd.com/
Wikipedia. (2010). Telemedicine. Retrieved from http://en.wikipedia.org/wiki/Telemedicine
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