Telemedicine is “the practice of medicine using a telecommunications system to provide clinical services at a geographically separate site” (Arizona Telemedicine Program). Telemedicine is under the umbrella term of telehealth, which encompasses various types of healthcare delivery provided from a distance using telecommunication systems. Other examples of telehealth include telenursing and telepharmacy. Telemedicine services can be delivered in “real-time” or through “store-and-forward.” Real-time telemedicine uses interactive video conferencing to manage acute health problems and emergencies, for example managing a patient presenting with signs and symptoms of stroke. Store-and-forward delivery may be more appropriate for less acute issues, for example, teledermatology, where images and data are transmitted for review at a later time.
As of 2011, over 1 million patients were cared for over the Arizona Telemedicine Program’s (ATP) state-wide telecommunications network. There are other telemedicine programs available in Arizona as well, such as Arizona Mayo Clinic Telestroke program, Carondelet Neurological Institute Telestroke program, and Banner Health eICU for critical care patients. For more information on telemedicine in Arizona see this report.
Rural telemedicine benefits
It is fairly obvious that various forms of telehealth would be an asset for rural communities struggling with access and workforce challenges. Distance, limited public transportation, infrastructure problems, and staffing shortages may prevent rural residents from receiving or seeking timely access to health services. Telemedicine can help overcome these problems. It can also allow access of specialty services, such as teledermatology and telepsychiatry. Telepediatrics may help reduce or prevent pediatric patient transfers. Telemedicine can help avoid travel costs and time for both specialists traveling to the community and patients having to go to larger centers, which would help reduce out-of-pocket costs related to travel, child or elder care, and missed work.
Take telepsychiatry for instance. According to the Center for Rural Health 2010 Workforce Trends Analysis, there are 7 psychologists per 100 000 people in large rural towns compared to 25 per 100 000 in urban areas. Unfortunately most studies looking at patient clinical outcomes in telepsychiatry versus face-to-face treatment are poor quality, with small sample sizes or lack randomization, but it appears the delivery systems are similar. It also appears that patients are satisfied with telepsychiatry. In one study, 89% of patients reported being satisfied with the telepsychiatry service they received.
Rural telemedicine challenges
There are several challenges that rural facilities face when contemplating using telemedicine services. These include technology challenges, such as ability to connect to broadband and unpredictable lapses in broadband connection. Other technology challenges can relate to not all staff having adequate training to use equipment, leading to resistance and poor uptake.
There are also financial challenges. Reimbursement for telemedicine services is sometimes less than for face-to-face interactions, leading to a dis-incentive for hospitals and specialists to provide telemedicine services. Another financial challenge is costs associated with implementing and maintaining equipment and networks.
Telemedicine moving forward
Although uptake of telemedicine is slow, it appears to be gaining momentum. Hopefully as the technology improves, and user-friendly devices and “apps” are adopted, providers and personnel will be more willing to incorporate telemedicine into their daily practice. Some telemedicine leaders are starting to advocate for telemedicine parity of reimbursement, which may alleviate some of the financial challenges. Challenges relating to equipment costs may be reduced as the technology becomes less expensive. As telemedicine is implemented widely, it will be important to continually evaluate telemedicine to ensure we are adding value in terms of improving patient clinical outcomes, satisfaction, access to services and reducing costs long term.
Celia is a 2008 University of Saskatchewan Bachelor of Pharmacy graduate and currently a Visiting Scholar with the Center for Rural Health. She is now in her second year of her Doctor of Pharmacy program at the University of British Columbia in Vancouver, BC. She has an interest in primary care, particularly interdisciplinary, collaborative team models of care. In her spare time, she enjoys cycling, hiking, playing ultimate frisbee and soccer, cooking, and learning new languages.