The Rise of Telemedicine

Rapid advances in technology have created new health care delivery models that are transforming the health care landscape. Telemedicine, which refers to the use of telecommunications to provide remote clinical services, is helping physicians maintain support networks and expand their scope of practice from any location. Using communication devices to treat patients remotely is not a new concept — two-way radios, telephones and teleconferencing systems have been used in patient care for decades. The difference is that today’s wireless broadband networks, mobile devices and advanced forms of data compression are prompting radical changes in the practice of medicine and the delivery of patient care.

Primary care physicians in rural areas and other remote locations are reaping some of the greatest benefits from telemedicine. Many are consulting with specialists via live videoconference and using store-and-forward technology to capture and transmit diagnostic images, vital signs and patient video clips for further review. The American Telemedicine Association (ATA) reports that in addition to improving access to a wide variety of specialist health care services, the use of telemedicine by primary care physicians benefits patients by reducing the cost of health care while increasing quality and efficiency.

According to the New England Journal of Medicine, “The trend of using electronic communication and incorporating sophisticated technology (i.e., connecting physicians and patients, or physicians and their colleagues practicing in a distant location) is proving beneficial for both rural- and urban-based physicians.” With the support of telemedicine, rural practicing physicians are able to manage a wider range of acutely ill patients and reduce barriers to care in underserved regions. They have the opportunity to become less isolated and to consult with specialists and experts in real-time. In addition, urban-based specialists are able to expand their practice by caring for patients in rural and underserved areas.

A growing number of patients with acute or chronic conditions such as diabetes or heart disease are benefitting from telemedicine technology in the home. They can schedule “virtual” visits with health care providers using videoconferencing, which decreases the patients’ dependence on visiting nurses and reduces the need to travel to a distant clinic or doctor’s office. Smart medical devices like blood pressure monitors that can be connected to the Internet are also bringing telemedicine into the home. Data collected from these devices can be sent to a home health agency or to a distant diagnostic center for interpretation.

The term telehealth is used to describe the use of telecommunications and electronic information to support a broader range of remote health care services than telemedicine, including medical education, health care administration and public health. Telehealth employs videoconferencing, the Internet, streaming media, store-and-forward imaging and wireless communications to connect health care providers and administrators with patient information.

Electronic health record (EHR) systems are a component of telehealth that eliminate the problems associated with tracking a patient’s health history through a paper trail. By storing all of a patient’s information online and making it accessible at any time through Web-enabled devices, EHR systems simplify operations for physicians and hospitals and improve health outcomes for patients. EHR systems are part of a larger telehealth framework known as health information technology (HIT) that is revolutionizing the way that health care providers, insurers, government agencies and public health professionals access patient information.

The George Washington University has been a leader in the telemedicine field for more than two decades. The Department of Emergency Medicine operates the Worldwide Emergency Communication Center (WECC), a system that uses global technology to provide around-the-clock telemedicine coordination to remote clients. From any worldwide location, WECC clients have direct access to more than 550 specialty and emergency physicians via phone, fax, email or video. Medically trained WECC operators assist clients and physicians during the consultation process and update patients’ EHR data.

The Department of Emergency Medicine has provided a Maritime Medical Access service since 1989, using WECC services to connect shipping vessels, yachts, aircraft and teams working with appropriate medical care. GW Onsite Medical Access, which provides access to an urgent care physician for patients who are at home or in an office or hotel in the Washington, D.C., area, is another service supported by the WECC.

On the research front, the federal government’s Center for Medicare and Medicaid Services (CMS), a division of the Department of Health and Human Services, has awarded a $1.9 million grant to a research team led the Dr. Susie Lew, professor of medicine, director of clinical services and medical director for the Acute Hemodialysis Unit at the GW Medical Faculty Associates. The team has undertaken an innovative study on the use of telemedicine to help dialysis patients administer their own treatments at home. Patients transmit health data using Bluetooth-equipped monitoring devices and can use video calling to consult with a nurse, a nephrology fellow or Dr. Lew.

According to Dr. Lew, “Hopefully we’ll be able to monitor their blood pressure readings daily and detect readings outside of the desired range. Therefore we hope to decrease emergency room visits and hospitalizations, because we’ll be able to take care of their medical issues earlier and as outpatients.”

Academic programs at the George Washington University are also addressing developments in telemedicine. In the summer of 2014, a special online hybrid institute entitled Mobile Healthcare: Innovations in Telemedicine will be offered. The program, which is open to qualified undergraduates, graduate students and professionals, will introduce telemedicine in a multidisciplinary format and will include guest lectures from individuals on the cutting edge of health and technology. Individual and collaborative assignments will help provide a comprehensive understanding of the rapidly evolving field of telemedicine.

Innovations in technology will continue to shape the future of telemedicine. At ATA 2013, the American Telemedicine Association Meeting & Trade Show highlighted several emerging trends including:

The ATA estimates that more than 10 million Americans benefitted directly from telemedicine in 2013, with clinical services such as radiology and emergency room treatment leading the applications. The organization expects that number to grow to 50 million within a few years, fueled in large part by the Affordable Care Act’s requirement for additional medical services.