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In Health Care Today, It's Electronic All the Way
Date:10/3/2009

Despite telemedicine advances, doctor-patient relationship remains key, experts say,,

SATURDAY, Oct. 3 (HealthDay News) -- Imagine that you see a new mole and don't like the looks of it so you take a picture of it using your cell phone and e-mail it to your family doctor for an opinion.

Or perhaps you have heart disease and take your blood pressure using a cuff that automatically uploads the data to your cardiologist's computer for review.

Using electronic communications equipment to transmit medical information for consultation or examination -- known as telemedicine -- has come a long way from its beginnings as a means for rural areas to have access via teleconferencing to top-flight specialists.

In fact, technology has advanced to the point that telemedicine is beginning to blur into the normal daily routine of a doctor, said Dr. Jason Mitchell, assistant director for the Center for Health Information Technology of the American Academy of Family Physicians.

"Someday we won't even consider it telemedicine anymore," Mitchell said. "It'll just be part of the way we practice medicine."

And evidence is mounting that telemedicine can play a positive role in health care. A study in the journal Stroke found that the use of teleconferencing and the transmission of CT brain scans is beneficial to the initial treatment of stroke victims, later assessment of the amount of brain damage they've received and the rehabilitation they will go through during their long-term recuperation.

Some new ways of practicing medicine already taking place that could be considered telemedicine include:

  • Ambulances transmitting EKG data to the hospital they're en route to
  • Automated pill counters that transmit data that lets doctors know whether medications are being taken as prescribed
  • Teleconferences to bring in specialists for consultation in such fields as dermatology, neonatal care, surgery and psychotherapists
  • Electronic scales for heart patients that trigger an alert to a nurse if the patient's weight increases dramatically

"One of the best early indicators for impending hospitalization for patients with congestive heart failure is an increase in body weight," said Dr. Lee H. Schwamm, vice chairman of the neurology department and director of TeleStroke & Acute Stroke Services at Massachusetts General Hospital in Boston and an associate professor of neurology at Harvard Medical School.

Schwamm describes such examples of telemedicine as "low-hanging fruit," easily done to great advantage for both the patient and the doctors involved.

Telemedicine could be a boon to preventative medicine, Mitchell and Schwamm said, giving doctors access to detailed data that would allow them to diagnose problems early. For example, data from the scales or the blood pressure cuff could give doctors a chance to get someone in for treatment before a heart attack or stroke occurs.

"It would identify for us when a patient should be seen rather than relying on the patient for that judgment," Schwamm said. "In my mind, that's the real promise."

Telemedicine also could provide tremendous cost savings. People might not have to take time off from work and drive to see their doctor to have a question or concern addressed. And people with serious illnesses might not have to travel hundreds or thousands of miles for a consultant's opinion. "It's expensive and inefficient to move people around when many visits require minimal care," Schwamm said.

Some impediments must be overcome, however. Insurance companies have not ironed out how a doctor should be compensated for different types of telemedical service. "That takes time. That takes expertise," Mitchell said. "There should be some level of compensation for making that happen."

And there are administrative barriers, too, Schwamm said. For example, can a doctor licensed and credentialed in one state "see" patients from another state via an Internet video link?

Mitchell believes telemedicine ultimately will strengthen people's relationships with their doctors, allowing them to share health information more easily. However, people first need to have a relationship with a doctor they trust.

"This is an adjunct to a relationship with a physician that's already there," Mitchell said. "I don't think the electronic interactions are going to completely replace the personal interaction, but they can augment them. You don't have to be standing in front of a physician to accomplish certain things, but that hands-on interaction needs to be there in many cases."

Don't write off doctor visits just yet, though.

"It's important to never underestimate the healing power of human touch," Schwamm said.

More information

The Telemedicine Information Exchange as more on issues related to telemedicine.



SOURCES: Jason Mitchell, M.D., assistant director, Center for Health Information Technology, American Academy of Family Physicians, Leawood, Kan.; Lee H. Schwamm, vice chairman, Department of Neurology, and director, TeleStroke & Acute Stroke Services, Massachusetts General Hospital, and associate professor of neurology, Harvard Medical School, Boston; Nov. 20, 2008, Stroke


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