Net Results in Telehealth

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Patient Centered Medicine and Technology Adaptation
In a message to Congress, the President of the United States said “Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection.” The President was Harry S. Truman - in 1945.

Indeed, how times have not changed.

The current financial model for healthcare stems from the business rules of the 1800s. People get sick. Clinicians fix them. They get paid for the service. It’s a business. Healthcare is like any other business, it requires cash. A constant revenue flow means a constant flow of customers (the industry calls them patients). We have what is better-termed a “sickcare” system. Beyond pure altruism, physicians have little incentive to keep patients healthy. Healthy patients, on the other hand, need less episodic care and more longitudinal care such as annual physicals, care treatment or monitoring plans.

Patient centered medicine is often correlated with the application called the Patient Centered Medical Home (PCMH), the terms are nearly interchangeable. This is a model based on enhanced primary care meaning comprehensive, timely and patient-centered care that embraces preventative tactics and suitable reimbursement where healthcare professionals can practice at the “top of their licenses,” a term used to outline a professional’s activities to perform services at the fullest extent possible stipulated by the license. This is accomplished using a team that includes not only the physician staff but also family members and social entities. Patient centered medicine is more than a model; it is a healthcare setting that promotes partnerships between those participants to create a team-oriented and supportive environment. In other words, the care spectrum spans various settings. To facilitate this requires more than a change in culture, it requires technology...

Creating Telehealth Networks from Existing Infrastructures

Implementing a telehealth program can be an engineering and financial challenge due to associated costs such as hardware, software, networking, administration and clinical expertise. To maximize potential and minimize costs, it makes sense to leverage existing telecommunications infrastructures and tailor the program based on what is available. This is especially critical in developing nations where funding is often limited.

The ability to reach remote areas with modernized medicine has been traditionally handled by short-term visits by medical professionals in specially outfitted vehicles for primary care or even surgery. However, much of the medical care that is needed can be accomplished – at least to a reasonable level of quality – through the use of telemedicine. By designing systems that utilize the existing and nascent telecommunications capabilities within a given region, a sustainable telehealth network can be achieved.

Clearly, one of the most profound advances in telecommunications in the past 10 years has been wireless. Voice over IP (VOIP) has also made a significant impact by lowering communication costs even from fixed, legacy systems. The former is considered an infrastructure technology while the latter is considered to be a platform technology. By combining an evolving infrastructure technology with a revolutionary platform technology new and immense opportunities are created.

The new opportunities can help to create a positive effect on the medical challenges throughout the world. The digital divide is despairingly wide for millions of people. International groups, relief agencies and other non-governmental organizations (NGOs) play a role in addressing the needs of the people on the fringes of the digital divide. Attempts to apply global governance has fallen woefully short of the actual needs. Using telecommunications, the barrier of geography can indeed be overcome...

Encyclopedia of Biomaterials and Biomedical Engineering

Telemedicine is the use of telecommunications to support the delivery of healthcare at a distance. The use of sensors to apprehend physiologic signs and transmission of these data were hallmarks of the space program from the time of Russia’s dog Leica onward. This telemetry in space science led to critical care telemetry in standard medicine and the possibility of telemedicine. Although satellite telecommunications was the hallmark of telemedicine’s genesis in the 1970’s (STARPAHC), videoconference consultation by microwave transmission made its debut in 1955 with a psychiatric program in Nebraska. This was two years before Sputnik.

The medical industry is changing. The advent of affordable computer technology and ubiquitous telecommunications topologies have created new paradigm in healthcare capabilities, cost models and challenges. The prospect of telemedicine holds the opportunity of increasing the quality and quantity of healthcare for millions of people. The technology plays an important consideration in this regard.

Telemedicine need not, nor should not be a radical change from traditional medicine. Familiar environments, existing protocols and standard tools need to be enveloped into a practice so clinicians and patients are not impositioned. The implementation of telemedicine or telehealth is finding its way into the bloodstream of the medical community – slowly.

The Internet and has enabled a new dimension for exchange of knowledge. Transmission Control Protocol/Internet Protocol (TCP/IP) is natively an ideal protocol for the exchange of medical data as discussed in a later section.

As telemedicine evolves to more commercial application, cost factors and market pressures will force systems to leverage existing infrastructures for communications topologies as well as affordable equipment and robust application software. To date, hundreds of funded telemedicine programs that have proved to be successful in terms of increasing the quality of care but the cost structure to be long term and self-supportive in a market environment is still in debate. Studies in the area of prison telemedicine have largely proved to be financially feasible while other areas have not. Ironically, the slow adaptation of telehealth in the mainstream industry is not the technology, rather the policies, reimbursement and legal issues. Until these issues are resolved the progression and acceptance will continue to be slow.

As clinical expertise is ferried across county lines and international borders, the patient record must be electronic. With the data collection and distribution capabilities now available, the aptitude of informatics becomes plausible and a potentially powerful tool for telemedicine stemming from electronic information about patients. There are many acronyms associated with names being debated such as the Electronic Medical Record (EMR), Electronic Health Record (EHR), Computerized Patient Record (CRP) and others. The terms stem from a variety of sources but the Institute of Medicine (IOM) is likely have the most influence on the eventual official name, if there ever is one. The challenge remains on how the EMR will look and feel...

Telemedicine Systems and Telecommunications

The practice of telemedicine can be divided into two distinct categories: realtime and store-and-forward. Realtime telemedicine involves synchronous interaction between the parties concerned. For example, a health-care professional and a patient may interact by videoconferencing. While realtime telemedicine is often effective in terms of consultation and patent satisfaction, it presents challenges.

Foremost is the scheduling of the parties concerned, because there are usually two health-care providers involved in the consultation (the local provider and the remote physician), and they both need to be available at the same time.

In contrast, store-and-forward (S&F) telemedicine is an asynchronous interaction, so that a clinical query, for example, can be transmitted by the referrer and then answered by a specialist at a convenient time. Email is a common example of this sort of telemedicine. Although diagnostic accuracy may be lower with S&F telemedicine, it is advantageous from the point of view of cost, complexity and convenience.

The field of telemedicine encompasses more than clinical interactions, of course. Having the technology to connect remote sites also allows distance learning. This may involve training or information sharing for health-care professionals that does not directly involve patients but still enhances care...

Evaluation of Unmanned Airborne Vehicles and Mobile Robotic Telesurgery in an Extreme Environment

While advances in robotics and computing have resulted in surgical robots that are currently used in operating rooms across the world, similar advances in telecommunications and computing have permitted development of telemedicine, which has seen a global expansion. Surgical teleconsultation is effective in bringing surgical expertise to the previously isolated operating room. Teleconsultation could overcome the barriers of time, distance, and interject expertise and order into the care of a soldier in the midst of the chaos of the battlefield.

Prompt, definitive care from a distance could improve soldier survival as well as decreasing the risk of delivering medical care for other soldiers. As the modern battlefield evolves to include more automated devices and remotely controlled vehicles, the integration of telesurgical robotics into battlefield care of injured soldiers becomes increasingly plausible. However, mobile robotic telesurgery (MRT) has not been feasible, primarily because the requirement of low latency, broadband telecommunications connections was not widely available and the robotic systems were not robust enough for use in extreme environments. Dr. Jacques Marescaux’s original and our recent basic science and clinical telesurgical experience demonstrated the applicability of remote robotic telesurgery. This research successfully used dedicated, terrestrial high bandwidth communications. This experience suggested that a remote surgeon could operate on an injured soldier on a distant, not previously feasible battlefield and also demonstrated that shorter latency results in improved surgical performance...

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