By Ann Braley-Smith

The practice of telemedicine holds new promise for both practitioners and patients, especially for those in remote or rural locations.

Telemedicine is broadly defined as using telecommunications technology to provide medical information and services. According to the Telemedicine Research Center (TRC) Web site, it can be as simple as two doctors discussing a case over the telephone, or as sophisticated as implementing satellite technology to broadcast a consultation between providers at facilities in two countries.

What's it all about?
While that might seem a broad sweep, the TRC says there are two broad telemedicine applications being used today:

• "Store and forward," used for transferring digital images from one location to another. A digital camera stores an image and then sends it to another location. Typically used for nonemergency situations, these store and forward tasks can be transmitted between locations in the same building, or from one building to another building across town--or to anywhere in the world.
• Teleradiology, or the storing and forwarding of X-rays, CT scans, or MRIs, is the most common application of telemedicine in use today, says the TRC. In fact, many radiologists are getting their homes equipped with the right computer equipment so they can have images sent directly to them for diagnosis, saving them an off-hours trip to a hospital or clinic.
• A second common telemedicine technology is two-way interactive television (IATV), used for one-on-one consultation. It is usually between the patient, a provider, and a specialist, but may be any combination of the three. Videoconferencing equipment at two or more locations allows a "real-time" consultation, and because technology has decreased in price and complexity over the past five years, many programs now implement desktop videoconferencing systems.

The advantages
Telemedicine offers many advantages to those who adopt the technology.

One of the most promising aspects of telemedicine, according to the TRC, is making specialty care more accessible to underserved rural and urban populations. Furthermore, telemedicine creates new opportunities for continuing education or training for isolated or rural health practitioners, who may not be able to leave a rural practice to take part in professional meetings or classes.

The disadvantages
While the advantages are clear, there are barriers to telemedicine that must be addressed before telemedicine can reach fruition.

For example, many states will not allow out-of-state physicians to practice unless licensed in their state, limiting the scope of videoconferencing capabilities and other applications. Medicare, Medicaid, and private insurance reimbursement rules limit many telemedicine practitioners, and potential malpractice suits are another real consideration for physicians.

Plus, the perception regarding a lack of "hands-on" interaction with patients must be overcome, although the TRC says the majority of patient satisfaction studies to date find patients on the whole satisfied with long distance care.

Technology and perceived cost barriers can also limit the success and acceptance of telemedicine. For instance, regular telephone lines do not supply adequate bandwidth for most telemedical applications--and many rural areas do not have cable wiring or other kinds of telecommunications access required for more sophisticated uses, so those who could most benefit from telemedicine may not have access to it.

Who's using it?
Despite these formidable barriers, telemedicine programs are forging ahead, and have shown real success in several health care situations.

For example, TRC says a telemedicine program at the University of Kansas is applying technology to help tackle the growing rural health care crisis. Similarly, telemedicine programs are being implemented at correctional facilities, to help broaden resources, lower risks of transporting inmates, and ultimately lower costs to taxpayers. The TRC cites a successful program from the University of Texas Medical Branch at Galveston--a pioneer program that now provides services to over 400 incarcerated patients per month.

The burgeoning field of home health care is another booming area of telemedicine, and is proving that telemedicine does not have to cost a great deal of money, as it helps provide services to those with no access to health care, using low-end technology, such as handheld computers and cell phones.

On the other end of the spectrum, state-of-the-art, high-end research by military and leading university research centers are developing robotics equipment for telesurgery applications, (where a surgeon in one location can remotely control a robotics arm for surgery in another location). Originally developed by the military for battlefield use, leading academic medical centers and research organizations are also harnessing the technology to reap benefits.

Bright future for patients, health care workers
Despite limitations, telemedicine is a growing field with a bright future.

According to career expert Helen Harkness, telemedicine is one of the most promising new career fields for those with the right skills. Harkness, who counsels people looking for career change, has found that telemedicine and medical infomatics--a new hybrid of medicine and computer science--are creating job possibilities to fit a unique skill set for potential employees. She says the field attracts people who might consider medical or nursing school, but have keen analytical and pragmatic skills and computer science or IT expertise.

What's more, the TRC says the field will only grow. According to the organization's Web site: "Once the current barriers are resolved, the practice of telemedicine will likely undergo a radical change and transition from its current state of grant-funded projects, military demonstration projects and a few self-funded programs, to become a major industry within the health care field."

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