Telemedicine – The Doctor Will See You Now From a Hundred Miles Away
The future of telemedicine is starting now, and the opinions of Osteopathic Family Physicians vary on its viability and effectiveness.
By Belinda Bombei
From across the country, research is documenting the encouraging impact of telemedicine on health care delivery. At many osteopathic medical schools, students are required to learn about telemedicine as part of their curriculum. For instance, The Oklahoma State University College of Osteopathic Medicine (OSU-COM) requires a telemedicine sub-rotation for all third-year students. By graduation at OSU-COM, students have learned how to search medical literature, videoconference, consult, and use peripheral telemedicine equipment. But for other osteopathic family physicians, telemedicine seems futuristic instead of a viable treatment option benefiting both patients and doctors.
Telemedicine Defined
You may not know this, but every doctor has practiced telemedicine at some level. In its most basic form, telemedicine is two doctors discussing a case over the telephone. In its more developed form, telemedicine consists of using satellite technology and video-conferencing equipment to conduct real-time consultations between doctors on different sides of the United States, or even different sides of the world.
Two different kinds of technology make up most of the telemedicine applications in use today. The first, called store and forward, is used for transferring digital images from one location to another. A digital image is taken using a digital camera, (‘stored’) and then sent (‘forwarded’) by computer to another location. This is typically used for non-emergent situations, when a diagnosis or consultation may be made in the next 24 - 48 hours and sent back.1
The other widely used technology, two-way interactive television, is used when a “face-to-face” consultation is necessary. The patient and sometimes their provider are at the originating site. The specialist is at the referral site. Videoconferencing equipment at both locations allow a ‘real-time’ consultation to take place.2 In fact, monitoring a patient at home using known devices like blood pressure monitors and transferring the information to a caregiver is a fast growing emerging service.
For example, a newly released report from the Sutter Medical Center in Sacramento, California has found that using videophones to connect health providers to families with diabetic children can reduce costs to health care providers while maintaining the quality of care. It also was found that such use could significantly reduce the number of school hours missed by the patient.
The study showed how videophone technology helped health care providers communicate with and manage children using insulin pumps in more than 17 California counties. The study’s results showed that use of the videophone improved patient compliance and increased cost savings without compromising patient satisfaction and quality of care. The biggest impact was on valuable provider time, where patients missed substantially fewer videophone exams than in-person exams.3
Opinions of osteopathic family physicians
Members of the ACOFP Medical Infomatics Committee were surveyed for their opinions on the viability and effectiveness of telemedicine. As the creators and reviewers of the ACOFP website and technology in general for the ACOFP, the Medical Infomatics Committee offers a well-educated opinion. Student leaders of OSU-COM also were interviewed, as OSU is a leader in telemedicine technology, with the state’s largest telemedicine network connecting physicians to patients via the Internet.
John R. Gimpel, DO, M. Ed., has little experience with telemedicine but feels the use of telemedicine may be an integral part of the solution for the projected physician workforce shortage, especially as it pertains to health care in rural America. “It also may be important in medical education, helping to provide education equivalency to clinical clerkships and residency program rotations, connecting campus-based basic science and clinical medical educators with preceptors and trainees in the field,” said Dr. Gimpel.
John E. Kazilionis, DO does not think telemedicine will ever be accepted by the average osteopathic family physicians. “I have had patients send me e-mails with requests for refills of medications and to tell me of medications prescribed by consultants. This is the best use of telemedicine utilization that I can imagine. It is not possible to practice quality medicine without examining the patient. A “hands on” approach is the foundation of osteopathic medicine. I think the potential is extremely limited due to the inability to examine patients on-line. It detracts from quality of care to do so.”
Melonie Ferry, MSII OSU-COM, Class 2010 believes most of the average rural osteopathic family physicians are open to telemedicine. She believes “it allows them to offer their patients many more procedures (such as mammograms, OB/GYN, and colonoscopies, etc.) without the physician having to do a lot of extra training.
“Also, for rural practitioners, many patients have to drive long distances for referrals. With telemedicine, they will only have to refer out when there is a problem that cannot be handled in-house, so their patients prefer it also.
“I volunteered to go with the OSU-COM telemedicine bus into Okemah, Oklahoma, a rural community. The bus is state-of-the-art and practically a mobile hospital. Patients were eager to utilize it, and actually began suggesting further areas of expansion.
“The town of Okemah is almost two hours from both Oklahoma City and Tulsa, and the people that came to the bus were ecstatic that they did not have to drive that far for routine screening tests. As a future physician in Okemah, I am elated that I will be able to offer future treatments in my practice that were previously unavailable locally.
“I know that in my future practice, I will utilize telemedicine applications such as the OB/GYN mobile sonogram, EKG applications, and radiology applications. The ENT will be great too. Honestly, I think each application is needed and extremely useful. I know I will utilize every one when I set up my practice.
“There are few limits to telemedicine. The only limit I see is the physicians themselves. The technology is available and it takes little training to utilize it. OSU-COM is making it a priority to go throughout rural Oklahoma educating doctors and helping them set up their telemedicine capable offices. The OSU-COM goal is that every rural doctor in our Oklahoma will be linked up to telemedicine, helping to solve the rural medicine crisis in our state.
“I believe telemedicine can revolutionize Oklahoma medicine. Family doctors all over the state will have ready and easy access to scores of specialists. These specialists can guide those family practitioners in doing the maximum amount possible of procedures in-house, then pick up where the family practitioners are unable to go.
“Imagine, as a specialist, how amazing it would be to have already seen the labs, tests, and real-time images of the patient before they ever set foot into your office or being a family practitioner that was able to catch cancer before it spread too far because of the help of a specialist, hundreds of miles away.”
Jeffry A. Lindenbaum, DO FACOFP dist. believes that for telemedicine to be accepted by the average osteopathic family physicians that there must be a guarantee of information security, HIPAA protection, ability to be reimbursed for services rendered, and indemnification for liability issues except in extreme cases. Though he has not had a personal telemedicine experience, he feels the most useful applications for osteopathic family physicians will be requests for prescription renewals, appointment management, referrals, and sending and receiving notes. Issues that are limiting osteopathic family physicians involvement current, he believes are the reimbursement issues and security concerns.
Conclusion
Telemedicine is no longer a futuristic tool; several osteopathic family physicians and students are using telemedicine on a regular basis. Telemedicine research is being conducted at highly regarded universities and hospitals across the country and the results are encouraging.
Some osteopathic family physicians are excited about the technology; others feel that telemedicine takes away from the central core of what it means to be an osteopathic family physician – hands-on care. As the use of telemedicine continues to increase, the debate will rage on between those who feel telemedicine will revolutionize medicine and lead to improved quality and accessibility of medical care at affordable prices and those that remain loyal to the tried and true, bricks and mortar medical practice.
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| Nonclinical uses of telehealth technologies |
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Belinda Bombei is the medical editor for tweakmywords.com and has over 14 years of editing experience, including five years of experience editing osteopathic medical articles. She provides suggestions to transform osteopathic medical content from good to outstanding, producing an article worthy of publication and recognition.
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