Telemedicine is the use of medical information exchanged from one site to another via electronic communication to improve a patient’s clinical health status (American Telemedicine Association, 2017). It includes a growing variety of applications and services using two-way video, smartphones, wireless tools, and email, as well as the more commonly known telemedicine video conferences between physicians and patients in different parts of the world. Telemedicine is not a separate medical specialty. In many cases, it is a tool used by patients to obtain more convenient access to medical care.
Despite a number of isolated successes, telemedicine remains an emerging tool in the healthcare system, offering great potential to improve the health of individuals and their communities. In the essay to follow, we will provide concrete evidence of how telemedicine has improved healthcare access at macro and micro levels. This evidence will clearly support the argument that telemedicine has and will continue to improve healthcare access. The evidence presented will also effectively address opposing views to this argument by demonstrating that, in comparison, telemedicine is a more efficient and economical method to achieving many of the same goals that other healthcare framework and service reforms aim to accomplish.
The current healthcare environment is in the midst of an information technology revolution. This revolution is being driven by consumers’ need for convenience, growing access to the internet, and the shift from a disease-oriented to a wellness-oriented healthcare system. Also sparking this revolution are the rapid development and deployment of telecommunication and information technologies. The principal tool at the center of this movement toward a more widely accessible and cost-effective healthcare system is telemedicine (Ljunberg & Kahan, 2010). Its application is changing the way that patients and providers interact. Furthermore, it is addressing the growing need for more accessible, convenient, efficient, and economical healthcare services. In Johnson County, Iowa, 34 percent of area adults and 70 percent of Johnson County students report using email for health-related concerns (Boffeli, 2005). Telemedicine through email and programs like “Ask a Nurse Practitioner” serves as a mechanism for these individuals to receive medical advice without physically traveling to a provider. This, in turn, can save patients time and money by reducing the number of office visits and also helps to solve issues by providing patients with a quicker resource for information and problem-solving (Boffeli, 2005).
- Benefits of Telemedicine
Telemedicine can also have benefits across the entire spectrum of care. For example, in the realm of outpatient care, patients with chronic conditions can be managed more efficiently and cost-effectively if they can easily maintain contact with their physician. A study of a pediatric cardiology clinic found that virtual follow-up visits for children with congenital heart disease resulted in a 40% increase in patients completing recommended care, and a 30% decrease in costs compared to traditional office visits. For adults, studies have found that telemedicine for patients with conditions such as heart failure, diabetes, and lung disease can lead to a reduction in hospital admissions and readmissions, emergency room visits, long-term care admissions, and can help manage the chronic condition and avoid acute exacerbations.
The benefits of telemedicine are numerous. More obvious are the benefits to underserved populations. In 2004, 9.6% of non-Hispanic Whites were uninsured. The rates of uninsurance among African Americans and Hispanics were much higher at 19.4% and 32.7% respectively. In the same year, 13% of non-Hispanic Whites, and 20% of African Americans and Hispanics reported cost as a barrier to obtaining medical care. Unsurprisingly, the rates of chronic diseases like diabetes, hypertension, and cancer are much higher among low-income minority populations. For communities such as these, telemedicine can increase access to medical services, provide a convenient and cost-effective way to receive preventive care, and help close the gap in health outcomes caused in part by unequal access to medical care.
- Challenges and Limitations
Telemedicine has the potential to improve the health of patients in community health centers by increasing access to specialist care. We examined the use of telemedicine at community health centers and conducted a case study of a store-and-forward telemedicine project at thirteen centers. Data collection methods included a national survey of community health centers that receive telemedicine grants, site visits to six of these centers, interviews with mediators and with program administrators at the Telemedicine, and interviews with key informants at the thirteen participating centers. Data collection took place in 2003-2004. During this period, 40% of U.S. community health centers received telemedicine grants. Although most centers used telecommunications primarily for remote access to secondary care services at the time of the survey, this may have changed since the passage of the Medicare Modernization Act. At the thirteen participating centers, telemedicine has been used for a variety of purposes, including case consultations, patient referrals, disease management, and patient and professional education. Uptake of telemedicine at these centers was found to be influenced by characteristics of the innovations, particularly relative advantage and compatibility with centers’ existing patient care systems.
- Telemedicine Implementation Strategies
The first of these categories, direct to consumer advertising, is focused on forming a patient demand for e-visits through the different types of telemedicine consultation. This method is often implemented by private companies that seek to provide a service linking consumers to physicians over the internet or phone and is used in the study mentioned where private Telehealth Alberta compared to limited public telemedicine consultations services in Ontario. Both types of services still had low utilization, where per e-visit as a total percentage of all consultations was 0.9% in Alberta and 0.5% in Ontario. However, the study found that the higher level of direct to consumer advertising in Alberta produced higher per capita rates of e-visits, showing that this method may be effective, but still influenced by the availability of the service.
Telemedicine strategies provide a valuable prospect for more than a few healthcare organizations and patients, and a variety of these strategies have been implemented to facilitate patients’ access to the physicians and healthcare they need. A Canadian study compared telemedicine implementation strategies in both Alberta and Ontario, using the planned behavior framework as an analytical tool. It concluded that there are a variety of procedural differences and specific strategies used that fall under four main categories. These categories were: Direct to consumer advertising, Professional to Professional marketing, System integration and monitoring, and changing or enforcements of practice acts or legislature.
- Conclusion
Telemedicine can be a cost-effective and convenient way of providing healthcare to the people in these communities. It can help improve access to specialty care. For example, a study was done in which dermatologists at a distant site evaluated patients with suspected skin cancer referred by primary care providers at rural clinics. The patients were offered a choice between live interactive teledermatology consultation or the earliest appointment at the university-based dermatology clinic, which was usually 6-12 weeks later. Subsequently, teledermatology services were offered to the patients in the study group. The results of the study showed that the patients in the teledermatology group were seen sooner and needed fewer additional follow-up appointments. It also showed that the diagnoses and treatment plans were generally the same for both groups.
The uneven distribution of healthcare professionals in the U.S. has led to limited access and quality of healthcare in rural, inner-city, and poor communities. Several factors have contributed to this inequity, including the widespread poverty, an insufficient number of primary care and specialist physicians who are willing to practice in these areas. High rates of uninsured and under-insured also limit access to medical care for many Americans. Research has shown that lack of access to primary and preventive care can lead to increased rates of hospitalization for ambulatory sensitive conditions, an increase in the spread of infectious diseases, and an increase in the prevalence of chronic diseases. There