The history and applications of telemedicine in modern healthcare

Healthcare Management Information Systems

Telemedicine

Telemedicine can be traced far back in the 1960 when the National Aeronautics and Space Administration (NASA) provided health care to it astronauts Bashshur & Armstrong, 1976.

The medical service was provided to the astronauts from a medical van that was linked to medical specialists equipped with a two way microwave telemedicine and audio transmission. The service was meant to telemeter astronaut's physiological response while on their space mission in their space suits

In 1967 a medical station was established in Massachusetts general hospital to cater for airport employees and deliver emergency medical attention and care to commuters. The diagnosis and evaluation of treatments was undertaken by selected nurses overseen by physicians Williams, May C.R., & Esmail a., 2002()

Further developments in the field of telemedicine were made to guarantee efficiency and accuracy in diagnosis. The need for remote video led NASA to conduct a survey establishing the minimal television system required for diagnosis. The study conducted marks the video conferencing which was used to provide video images through diagnosis and treatment.

Application of telemedicine in recent time has developed to be part of emergency preparedness and disaster response. Incidences of natural calamities have received attention from specialist even when physical presence in duly unavailable. In the current millennium it is appreciated that telemedicine has contributed to rural areas across the state providing much needed support the health institutions are physically incapacitated to provide.

Telemedicine

Telemedicine according to Mort, May, and Williams (2003)

, telemedicine involves monitoring, treatment and diagnosis where patients and doctors are detached by space and time. Medication is through information technologies. In this aspect Telemedicine has capability to improve on efficiency and cost of treatment where the patient doctors and hospital management benefit. With Telemedicine, a vision of a global hospital is prospected where geographical barriers are broken. Cartwright (2000)

, argues that Telemedicine will most likely bring forth a new pattern of global village and thus a new global paternalism will consequently emerge.

Telemedicine is argued to be affording clinical practice to explore more possibilities other than just increased access to health care. Cartwright (2000)

, observed that with Telemedicine there will be prominent increases in access to quality healthcare that is affordable and most importantly efficient in terms of delivery and a healing. The effectiveness observed by Cartwright, is discussed by Williams et al. (2001)

, with specific reference to delivery efficiency. Edwards, Hall, and Shaw (2005)

, explored the policy implication and management aspects that telemedicine improved.

Application and Use of Telemedicine

Telemedicine encompasses care giving methods in a virtual health care institution. It entails the interplay of clinical and information technology applications that capture medical information to investigate, diagnose, consult and treat. The application of the procedure uses secure internet web-based connections and a help desk for end users Cartwright, 2000()

The technology utilizes the use of a standard telephone connection, personal computers, internet connections, still images and video outputs for virtual communication, robotics an satellite transmission. In addition to this it is noted by Bar-Yam (2006)

that smart phones have enabled enhancing care provision by facilitating fast and clear access to digital image and correspondence between the patient and physician.

Telemedicine applications are in most case real time-based which enable healthcare providers to observe patients and test the likely results there by render clinical assessments with no constraints of distance or geographical barriers Bar-Yam, 2006()

Concerns arising from the use of Telemedicine

With the continued growth and embrace of telemedicine services a variety of issues are coming up. As an integral part of many health institution telemedicine is setting in matters concerning administration, delivery of payments and privacy.

Licensing

It is appreciated that as telemedicine is breaking geographical barriers issues touching on licensing are coming up. It practically impossible for medical practitioners to obtain licenses in each and every state that telemedicine will offer them an avenue to operate. As Williams et al. (2002)

, puts it, it practically for health practitioners to take exams in different states and regions and travel for interviews all in the name of obtaining licenses to practice. The cost involved in this procedure given the stretched avenue provided by telemedicine makes it virtually impossible. The concern in this case is the possibility of adapting international procedural standards that will accommodate the operations of telemedicine.

The first challenges -- which are interrelated in many respects -- that legally hinder the development of telemedicine include issues related to interstate licensing, legal liabilities, and institutional credentialing of physicians Roback & Herzog, 2003.

Unfortunately, many of these legal matters are still unanswered and unresolved within both the U.S. health care and judicial systems. For example, in interstate medical transactions where mechanical devices are used for surgery or radiology, if there is a mechanical failure or glitch that results in harming the patient, deciding on who is responsible for that accident is debatable and can be a major headache for legal authorities. Another key issue implicit in this scenario is that these practitioners who are treating and communicating with the patient are operating out of different states.

Because laws regarding telemedicine and health care certification are unique in each state, legal liability, malpractice, and jurisdiction become serious matters of concern for the judicial, legal, and medical systems Turner, 2003.

For instance, in the event that an inexperienced physician located in Arizona is physically operating on a patient and is engaged in a live telemedicine communication with a specialist in New York whose guidance and direction botch the surgery and result in the patient's death, the prosecutors and legal officials in Arizona would find difficulty in placing blame and litigation on the party in New York. An issue like this one is a typical scenario in which telemedicine presents some legal and licensing issues. However, as telemedicine and its associated technology evolve, feasible solutions (i.e., legal policies and amendments) to these problems should be discovered and made available.

Knowledge and Expertise in Telemedicine

Another challenge has to do with the limited knowledge and expertise in telemedicine as well as the need for enhanced and modified telemedicine systems. In this sense, little knowledge currently exists among medical practitioners on how to effectively and practically use various forms of telemedicine. This knowledge gap on insight into telemedicine, in effect, hinders the creativity to explore more efficient and effective modalities of telemedicine applications. As a result, teaching medical practitioners to learn and adopt this new way of accomplishing health services, through telemedicine, has become a significant hurdle to implementation Turner, 2003.

Special competence is also required before implementation of telemedicine can be allowed and render success to those concerned. In this regard, a unique term, telecompetence, was created to describe the required skills and credentials practitioners must have in order to carry out this kind of specialized work Turner, 2003.

Telecompetence is a must in order to be a health communication expert regarding telemedicine. In particular, according to Turner (2003)

, there is a three-stage process involved in such health communication aptitude. As such, telecompetence consists of;

1. planning and establishing,

2. learning and use, and

3. Formalizing routines.

Unfortunately, achieving this level of competence could be considered a major adversary to telemedicine implementation, because considerable training and finances are not always available resources to enable this kind of campaign. To this end, in some medical settings where resources are limited, telemedicine may not be a feasible or affordable option.

According to Edwards et al., 2005()

telemedicine has its limitation compared traditional, face-to-face diagnosis. Face-to-face diagnosis offers an added advantage where interactions can be combined with physical comparisons. In the case where physical contact is said to provide a perfect avenue for diagnosis telemedicine can then be termed as inadequate. The inadequacy is worsened by the physician's competencies and experience. Experienced physician can be able to make complete and accurate diagnosis using limited information which makes telemedicine appropriate. In reality however, the experience of physician is limited in term of regions of operation and the number of years in practice Mort et al., 2003.

This brings out the ineffectiveness of wholesomely relaying on telemedicine.

The quality of technology used by Physicians and patients greatly contributes to the diagnosis and thus effectiveness of telemedicine. In the world technology is not standardized thus, in as much as telemedicine is breaking geographical boundaries, its overall application in global perspective is limited Bar-Yam, 2006()

Accountability of medical practitioners in the telemedicine is limited owing to its admissibility in certain region and lack of broad guidelines. The argument brought out by Brookfield and Smith (2006)

, is that individual physician will set their guiding principle according to the best interpretation laws concerning malpractice. Observed from this issue is that a set of guidelines touching on practicing telemedicine is required in order to avoid inadequate diagnosis and treatments.

Solution

Training to Medical Practitioners

The continued growth of telemedicine needs to be harnessed and incorporated in the management of hospital information systems. For result in the provision of healthcare using telemedicine, there is the need to consider training to physicians and attending nurses. This will increase efficiency as telemedicine is offered by allowing for coordination of actions and expectation as well and diagnosis. Physicians need to be trained through refreshers courses to equip them with diagnosis information and reading digital data.

Training to medical practitioners may enlist feelings of inadequacy among the staff and also reduce motivation among those who are not offered the training. To the hospital, it will seem be a venture whose needs are not conceptualized.

Licensing and practicing

Licensing and practicing telemedicine should be considered as a new development, and new measures to govern it are required. The authorities need to come up with regulatory measures that are linked to Telemedicine as opposed to the existing guides. The need to incorporate countries and regions in the creation the rules and licensing procedure is emphasized owing to the fact that telemedicine has no boundaries.

Coming up with rules, regulation and licensing boards for telemedicine will entail a bureaucratic process which may lead to stagnated growth of the developments made. The ideal measure would be to have states incorporate their own measures, rules and regulation governing the practice of telemedicine and then tries later standardize theme to fit the standards of the world. This process may take a while but, it is much better.

Payments and Reimbursements

In some instances need arise for a physician to offer healthcare to patient with consideration for their payments. The Telemedicine development have not been able to incorporate direct payment to Physicians rather they get reimbursements it is evidenced that the growth in practice may not be sustainable if a payment system is not considered. There is the need to consider online payment methods which greatly contributes to the field's growth.

Recommendations

In the present day and age, we know that a considerable portion of world society relies mostly on technology and electronics for communications, memory storage, military operations, and medical procedures. With the advent and advancement of telemedicine -- especially via the Internet -- our medical and health care systems have taken a near complete redirection in how health communication is channeled and exchanged. Humans on all sides of the health care system are now becoming digitized, virtual, and cyber Turner, 2003.

Brookfield and Smith (2006)

, adds that activities by humans to embrace technology has increased in a substantial telemedicine and its modernization.

It is interesting that the subtractive communicative effects of telemedicine have often been overlooked in health communication. In addition, Turner (2003)

argued that few studies have been conducted on the communicative and interpersonal implications of telemedicine. Thus, we believe that it is important to address this issue.

Indeed, e-health services represent the most interpersonally and communicatively reductive telemedicine technologies that exist today Brookfield & Smith, 2006.

The reason lies in the fact that face-to- face contact and nonverbal communication are absent or absolutely minimal in this medium Roback & Herzog, 2003.

As such, telemedicine services on the Internet (i.e., e-mail) deprive humans of the fundamental contact that is so essential in social interactions Roback & Herzog, 2003.

Although Bar-Yam, 2006()

has argued that e-mail can provide a rich social presence, others assert that e-mail services are mere exchanges of written words, absent of any facial expressions and gestures Aragon (2003)

and that they diminish interpersonal contact with others because all communication is electronic Aragon, 2003.

Also, because telemedicine can be a sort of dialogue between distant users, e-mail is oftentimes adopted as a channel to carry out such dialogue. Unfortunately, e-mail is appropriate only for asynchronous communication. In addition, the present condition of the Internet does not usually produce expeditious delivery times Turner, 2003.

So the question arises as to why e-mail is preferred if it is oftentimes slower than other forms of communication.

Likewise, health care information that is posted on WebMD.com does not require that the information-seekers consult with a human being or physically visit with someone in an office. For instance, health care consumers can search for pharmaceutical information (i.e., prices, descriptions, side effects, and contraindications) and diagnostic information about diseases (i.e., images, symptoms, and current and innovative treatments) on these types of sites without any personalized visits, phone calls, or any manner of communication that requires two individuals to exchange ideas. It seems that the Internet provides a user-friendly, omniscient encyclopedia of health care information, allowing doctors to be thrown on the wayside or deemed obsolete in many cases. To this end, Internet-based telemedicine services can, in many cases, erase or at least significantly reduce the need for human communication and contact.

Reference

Aragon, S.R. (2003). Creating social presence in online environments. New Directions for Adults & Continuing Education. 100(57-69).

Bar-Yam, Y. (2006). Improving the Effectiveness of Health Care and Public Health: A Multiscale Complex Systems Analysis. American Journal of Public Health, 96(3), 459-466.

Bashshur, R., & Armstrong, P. (1976). Telemedicine: A new mode for the delivery of health care. Medical Inquiry, 13, 233-244.

Brookfield, D., & Smith, D. (2006). Managerial Intervention and Instability in Healthcare Organizations: The Role of Complexity in Explaining the Scope of Effective Management. Risk Management, 8(4), 268-293.

Cartwright, L. (2000). Reach out and heal someone: Telemedicine and the globalisation of healthcare. Health 4(3), 347-377.

Edwards, J.S., Hall, M.J., & Shaw, D. (2005). Proposing a Systems Vision of Knowledge Management in Emergency Care. The Journal of the Operational Research Society, 56(2), 180-192.

Mort, M., May, C.R., & Williams, T. (2003). Remote Doctors and Absent Patients: Acting at a Distance in Telemedicine? Science, Technology, & Human Values, 28(2), 274-295.

Roback, K., & Herzog, a. (2003). Home informatics in healthcare: Assessment guidelines to keep up quality of care and avoid adverse effects. Technology and Healthcare, 11, 195-207.

Turner, J.W. (2003). Telemedicine: Expanding healthcare into virtual environments. In a.M.D.T.L. Thompson, K.I. Miller, & R. Parrott (Ed.), Handbook of health communication (Eds.), (pp. 515-535). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.

Williams, T.L., May C.R., & Esmail a. (2002). Limitations of patient satisfaction studies in telehealthcare: A systematic review of the literature. . Telemedicine Journal and E-Health, 7, 293-316.

Williams, T.L., May, C.R., Esmail a., Griffiths C.E.M., Shaw N.T., Fitzgerald D., . . . Kelly S. (2001). Patient satisfaction with teledermatology is related to perceived quality of life. British Journal of Dermatology, 145, 911-917.