Telemedicine is the use of communication technologies to deliver health-related services over a distance. Many health care practitioners prefer the term telehealth as a more comprehensive means to express the clinical, health education, and data management applications of these technologies. Telemedicine is not a new concept and can be traced back to the 1950s, when a psychiatrist provided mental health services to inmates by connecting to a prison 150 miles away using closed-circuit television. A handful of telemedicine projects through the 1960s and 1970s gained attention but not traction, as they fizzled out in the 1980s. However, a series of significant health care challenges led to the reemergence of telemedicine in the final decade of the 20th century.
The resurgence and continued growth of telemedicine in recent years can be linked to the ongoing search for solutions to difficulties faced by health care systems worldwide. In the United States, the share of the economy devoted to health care increased from 7 percent in 1970 to more than 18 percent in 2012. Some predict health costs to soar to 25 percent of gross domestic product by 2025. In addition to a rapidly aging population, U.S. citizens have the highest documented rate of chronic diseases, such as diabetes, congestive heart failure, or asthma. Diagnoses and treatment for chronic disease are themselves chronic problems, as coordination of care is one of the biggest issues facing the treatment of these illnesses. Add the challenge of frequent medical, medication, and lab errors in the United States and it becomes clear why many seek telemedicine as a solution to address American health woes.
Traditionally, telemedicine has been divided into two categories of technological applications. The initial technologies predominately employed were synchronous, which used videoconferencing and medical peripheral devices to allow providers and patients to engage in real-time consultations over some geographic distance. This type of interaction is actively employed today to enable patients to access primary and specialized care that is unavailable where they live.
The second category for telemedicine allows for asynchronous, or store-and-forward solutions. These technologies allow for remote capturing of images or physiological data that are transferred to a health provider who assesses them at a convenient time and location. Technological advances such as improved broadband access, increasing electronic storage capabilities, and mobile devices are impacting the growing rate of asynchronous telemedicine applications. Current technological solutions appear to be heading toward a convergence of synchronous and asynchronous methods for delivering health services. For example, smartphones allow for automated text messaging systems that enable a dynamic and interactive platform for the patient to manage his or her health while also storing the information for a provider to view at a later time. Another new trend can be found in the multitude of wireless, “smart” sensors for monitoring the health status of individuals.
The range of health services provided via telemedicine is staggering. First, primary care providers and specialists provide a broad array of consultative and ongoing care for patients often located in underserved areas. Though telepsychiatry is often credited as the most common application, specialists from such fields as neurology, cardiology, dermatology, and oncology also employ telemedicine. Second, remote patient monitoring is rapidly expanding as a telemedicine application. This includes telehome health, in which devices are employed to collect and send patient data to a home health provider, physician’s office, or remote diagnostic testing facility. Remote patient monitoring is viewed as an important solution to address the ongoing management of chronic illnesses. The goal is to help patients manage and monitor their health status to prevent costly visits to their doctor or a hospital. A third application for telemedicine can be evidenced through medical and health information directed to consumers. This includes the use of the Internet and wireless devices for consumers to gather specialized health information or to access discussion groups or online support. Finally, telemedicine can facilitate education by enabling continuing medical education for health professionals and special health education programming for targeted populations.
Barriers to the successful deployment of telemedicine have been well documented, such as legal and regulatory issues. For example, the lack of universal reimbursement is often cited as a significant challenge. Medicare reimbursement is complex and limited in large part to nonmetropolitan service areas, and reimbursement from private payers varies widely from state to state. Licensure laws also vary dramatically across states, limiting the opportunity for cross-state services. Although issues such as reimbursement, liability, technical challenges, and licensure/credentialing are typically cited as the main barriers to telemedicine, the slow adoption by many providers cannot be ignored. Telemedicine can often be a disruptive solution by changing processes in care delivery, which can serve as a disincentive for busy providers. Additionally, overarching aspects of health organizations play an important role as facilitators of telemedicine. Documented central themes for successful telemedicine programs include an effective organizational structure and design, forward-thinking leadership, goals to improve quality of patient care, and financial stability.
Telemedicine serves as a perfect example of a health innovation that must be studied from multiple perspectives to explain and understand its impact and outcomes. Telemedicine research to date suggests mixed results yet enormous potential. Much of the published research has documented clinical effectiveness across a wide array of disciplines. Positive clinical outcomes have been documented for heart disease, psychiatric conditions, medication compliance, heart failure, hospital readmission, emergency visits, and some telehome health programs.
Evidence for the cost effectiveness of telemedicine is mixed, however. Many authors have concluded that there are not sufficient data to determine the true economic impact. In regard to perceptions, a great deal of research has established high patient satisfaction with a variety of services received through telemedicine. Studies have also documented overall satisfaction among health care providers and that their general acceptance of telemedicine is positive. Yet it is generally agreed that actual utilization of telemedicine technologies by providers has not reached its full potential within the broader context of health care.
One area of opportunity for telemedicine research is the inclusion of enhanced theory construction and testing. The most common theoretical concept applied to telemedicine research to date is Everett M. Roger’s diffusion of innovations model, which is rooted in a sociological focus on social groups and processes. Other studies have built on psychological theories seeking to explain and predict conscious behavior such as Fred Davis’s technology acceptance model (TAM) and its immediate predecessor the theory of reasoned action by Icek Ajzen and Martin Fishbein. Such social-cognitive models are applied to telemedicine research to identify general determinants of behavior (e.g., technology acceptance). Still other studies focus primarily on changing health-related behavior where telemedicine is secondary to the purpose of the technology intervention. These studies test common theories from health psychology and health promotion (e.g., health belief model, transtheoretical model, self-efficacy) and tend to focus on the patients.
With the continued outpouring and acceptance of new communication technologies, telemedicine’s future appears secure. In addition to the more traditional research completed to date, the field serves to benefit greatly from enhanced cross-disciplinary scholarship that further addresses human factors and ergonomics, process and workflow factors, usability, and business and management model development.
Computer Kiosks, Free-Standing
Diffusion of Innovations Model
Health Belief Model
Theory of Reasoned Action
- An Overview and Analysis of Theories Employed in Telemedicine Studies: A Field in Search of an Identity.” Methods of Information in Medicine, v.47/3 (2008). ; ; ; ; . “
- The Multiple Contexts of Borders That Impact Telemedicine as a Healthcare Delivery Solution.” Journal of Borderland Studies, v.25 (2010). ; . “
- Telemedicine: What Have We Learned?” Applied Clinical Informatics, v.1 (2010). ; ; . “
The Health Resources and Services Administration (HRSA, 2001) defined telehealth as “the use of electronic information and telecommunications...
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Globally, one of the great challenges of the modern world has been to make high-quality health care universally available. A traditional difficulty