Telehealth and telemedicine, sometimes the terms are used interchangeably, is the access point to medicine for millions of Americans, and will be greater every year. ASCO members and all health professionals who are caring every day for those impacted by cancer have found or will find that electronic communication is a tremendous advantage that if used wisely, will lead to greater access and affordability and quality convenient care.
"Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status. Closely associated with telemedicine is the term 'telehealth,' which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telemedicine and telehealth."
The use of electronic communications is a huge business growing at an estimated 55% annually. With the government mandating the use of electronic health records, the new health reform act (The Patient Protection and Affordable Care Act [PPACA]) bringing more than 30 million newly insured patients, the estimate that there will be a shortfall of tens of thousands of physicians, a Merritt Hawkins Consulting firm survey that it takes patients 2-6 weeks to obtain a consultation, the need for affordable, accessible, quality health care is not only a present crisis, it is only going to get worse...a lot worse.
Although telehealth is particularly well-suited for primary care, dermatology, cardiology, mental health, ophthalmology, pathology, radiology, and fetal medicine have all used electronic communication effectively. In 2004, the last year data is available, there were 1 billion outpatient visits in the US, including 104 million in emergency rooms, 430 million seen in primary care offices and 403 million seen in specialists offices and another 63 million in hospital outpatient departments. At least 100 million visits were for non-emergent health conditions for example 28 million were for symptoms of an upper respiratory infection. Many of these could easily been treated via electronic communication.
Rural populations commonly have difficulty getting to primary care physicians, and specialty care is extremely difficult. Telephonic or video consultations for acute, non-episodic, non-life threatening conditions are cost effective and convenient. These patients deserve quality care and electronic communications do not replace a personal "hands-on" consultation when necessary, but they are not always necessary.
Telemedicine offers the opportunity to achieve many goals, but it is not the panacea that solves all of the seemingly insurmountable issues that are inundating our profession. The government demands more care, yet provides regulatory barriers to creative solutions. Fortunately, private insurance companies and government insurance are beginning to pay for telehealth consultations.
The perfect cannot be the enemy of the good. There needs to be alternative access to quality health care. Thus, new, creative, affordable convenient care fills a need that is being created by the economics of medicine.
Oncologists care for a critical subset of patients with special needs, some physical and some emotional. Telehealth offers the opportunity for specialists to communicate and thus care for those patients who are unable to access high quality care in an affordable convenient manner.
All health care is advanced and improved through robust communication. The basis of the medical home is communication. With electronic health records and secure HIPPA compliant interface, the patient and family can communicate with the oncologist to discuss any health issue. Family conferences anywhere in the world can easily occur. Patients fears can be allayed. Routine follow-up visits can be easily occur without the hassle of travel whether urban or rural.
Like all technology and medical advancements, health professionals must be at the forefront to control to be certain that it is ethically used with the patient being the center of the process. It is our responsibility and will make our patients healthier and happier, and our practices more satisfying.