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Online Doctors: Efficient, Cost-Effective and Practical

Technology has impacted the practice of medicine in countless ways.  From the days of doctors making house calls on horseback to electronic medical records, the practice of medicine is constantly changing.  While some of the so-called progress may not be universally accepted, it is nonetheless, an amazing evolution.


One problem with medicine has persisted for years:  a high concentration of specialized medicine in urban areas, and a shortage of specialists in others. However, advances in digital technology are making great strides in leveling this mismatch of resources. In support of this effort, telemedicine was born. 


Telemedicine is Ubiquitous throughout the Healthcare Arena


Telemedicine is not a unique specialty of medicine; rather it represents the use of products and services that allow improved delivery of high quality care. In its purest sense, telemedicine is defined as a method employing electronic communications to convey information from site to site, in order to support enhancements in a patient’s clinical wellbeing. The tools employed may include a variety of communication modalities, such as multi-way video, e-mail, wireless devices and an evolving suite of electronic technology.


Telemedicine had humble roots. This method of practice began in the 1970s as a way to bring modern healthcare technology to remote regions of the world.  More recently, as the technology evolves, telemedicine has become ubiquitous throughout the arena of healthcare. This pervasiveness is due to reduction of cost and the ability to meet industry standards (American Telemedicine Association, 2012).


Researchers Prove Electronic Data Reduces Costs and Clinic Visits


As early as 2003, technological researchers Chase and associates provided examples of how technology could be used instead of a regular clinic visit in the management of Type 1 diabetes. In this example (which relied on what would now be considered ancient technology), patients transmitted glucose levels electronically, via a modem, in order for the doctor to assess the condition. Although this example is clearly outdated, it illustrates the explosion of technology in the past 10 years. Provided below are highlights of this approach to healthcare technology.


Validity of Telemedicine Based on Ability to Meet Certain Standards


In order to demonstrate validity, telemedicine technology must meet particular standards, and several factors should be evaluated. These include:  accurate digital data, secure electronic medical records, tools for remote analysis, secure and effective communication. An accurate collection of data in digital format involves tests and indications, such as blood glucose levels, blood pressure and HgbA1C levels, to be transmitted from patient to doctor. Furthermore, there must be incorporation of these data into a secure electronic patient record. For remote analysis, tools must exist to process the data. Finally, the system must promote effective, secure communication between all stakeholders. 


Efficacy, Cost-Effectiveness and Practicality


As with other forms of medical practice, long term efficacy must be the goal of telemedicine. Control of glucose levels over the short term may or may not be associated with enhanced outcomes. In the case of type 1 diabetes, HbA1C is typically accepted as a surrogate for glucose control over time. In addition, evaluators should assess symptoms of hypoglycemia, as well as emergency room admissions that result from the condition. In the determination of the telemedicine intervention’s safety and efficacy, factors to consider involve overall control of the health condition.


With the realities of today’s economy, doctors are under tremendous pressure to ensure that all treatment interventions are cost-effective, as well as efficacious. Cost-effectiveness can be defined as the ratio resulting from the value of the telemedicine benefit, divided by the cost of the intervention. A ratio above 1 is favorable and revenue positive, whereas a ratio below 1 is not as desirable.


Telemedicine will most likely solve many problems, while simultaneously creating new issues.  Physicians are among the professionals most resistant to adopting new technologies to their practice.   Telemedicine may be more suited for incorporation into managed care programs where providers receive salaries versus conventional settings where physicians receive pay per visit. Further to that, an effective telemedicine platform should integrate into other programs, databases and peripherals.


Final Thoughts


Although descriptions of different technology approaches reach beyond the scope we offer with this article, it is evident that the time has come to incorporate new efficiencies into the practice of medicine. Key elements include synchronous videoconferencing, transmission of patient data, secure messaging, support of clinical data review, and the provision of current educational materials. There is a need to support greater telemedicine technologies as an adjunct to the treatment of diabetes and other diseases, from both a patient care standpoint as well as economic perspective.


References


American Telemedicine Association (2012). What is Telemedicine? Retrieved from: http://www.americantelemed.org/learn


Chase, HP, Pearson JA, Wightman C, et al. (2003). Modem transmission of glucose values reduces the costs and need for clinic visits. Diabetes Care, 26:1475–1479.


Slater, C. (2013). The Doctor of the Future. Retrieved from:                                                      http://www.fastcompany.com/1266043/doctor-future

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