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Telemedicine Wave of the Future?

A “wave of the future” is any product, idea or movement that is viewed as a trend or force that will inevitable prevail. As our society comes to expect the benefits of the digital age, we presume this to also be applied to medicine. Which makes us wonder: Are advances in technology a respectable solution to this mismatch of resources? And is telemedicine the wave of the future?


Making rounds from house to house, toting his black bag, the traditional doctor seems now like a dinosaur. This extinction may be for the best, because a huge problem in the practice of medicine is the uneven distribution of specially trained physicians. There seems to be far too many specialists in the urban areas, whereas rural regions typically have too few. In cases where rapid, expert diagnosis is critical to survival, this deficit exacts a large price on patient wellbeing. 


Telemedicine is a Way to Bring Modern Healthcare to Remote Areas


Enter telemedicine. Telemedicine is not a unique specialty of medicine, rather, it represents the use of products and services in order to more efficiently deliver 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, including multi-way video, e-mail, wireless devices and an evolving suite of electronic technology.


Telemedicine had humble roots. Beginning in the 1970s as a way to bring modern healthcare technology to remote regions of the world, this new-age form of practice gradually developed into a convenient form of healthcare. More recently, as the technology continuously evolves, telemedicine has become ubiquitous throughout the healthcare arena (American Telemedicine Association, 2013).


Leaps in Technology Fuels Telemedicine


The spread of telemedicine is fuelled by leaps in technology.  Some of the most innovative forms of advancement include:


2D Videoconferencing – Two dimensional (2D) videoconferencing is quickly becoming the industry standard. This technology, commonly used in desktop videoconferencing, can be accommodated fairly routinely with the existing data infrastructure, and it allows the simple sharing of images.  2D videoconferencing permits for a remotely based physician to “interview” his or her patient, look at diagnostic images and view medical records. The downside of this technology is that it suffers from a sense artificial being:  It does not increase “social presence.” The way someone feels connected with another person is social presence. This is often interrupted with a telecommunication interface (Hauber et al., 2005).

State of the Art Videoconferencing – In a study of 42 individuals in 2005, Dr. Hauber and associates found significantly higher levels of social presence with the use of three-dimensional (3D) videoconferencing. This was compared to 2D videoconferencing, which did not allow for such social presence. When applied to the actual practice of telemedicine, these findings are paralleled by reality.  While 2D videoconferencing is the norm in many settings, leading more and more professionals to use this technology, an open question remains:   Is a more intense and lifelike technology necessary for telemedicine to progress to the next level?

High Definition (HD) Video – Usually defined as 1280*720 pixels or (720p) per frame, HD video provides a very fine-grained video image. This results in a high quality viewing experience. Three-dimensional (3D) video relies on an illusion of depth perception, which encompasses recording an image as seen from two different perspectives. The images are then melded together using specialized production hardware to provide the illusion of depth.

While these technologies have become all of the rage in the motion picture industry, the combination of HD and 3D (HD3D) may well have an important role to play in the practice of telemedicine. Multiple investigations of the technology suggest that the use of HD3D enhances the degree of cognitive immersiveness (or sense of being there) experienced not only by the physician, but also by the patient.  On its own, this may lead to better outcomes for telemedicine.


Areas of Practice Could Be Improved by Telemedicine Technology


Further to the enhancement of the patient-physician encounter, HD3D, with its increased video quality attributes, has the potential to open other areas to telemedicine that may have been previously limited by the technology. These include:


• Surgery –Stereoscopic laproscopic surgery is becoming commonplace, with the belief that it may permit more accurate cutting and suturing. Another obvious application would be simulation for training, or consultation, in real time with offsite surgeons.


• Wound Care – Chronic wound infections are responsible for a great amount of morbidity and economic burden. Certain patients can benefit immensely if assessment and treatment by appropriate wound care specialists. Recent research in Australia demonstrated that clinical assessments made using HD3D technology and live, in home assessments were similar in quality.  By keeping the wound specialist busy making assessments, rather than traveling from house to house, productivity increases.


• Oncology –A tele-oncology application involves the patient attending a remote chemotherapy session and participating in a HD3D consultation with a remotely based oncologist. HD3D would enhance the experience by providing a greater feeling of “being there” than is possible with 2D technology. Experts believe that the success of an oncological interaction is dependent on human interaction factors, so anything that can improve the quality of the meeting should be beneficial. One potential downside of this approach is the need to wear HD3D glasses. It is possible that the use of these glasses may diminish the quality of the interaction due to the importance of body language cues, which may suffer from the use of these devices.


• Psychiatry – While many of the same issues for oncology also apply to psychiatry applications, there are some differences. First, unobstructed eye contact is not as important in the practice of this specialty.  Secondly, many psychiatric evaluations require the assessment of fine motor movements, a need well served by HD3D.


Final Thoughts


It is evident that telemedicine is here to stay, and this form of practice is evolving rapidly.  HD3D, an up and coming technology, has already started to make its appearance. While the enhanced level of patient-physician immersion is apparent, research continues for the most productive niches for this emerging technology. In addition to identifying the best roles for HD3D, the widespread adoption will also depend, to a great extent, on the availability of higher bandwidth digital systems, which carry the massive amount of data required to power the technology.


References


American Telemedicine Association (2013). What is telemedicine? Retrieved from: http://www.americantelemed.org/learn


Hauber, J., Regenbrecht, H., Hills, A. et al. (2005). Social presence in two- and three-dimensional videoconferencing. University of Cantebury Research Repository. Retrieved from: http://ir.canterbury.ac.nz/bitstream/10092/352/1/12596470_2005-SocialPresenceVideoconf.pdf
Slater, C. (2013). The doctor of the future. Retrieved from: http://www.fastcompany.com/1266043/doctor-future

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