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Virtual Medicine: Benefits and Obstacles

Recently, President Obama surprised many with a bold proclamation that the biggest threat to the U.S. bottom line was not insolvent banks, paralyzed credit markets or trillion dollar bailouts, but rather the skyrocketing costs of modern health care. Healthcare costs account for over 15% of the money spent in America, and this number is climbing twice as fast as the current rate of inflation. In response to these mind boggling costs, physician scientists have been hard at work building a suite of novel and innovative medical solutions designed to help pare the expense down to a more manageable level.

 
Previously known as “telemedicine,” perhaps a better descriptor may be “virtual medicine” due to the breadth and scope of the technology revolution. With online medical practice now spanning the gamut, from consulting to remote surgery, everything occurs online these days. At its most basic level, telemedicine platforms allow remote doctor-patient consultation via a variety of mechanisms, including telephone, e-mail, instant messaging, and in some cases, videoconferencing.  These new communication modalities are following the availability of less expensive broadband digital networks.


Researchers Compare Telemedicine to Conventional Practice


In 2002, virtual medicine researchers Hailey and associates conducted a systematic literature review that found 66 credible scientific studies that compared telemedicine to conventional practice. Over 55% of these studies suggested that telemedicine was advantageous over the conventional approach. Also, more than 35% of the reports highlighted the negative aspects of telemedicine. The most convincing efficacy and effectiveness evidence was given in the reports about teleradiology, particularly neurosurgical applications. Other areas that were deemed favorable included telemental health, teledermatology, home telecare, medical consultations, and transmission of echocardiogram data.


While many reports available referred to short-term outcomes and pilot projects, few suggested any routine use or long-term effectiveness of virtual medicine. Many of the benefits listed included avoidance of travel, cost effectiveness, and no delays in healthcare. Although useful economic outcome data has been received from telemedicine studies, good-quality trials and reports are fairly scarce and the most clinical findings are limited.


Benefits of Virtual Medicine


Crowdsourcing diagnostics are a powerful tool, harnessing the energy of the Internet and collecting the experience, knowledge and wisdom of hundreds of doctors. The result of this technology involves more accurate diagnoses. Other recently developed systems generate automated messages designed to remind patients to take medications, check blood pressure and refill prescriptions.  There are many benefits of virtual medicine, and perhaps the most powerful tools are those designed to convey specialist care to remote regions, using advanced communication modalities. Other benefits include:


• Cost-efficiency – Less overhead means cheaper bills.
• Convenience – Patients schedule appointments online and avoid waiting rooms and long drives.
 Privacy – It provides a level of anonymity, more discrete than conventional doctor’s office visits.


Obstacles of Virtual Medicine


Certainly, like with every emerging technology, there will always be a collection of luddites to undermine the possibility of the concept.  Some of the arguments presented include:


• Dehumanization – Patient will feel less empathy than what is felt during a face to face encounter. Technology will be hard-pressed to replace the bedside manner of a well-practiced physician.


• Data Integrity and Privacy – The news is chock full of cases of data breaches and hacking. Increased data security is critical to the complete acceptance of virtual medicine.


• Regulation and Accreditation – Virtual practices can be located anywhere, with varying degrees of oversight and regulation in place from region to region.  At this time, virtual medical practice is fairly unregulated.


Pressing the Limits of Technology:  Robotic Surgery


Telesurgery, conducted by so-called “online surgeons”, needs to be distinguished from robotic-assisted surgical technologies like Da Vinci or Zeus. Robotic-assisted devices require a surgeon physically present for operation.  Pure telesurgery, also called robotic surgery, is a remotely-guided process, with the surgeon seated at a console guiding the robotic arms from afar. These exciting developments allow the conduct of transatlantic kidney operations. It should be noted that these patients, while operated on by remotely located surgeons, still require the physical presence of support personnel.    


Robotic surgery has become commonplace for many procedures, to include prostatectomy and various gynecologic maneuvers. These methods are widely embraced because of miniaturization, precision, reduced risk of infection, faster healing time and less blood loss.  Nonetheless, robotic surgery still faces several limitations. These include:


• High costs – It can be more expensive than regular surgery.
• Acceptance – Many people are not ready to be cut by a machine.
• Training – There is extensive training and experience required before a surgeon can confidently, safely and efficiently perform surgery by this means..  Most surgeons cannot justify the time and expense required to become qualified to conduct robotic surgery.

Virtual Intensivists and Distant Nurses

For intensivist physicians and nurses (who work in intensive care units), telemedicine is an increasing trend in inpatient healthcare. Healthcare workers are now able to monitor patients with bedside cameras and electronic tracking of clinical information, such as laboratory reports and vital signs. Considered remote care, the professionals can communicate orally with bedside caregivers in real-time to offer around-the-clock care (Yoo and Dudley, 2009).


In 2007, telemedicine investigators Barlow and colleagues conducted a review of the literature regarding home telecare for frail elderly adults and patients with chronic diseases. At least 60% of the studies originated in America, and more than 55% of the reports were published within the previous 36 months. The most effective telecare interventions were telephone nurse follow-ups and automated vital sign monitoring, which reduced health service requirements and improved clinical indicators. The researchers cited insufficient evidence about cost-effectiveness, security and home safety.


Final Thoughts


Like it or not, with all its power and flaws, virtual medicine is here to stay. It is becoming more prevalent every day, with doctors utilizing technology in the practice of medicine regularly. Although telemedicine will never fully replace the conventional practice of medicine, it will undoubtedly continue to evolve into a distinct practice specialty all its own.


References


Barlow, J, Singh, D, Bayer, S & Curry, R (2007). A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions. Telemedicine and Telecare, 13(4): 172 – 17.
Docs Online (2009). The Doctor is IN Somewhere

Fast Company (2009). The doctor of the future.

Hailey, D, Roine, R & Ohinmaa, A (2002). Systematic review of evidence for the benefits of telemedicine. Telemedicine and Telecare, 8(1): 1 – 7

Yoo, EJ & Dudley, RA (2009). Evaluating Telemedicine in the ICU. JAMA, 302(24): 2705 – 2706.
doi:10.1001/jama.2009.1924

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