Way back in the distant past, the early 1970s, as I was trying to focus my thoughts on telecommuting, telemedicine kept appearing as one of the options. Assessing the future of telemedicine by testing it was one of my research team’s initial set of possibilities. But the complexities of dealing with the medical establishment — and the fact that we had a very limited research budget — led us to focus on more accessible business operations; the insurance company we used as our first test site.
The basic concept for both telework and telemedicine is the same: Where and how is it possible to use information technology to couple expensive/scarce resources with human needs? In the case of telemedicine the resources — physicians and some health care personnel together with their support equipment and facilities — can be both scarce and expensive. Those in need of the sort of care they provide must often travel great distances to get from home to the facilities, face fees beyond their capacity, or go without. The prospect is daunting!
So how, via telemedicine, do we shrink those distances and reduce the costs to those in need? The first experiments were relatively simple. For example a closed circuit TV link was established between a university medical center, the expensive resource, and one or more outlying communities where there were available nurse practitioners. An MD in the university would “examine” the patient with the aid of the nurse practitioner and the equipment available in the remote community. The results were similar to, and less expensive than, a visit to the university center by the patient. Information technology shrunk the geography!
That was the Eureka, It Works! part of the process. The next phase of the application of telemedicine depended both on improved technology and the cooperation of government and the medical professions. It still does.
As with telework/telecommuting, technological advances have come at a satisfying pace. Your smartphone can now provide more detailed and accurate data, and for prolonged periods, than was even imaginable in those early-70s TV experiments. Heart rate monitors, blood pressure checkers, blood oximeters and glucose monitors are all readily available at relatively low cost to be sent to medical experts anywhere, anytime.
But, as with telework, many of the barriers to more rapid expansion of telemedicine are organizational and attitudinal. As an example: Medicaid, the federal/state partnership to help provide health care to the lower income part of the population, has some strict who can play rules, such as these:
Medicaid guidelines require all [telemedicine] providers to practice within the scope of their State Practice Act. Some states have enacted legislation that requires providers using telemedicine technology across state lines to have a valid state license in the state where the patient is located. Any such requirements or restrictions placed by the state are binding under current Medicaid rules.
One of the barriers is explicit in this: you can’t get help from a medical expert who is in another state than yours unless she is also licensed to practice in your state. This sounds reasonable but suppose your problem is one which involves a really scarce resource, like a doctor in some distant state or country. And if your problem is shared by individuals in many states other than the one where the doctor lives, then would that doctor have to go through the certification processes in each and every one of those states in order to help you? Yes, if it’s via Medicaid.
This, and similar situations and possibilities, is what made us decide to focus on business rather than medicine in our 1973 feasibility research. The barriers in medicine are formidable but not insuperable. Progress is being made, particularly in the developing world. The advantage there is that there is little or no pre-existing organizational infrastructure to tear down or remodel before telemedicine can grow.
So despite the usual suspects, technology is advancing rapidly and telemedicine has a bright future. Even in the United States.