Gartner: Advances In Telemedicine To Have Broad Impact

That's the word from Jonathan Edwards, research vice president at Gartner, who discussed the new technology at a presentation at the Healthcare IT Summit, held this week in La Quinta, Calif. The conference is hosted by Everything Channel, the parent company of

Edwards defined telemedicine as the delivery of health-care services when the clinician and the patient are at different locations.

However, Edwards said, telemedicine is not the same thing as telecare, which is more involved with technologies and services in the home for which customers pay, including fall detectors, bed monitors and panic alarms.

Edwards said that the time to stop talking about telemedicine has arrived, because people have been talking about it way too long.

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He said there have also been too many pilot programs done for the wrong reasons. For instance, vendors may throw money at something that looks cool, then write a press release and walk away. Or a university may set up a controlled pilot program in an artificial environment, say it looks cool, and then walk away.

"I'm not saying, don't do a pilot," he said. "I'm saying, do a pilot that you don't walk away from."

Telemedicine is a technology that offers many benefits, Edwards said. Patients, for instance, get easier access to care rather than having to drive long distances, and many patients who otherwise might have to stay in a nursing home may be able to live at home instead.

For medical staff, telemedicine means less travel time and more ability to monitor patients from remote locations. Telemedicine also facilitates the transfer of skills from specialists to primary care physicians, Edwards said.

Medical organizations also benefit from reduced travel costs, better care and monitoring in rural areas, the ability to provide equal access to care and the ability to offer new services and reach new patients, he said.

However, there is still a lot of work to be done before telemedicine becomes a reality, Edwards said.

The financial issues involving reimbursement of funds, how to pay physicians for longer-term care, and the justification of telemedicine for a hospital when the end result will be a cut in hospital stays all have yet to be resolved.

Meanwhile, medical staff will require new training in order to coordinate remote care, and will face new licensing, legal liability, accreditation and regulatory hurdles.

And, on the technology side, there is a lot of work to be done to integrate telemedicine with electronic medical records and deploy the needed accessibility and bandwidth infrastructure, he said.

There are already some successful examples of telemedicine implementations, Edwards said.

For instance, two private companies, TCCN and KYSOS, were set up in the Netherlands with the help of insurance companies to provide teledermatology for the remote treatment of skin problems.

In this case, patients with skin problems see their physicians who take photos of the conditions and send them to a remote location where the diagnosis is done in three hours vs. the three months it took before. This is already resulting in 70 percent fewer face-to-face referrals, a significant cut in insurance payouts and more flexibility for the physicians, Edwards said.

In another example cited by Edwards, the U.S. Veterans Administration has set up home monitoring systems which cut the number of patients needing nursing home stays by half and increased the use of video consultations for mental health and rehabilitation issues.

Edwards also cited the Ontario Telemedicine Network in Canada which serves the needs of 2 million Ontario residents, many of whom can only be reached by airplane. OTN works with rural hospitals who pay for membership and fund the telemedicine coordinators to provide more early diagnosis and treatment of patients, better triage of patients, improved preoperative and postoperative care and reduced travel costs, he said.

Changes in the nation's IT infrastructure and in technology are helping lay the foundation for an expansion in telemedicine, Edwards said.

This includes the government's stimulus plan, which has allocated $2.4 billion to improve broadband infrastructures and $1.6 billion for telecommunications and information administration.

Several changes in video technology are also helping push telemedicine along, including government-funded improvements in broadband access, the move by Medicare to make better use of video capabilities, a fall in high-definition video prices and improved interoperability between various video equipment manufacturers and between video equipment and other medical equipment, he said.

For healthcare providers looking to implement telemedicine, there are some steps they can start taking now, Edwards said.

The top priority is to develop the right staff, scheduling, incentives, workflows, and tech support. Providers should also collaborate to get adequate scale. "It's no surprise that initial projects are large projects," Edwards said.

In order to take advantage of home and remote health monitoring technologies, Edwards said providers should only deploy them as part of an overall care management program, and plan for difficult changes in their procedures.

On the technology side, the hardware devices such as sensors are fast becoming commodities, while the real differentiators will come from software, decision support, and care coordination infrastructures, he said.

However, Edwards warned, while some of the technology involved with home and remote health monitoring could have a massive transformational impact, much is still on the frontier.

For instance, he cited a recent demonstration of a "smart pill." This is a pill with an embedded smart chip that interfaces with another chip on the patient's skin to notify doctors when the pill is swallowed and shows the impact as it is absorbed.

Over the next three years, telemedicine will result in rapid advances in the types of sensors available, including sensors to monitor vital signs, drug delivery, implants and personal emergency response, Edwards said.

That will have large impacts on related technology, he said. For instance, telemedicine will require increasingly large amounts of storage capacity and data retention technologies, as well as new security methods.