Telemedicine promises to one day equalize access to health care for urban and rural populations and alleviate a number of the serious problems facing rural practitioners.
Over the last two decades, the rapid introduction and development of electronic communication technologies have transformed the ways people correspond and exchange ideas with each other, defeating geographic and cultural barriers along the way. The profession of medicine is equally caught up in this technological revolution. Witness the proliferation of Internet medical web sites and various telemedicine endeavors for continuing medical education and clinical service provision.[2-4] Telemedicine seems poised to continue its momentum in expanding exponentially this decade. How should physicians respond to this emerging age of information technology? An understanding of the promises, shortfalls, and potential areas of expansion of telemedicine would be a good start.
The promise of equalizing access to health care for urban and rural populations will likely be the biggest driver to fuel the growth of telemedicine over the next several years.[5-8] Whereas currently, rural physicians often operate without tertiary support for case management, telemedicine provides the possibility of the full spectrum of subspecialty support to rural physicians for clinical decision making, real-time consultation, and image interpretation such as CT scans or X-rays. The same technology can enable the delivery of continuing medical education to rural health professionals in their own communities.
This negates the need for rural health professionals to leave their communities in order to get professional updates, saves on the direct cost of travel and indirect cost of loss of income, and maintains physicians’ availability to their communities. Telemedicine can substantially reduce the professional isolation felt by rural health professionals, which in turn will help non-urban communities to recruit and retain health professionals and enhance their professional satisfaction.[3,6]
What’s holding back telemedicine, then? Unfamiliarity with the technology, the fear of job displacement by telemedicine services, health professional remuneration, a heavy demand of personnel to implement and maintain content and services, and a lack of current financial resources from the public system to invest in telemedicine infrastructure are major barriers.[6,8,10-12] But these barriers are not insurmountable. Exposing physicians to the technology gradually and superimposing telemedicine on existing practice and referral infrastructure will demonstrate the utility of telemedicine in augmenting communication and consultation without challenging the relevance of the current model of medical service delivery.
Over time, with increasing buy-in from health professionals, appropriate remuneration for their involvement, and the collaborative efforts of individuals, medical institutions, and service delivery agencies, a robust telemedicine system with relevant content will be established. Sufficient funding can be generated through public and private partnership. Ultimately, if the medical community and the public see value in telemedicine, building such an electronic communication system to augment health-care delivery is entirely conceivable and achievable in the near future.[8,10,13]
Telemedicine, the primary value of which is in the augmentation of access of care, can address challenges in service delivery due to geography faced by the current medical system. Yet, telemedicine will never replace the need for human contact between physicians and their patients, both in communication and management. Ultimately, telemedicine will achieve its full potential only when the entire medical profession embraces and shapes it according to the needs of the medical system in which we practise.
1. Zajtchuk R, Gilbert GR. Telemedicine: a new dimension in the practice of medicine. Dis Mon 1999;45(6):197-262.
2. Bruera RP. Telemedicine and processing of scientific information in programs of continuing education. Rays 1999;24(4):506-533.
3. Watanabe M, Jennett P, Watson M. The effect of information technology on the physician workforce and health care in isolated communities: the Canadian picture. J Telemed Telecare 1999;5 Suppl 2:S11-9.
4. Taylor P. A survey of research in telemedicine. 2: Telemedicine services. J Telemed Telecare 1998;4(2):63-71.
5. Nesbitt TS, Ellis JC, Kuenneth CA. A proposed model for telemedicine to supplement the physician workforce in the USA. J Telemed Telecare 1999;5 Suppl 2:S2-6.
6. Swanson B. Information technology and under-served communities. J Telemed Telecare 1999;5 Suppl 2:S3-10.
7. Wootton R. Telemedicine and isolated communities: a UK perspective. J Telemed Telecare 1999;5 Suppl 2:S27-34.
8. Picot J. Telemedicine and telehealth in Canada: forty years of change in the use of information and communications technologies in a publicly administered health care system. Telemed J 1998;4(3):199-205.
9. Ho K. Videoconferencing and the Internet: new CME frontiers (editorial). Can J CME 1998;10:1-2.
10. Anonymous. Telemedicine: an overview. Health Devices 1999;28(3):88-103.
11. Lobley D. The economics of telemedicine. J Telemed Telecare 1997;3(3):117-125.
12. Sanders JH, Bashshur RL. Challenges to the implementation of telemedicine. Telemed J 1995;1(2):115-123.
13. Grigsby J, Sanders JH. Telemedicine: where it is and where it’s going. Ann Intern Med 1998;129(2):123-127.
Dr Ho is the associate dean and director of the Division of Continuing Medical Education and an assistant professor in the Division of Emergency Medicine at UBC.
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