Science fiction or reality? Telemedicine is changing the way medical care is delivered.

The old way: You develop a mysterious rash. You call your doctor's office for an appointment, leave work early, sit in traffic, and then sit some more in the waiting room. After examining your rash, your doctor decides you need to see a dermatologist. You obtain a referral, make another appointment (which may not be immediately available), rearrange your schedule, sit in more traffic, and finally arrive at the dermatologist's office for diagnosis and treatment.

The new way: Right there in the exam room, your doctor photographs your rash with a digital camera and sends it, along with her examination findings, via computer to the dermatologist. He reviews the information, asks additional questions if necessary, makes a diagnosis, and recommends a course of treatment. Or perhaps your doctor establishes a video link to the specialist, allowing you to receive an immediate consultation, diagnosis, and treatment plan.

Sound like a Jetson's cartoon? Yes. Impossible? No.

The Technology Exists

It will be some time before such scenarios become commonplace because a number of legal, financial, and ethical issues need to be worked out first. But telemedicine—the use of telecommunication lines to transmit medical information—is one of the fastest growing and most quickly evolving US industries, according to Jon Linkous, executive director of the American Telemedicine Association. Over the last several years, telemedicine has gone from demonstration mode to real-world applications.

Benefits for Patients

"Telemedicine expands the potential for patient choice," says Linkous. Not long ago, telemedicine was used mainly to facilitate the exchange of information between doctors and medical institutions. As the technology improves and becomes more accessible, new avenues of diagnosis, monitoring, and treatment are opening up. In fact, Medicare now reimburses for telemedicine in rural areas, Linkous says, and government grants are now available for the establishment of telemedicine networks.

Here are the highlights of how people are benefiting from telemedicine:

  • Patients in rural and underserved communities gain access to quality healthcare.
  • Technological advancements enable emergency responders to transmit more and better information from emergency vehicles to emergency room personnel.
  • Video links between medical institutions and nursing homes or patient's homes will (and already do, in some cases) provide caregivers and patients with immediate access to physicians.
  • Monitoring devices allow homebound patients to transmit their heart rates, blood pressure, glucose levels, etc., from their homes to their healthcare provider.
  • Correctional facilities are beginning to use telemedicine to avoid transporting a prisoner to a doctor's office.

Helping People at Home

Woodrow Kessler, MD, PhD, has been involved in the development of telemedicine for more than two decades. Recently, Kessler opened a new office, staffed by a nurse, in a suburban Philadelphia shopping mall where he sees patients via a two-way video/audio link from his primary office several miles away.

He has been involved in developing telemedicine programs in underserved areas as well. He relates the story of a rural Kentucky man with diabetes who suffered repeated hospitalizations. The staff sent him home with a televideo unit to monitor him at mealtimes. Upon seeing his meals, medical personnel discovered the man wasn't eating right. After receiving training in managing his diet, the frequency of his hospital visits dropped.

Kessler also cites the case of a South Carolina mother whose child was born with a cleft palate, a condition that requires special feeding techniques. By establishing a video/audio link in the mother's home over which she received training in these techniques, the baby was able to leave the hospital earlier than would have been possible otherwise.

Helping People Abroad

Telemedicine has also rescued travelers who have become ill far from home.

Daniel J. Carlin, MD, is the founder and CEO of World Clinic, a global telemedicine practice based in Massachusetts. A patient of Carlin's was vacationing in the Azores when she developed a yeast infection. She did not speak Portuguese, nor did she know where to go for help. She contacted Carlin by satellite phone. He reviewed her record, interviewed her about her symptoms, and told her to check her e-mail in half an hour. In the meantime, he went to his database, located a pharmacy in her area with the appropriate medication in stock, prescribed it, and obtained directions from her hotel to the pharmacy, which he then e-mailed to her.

In another instance, Carlin downloaded from the Internet and e-mailed an anatomical drawing of the ear, along with instructions, to help a ship's captain perform a procedure on a crew member whose ear was badly infected.

"The trick is to identify the resources available and connect patients to those resources," he says.

The Internet as a Medical Tool

Carlin is excited about the future of telemedicine.

"The universal language of medicine used to be Latin," he says. "The new universal language is binary. The Internet is going to have a bigger effect on medicine than Guttenburg's press," he proclaims.

There are two sides to telemedicine, he explains. "The first half of the equation is clinical telemedicine, which works where there is underserved or delayed access to medical care." Information is the other half of the equation. The Internet provides physicians and their patients with access to a tremendous volume of information.

Remote Surgery?

At the cutting edge of telemedicine are devices that allow surgery to be performed at a distance. A renowned heart surgeon in the US, for example, could use Internet-controlled devices to operate robotic surgical equipment in Africa. While the practical application of this approach remains in the future, there have already been demonstration trials.

Let the Buyer Beware

As patients use the Internet to find health and medical information, both Carlin and Linkous warn that consumers should be careful.

"You don't always know what you are getting," Linkous says. "There are no guidelines out there. Stick with information from trusted sources that are known entities." And share any information with your doctor before acting on it.

On the Internet, you can get prescriptions filled and even visit virtual doctors' offices; all you need is a credit card. But Linkous warns, "There is not enough being done yet to create standards and guidelines. This is an international issue that is still very much in the 'buyer beware' category. I personally wouldn't do it right now."

Carlin doesn't recommend seeking clinical care over the Internet in the US right now, unless it's an absolute emergency. He warns that consumers should not view Internet medicine as a way to avoid the hassle of medical appointments. For now, doctor's visits—no matter how inconvenient—are still a more established method of treatment than Internet medicine.

"Health care is not always convenient," he says. "You have to make the time."

A Bright Future

"Telemedicine is going to fundamentally change the way medical care is delivered," says Linkous. "Patients love it, the cost savings have been significant, and its efficacy has been proven." But physicians, he says, are somewhat reluctant.

"Physicians who are late responders to the technology will start to be won over after they see just one benefit," says John A. Coller, MD, director of the Ambulatory Surgical Research Center and Telemedicine Initiative at the Lahey Clinic in Burlington, Massachusetts.

Conferences and seminars addressing telemedicine issues are being offered, and medical schools are beginning to address it in the classroom. Insurers will hop on the bandwagon when they see documented efficiencies that replace or displace other costs, says Coller.

As time goes on and the financial, legal, regulatory, and ethical wrinkles facing telemedicine are ironed out, Coller predicts that it will open up access to medical care and improve its efficiency.

Carlin goes a step further. "Telemedicine is going to be phenomenal on a global scale," he predicts. And if you're having trouble imagining the concept, remember that anesthesia was viewed as pretty radical for its day, too.