User talk:Gomason2

Introduction: Telemedicine is the latest and greatest growing trend in the healthcare industry. The American Telemedicine Association defines Telemedicine as “The use of medical information exchanged from one site to another via electronic communications for the health and education of the patient and healthcare provider and for the purpose of improving patient care.” (Linkous, 2001) As we begin the discussion of telemedicine is it important to recognize the difference between Telemedicine and Telehealth. “The World Health Organization makes a distinction between telemedicine and telehealth. It defines telehealth as “the integration of telecommunication systems into the practice of protecting and promoting health, while telemedicine is the incorporation of these systems into curative medicine.” (Darkins & Cary, 2000) As more people gain access to health insurance, there is a greater push to provide people affordable health care that is also easily accessible. Specifically providing an advantage to individuals residing in rural areas of the country, telemedicine is reducing healthcare challenges and revolutionizing medical paradigms by saving patients the time, money and resources that it takes to conduct an in office doctor visit. Patients can talk with their doctor from the privacy of their own home without needing to worry about transportation, leaving work early or any traditional hassle associated with an in- house appointment. As with any new technological advancement there is always pushback from parts of the public and industry leaders. There are also major security threats as well as ethical and social considerations to think about. This paper will cover the topic of telemedicine from the beginning of its history to its impact on modern medicine while also dabbling in the risks, advantages and major medical breakthroughs that can be accomplished by utilizing modern medicine. Background: There has been a general ebb and flow of the notion of telemedicine throughout the last 60 years. A new wave consensus that medical advice, diagnosis and patient care could be provided without being in the physical presence of a licensed professional. For many people, when we are not feeling well the last thing we want to do is get ourselves dressed, drive to the closest doctor, wait in a sterile lobby for thirty minutes- all just to have a ten minute conversation and walk out the door with an illegible prescription for medication. The idea is convenience and the method was introduced in 1950 when the first reference to telemedicine appeared in medical literature. The notion was the transmission of radiological images via telephone between West Chester, PA and Philadelphia. Later in the same decade, Canadian radiologists created a tele radiology system. This sparked ideas across the globe as medical professionals began to pioneer the use of technological platforms to communicate medical messages (Rho, 2008, p.3) While the idea was brilliant and the knowledge was in place, technological and financial roadblocks stunted the progression of telemedicine. “During the mid 80’s high transmission costs led to the decreased interest in telemedicine and the demise of many programs (Institute of Medicine, 1996)(Rho) Additional contributing factors to this decline were the limitations and uncertainty of available technology, the absence of long-term institutional-funding commitments; and poor program planning and design.” (Demiris, 2003) (rho) Until the technology boom of the early 2000’s, the traditional appointment method was used across the nation.

Current Use: Today, telemedicine is being integrated into nearly every category of healthcare. From psychologists to dermatologists, medical professionals are using this technology to bridge the gap for elderly, disabled, underprivileged or simply busy individuals who cannot or choose not to travel to their doctor for treatment or a consultation. The main factors here are travel time and money. Everybody saves time without having to travel and the cost of medical care is dramatically decreased due to the lack of resources needed to serve in office patients on a daily basis. “Renewed interest in telemedicine has resulted in part from improved technologies, lower costs for equipment and transmission, and the development of payment schedules by insurance companies and third party players.” (Coleman 2002, Institute of Medicine, 1996; Norris et al, 2002.) (rho) There are two main methods of technology used in modern telemedicine practice; store and forward and two-way interactive television. The store and forward method is used to transfer digital images from one location to another. Two-way interactive television connects people together for real-time consultations. (American Telemedicine Association, 1999; Brown, 1996.)(Rho) The use of two-way interactive television is the most common channel of patient care when it comes to modern telemedicine. It provides the most personal and in-depth communication without the inconvenience of traveling and waiting to be seen by a medical doctor. For example, “Curtis Lowry, M.D., professor chair and maternal-fetal medicine director of the Anetnatal and Neonatal Guidelines, Educaton and Learning Systems (ANGELS) program at The University of Arkansas for Medical Sciences in Little Rock makes the point that “Via the videoconferencing technology, physicians can examine a fetus using ultrasonography. Communication methods between physicians and patients do not change significantly whether they occur in an office or online, said Lowery. "You can talk with the patients the same way. Everything else is virtually the same." For example, if the physician notices a medical anomaly in a patient in a rural location, that patient would need to schedule a visit to the main Little Rock facility. In addition, said Lowery, if a patient needs to hear bad news, he or she usually prefers to be close to home or in a familiar setting accompanied by family members.” (Laff, 2014) Telemedicine also offers a huge benefit for those suffering from a chronic condition. It allows the doctor to monitor the patient regularly without needing to see them in person every few weeks. Imagine the money you save on gas! Potential Benefits: The potential benefits of Telemedicine are extensive. Studies have estimated that telemedicine can reduce health care costs by $36 billion dollars annually (Kurec, 1998). Telemedicine can improve access to health care specialists, improve medical decision making among health care providers and patients, offer greater continuity of care because local physicians retain greater control of their patients, offer greater patient satisfaction due to reduced travel time, and enhance training and medical education (Bauer, 1999; Brown, 1996; Charles, 2000; Hakansson & Gavelin, 2000; Kurec, 1998; UT Telehealth Network, n.d.) Telemedicine could have significant positive environmental affects as well as medical. There are thousands if not millions of people who drive long distances to see their doctor multiple times a week or month. If we can reduce the amount of times an individual has to drive to see their doctor we can drastically reduce the amount of greenhouse gasses emitted into the environment on a global level. This could slow the process of global climate change and prolong the life of our beautiful planet.

Security Aspects: Personal privacy is among the top concerns for those who utilize telemedicine. Medical records are extremely personal and confidential where the internet is not always such. A practitioner “needs to obtain patients permission before participating in teleconsultations, including a written agreement for recording of sessions and storage of tapes as a part of medical records. Also, you need to use data protection techniques during the transmission, including security for the computer systems and other media on which information is stored. There are also official concerns regarding user verification, access, authenticity, security and data integrity” (Ashley, 2002, p.3) If a person’s medical records are publically released, it could have detrimental effects for the future of the individual. A company could avoid hiring an individual due to mental illness or a contagious disease such as AIDS. Personal health information is also of great value to insurance companies. Such company could use this information to avoid insuring an individual or increase the price of their monthly payments. (Mihaela & Catalin-Jan, 2012, p.197) Mihaela and Catalin-Jan also point out that there is a “big brother” abuse risk. She explains that “the communication channel is under risk of getting used by third parties that are getting access to the patient real time recordings. They can either share the information with the others or can add wrong data into the channel, producing false positive replies from the system side. Subsequently, this produces final wrong patient medical status and treatment.” (Mihaela & Catalin-Jan, 2012, p.197) Another concerning threat associated with this type of communication is the potential for prescription information to be leaked. This is especially concerning for patients prescribed controlled substances. A hacker could potentially unlock the patient’s personal information such as their home address and take extreme measures to gain access to the controlled substances- a very high risk situation for elderly individuals who may live alone.

Ethical and Social Implications: There is no doubt that telemedicine has vast advantages but there are serious ethical and social implications that must be considered as well. It has been noted that the disadvantages are more related to the moral aspects than the technical issues, however both are still relevant. Many health care seeking individuals cannot afford the technology required to perform such tasks. It is not fair for said people to lose out on the opportunity to receive medical attention simply because they cannot afford the medium. There is also a dramatic learning curve for a large majority of patients who would require technical skills prior to using the system- this curve increases with the patient’s average age. One must also consider “patient marginalization by social isolation and lack of social contact. This issue is a big problem especially in the case of patients mentally ill, with medical prescription of social contact. A secondary issue is that the telemedicine system cut out the feelings the physician could get from real life (Mihaela & Catalin-Jan, 2012, p.196)” “Technologies will never broadcast the emotions the feelings the same way in real life, the pain, the discomfort. Everything becomes numbers that cannot count the empathy. The emotional level is damaged and that is an important barrier to the positive treatment result.” (Mihaela & Catalin-Jan, 2012, p.198)”

Future Use: The future of telemedicine looks promising with new regulations across the board from Federally regulated organizations, insurance companies, physicians and specialists.

References Ashley, R. C. (2002). Telemedicine: Legal, ehtical, and liability considerations.American Dietetic Association.Journal of the American Dietetic Association,102(2), 267. Mihaela, H., & Catalin-Jan, I. (2012). TELEMEDICINE AND ETHICS. Universitatii Maritime Constanta.Analele, 13(18), 195-198. Roh, C. (2008). Telemedicine: What it is, where it came from, and where it will go.Comparative Technology Transfer and Society, 6(1), 35-57. http://www.aafp.org/news/practice-professional-issues/20140205rgctelemedicineforum.html (Visited 2/11/2016) http://www.americantelemed.org/about-telemedicine/what-is-telemedicine#.Vr07lVgrLIU (Visited 2/11/2016) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192643/ (Visited 2/11/2016)