Telemedicine is changing the practice of medicine. It is part of the ever-growing
use of communications technology in health care being used in prevention, disease
management, home health care, long-term (chronic) care, emergency medicine, remote
medical imaging, and many other applications. The pace at which telemedicine is being
adopted and integrated into the healthcare enterprise is exponential and, for many
(even those in the field!), it is often difficult to keep up with all of the changes
occurring. Thus, it is useful periodically to stand back and summarize recent advances,
to take stock, analyze where we have been, and project where we are headed.
This Special Issue of Healthcare features invited papers by experts, on important
topics in the fields of telemedicine, telehealth and mHealth (i.e., mobile Health).
After a gestation period of a half a century, since the first multi-specialty telemedicine
service was created in Boston at the Massachusetts General Hospital in the late 1960s,
telemedicine is now reaching its stride as an important and practical way to deliver
a broad spectrum of healthcare services to patients. Over 60 subspecialties of medicine
and nursing are involved with telemedicine and telehealth. For example, teleradiology
has become a standard-of-care for night time coverage in rural and urban hospitals.
Telestroke networks may become the next essential “urgent care” service. Telepsychiatry
is commonplace in many practice environments. The “smart phone” is being shown to
be well suited for use in many mobile telehealth applications. Today, thousands of
healthcare apps are being developed, tested and marketed to healthcare providers as
well as patients. This Special Issue of Healthcare features original papers by leaders
in telemedicine whose work is at the leading edge of this rapidly advancing field.
The issue features a paper by Tim Hunter, MD on teleradiology that will prove very
useful to those “shopping” for a teleradiology service entitled “University-Based
Teleradiology in the United States” [1]. It reviews the long-standing and very successful
University of Arizona’s teleradiology practice, as well as university-based teleradiology
practice in the U.S. in general. It very nicely describes the unique benefits and
challenges of engaging a university-based radiology practice for teleradiology services,
including a discussion of reimbursement models, consultation models, and what types
of questions one should ask when searching for a teleradiology service. Readers will
find Table 4 in the article very useful as it succinctly summarizes nine key recommendations
for a successful university-based teleradiology practice that both those seeking and
those providing services can readily refer to.
Dr. Elizabeth Krupinski also submitted a paper, “Human Factors and Human-Computer
Considerations in Teleradiology and Telepathology”, that deals with teleradiology,
but from a very different perspective that also addresses telepathology [2]. Both
of the specialties are in many ways more developed than other clinical specialties,
perhaps because both are traditionally image based and for the most part have fewer
direct patient encounters. This paper reviews the rather unique digital viewing environments
for teleradiology and telepathology, providing a new look at how to optimize case
reading environments and address human factors issues. It reviews key components that
need to be optimized for effective and efficient practice of teleradiology and telepathology
using conventional digital imaging workstations, as well as some of the newer mobile
viewing applications.
Although the practice of telemedicine is slowing being integrated into traditional
healthcare delivery systems, in many ways it still requires a dedicated workspace
or at least special attention to converting an existing workspace into one that is
amenable to the tele-encounter. In “Telemedicine Workplace Environments: Designing
for Success”, Dr. Krupinski further explores the topic of ergonomics in telemedicine
by looking at the workspace environment [3]. Although the future practice of telemedicine
is likely to be more of a mobile-based practice and centered more in the home than
it is now, it is still very important to consider ways to optimize the design of clinic-based
telemedicine facilities. This is true on both ends of a consultation—where the patient
is and where the consultant is. The paper covers everything from lighting and acoustical
considerations to what color the walls should be painted, outlining a variety of easy
to take steps to optimize rooms for telemedicine.
Setting up the basic technology and networking infrastructure for telemedicine is
one thing, but convincing practitioners to actually use telemedicine is often another
challenge unto itself. There are many ways to champion telemedicine and find converts,
but giving someone a practice guideline developed by experts engaging telemedicine
on a daily basis can often be the most convincing and useful tool you can provide.
In “Standards and Guidelines in Telemedicine and Telehealth”, Dr. Krupinski provides
an overview of the development of guidelines and standards that help insure effective
and safe delivery of quality healthcare [4]. The paper reviews critically important,
sustained, efforts by the American Telemedicine Association in developing telemedicine
practice guidelines, review the role of research in guidelines development, review
data regarding their use, and discuss some of the additional areas where guidelines
are still needed. There are lots of references to the existing guidelines that readers
can download freely and adopt today!
Finally, there is a paper by Chan et al., “Mobile Tele-Mental Health: Increasing Applications
and a Move to Hybrid Models of Care” that very nicely describes the vast potential
of mobile devices for psychotherapy, psychosocial interventions, and other behavioral
health programs [5]. Particular emphasis is placed on novel interventions that integrate
sensors to monitor patients and algorithms that provide “interpretations” of these
data to help predict when patients require some sort of intervention. As with the
first article on teleradiology, the benefits and challenges associated with mobile
devices are reviewed and a number of recent key studies in the topic summarized. Some
key clinical scenarios in which mobile options are proving to be useful are described,
followed by a discussion of what is still needed to make these devices are part of
regular care, including more research validating them, more clinical trials, and adoption
of existing guidelines.
The final few sentences of the Chan article provide a glimpse of what is certainly
going to be healthcare in the very near future—a “hybrid” practice in which mobile
and other emerging technologies are used regularly as part of every practice to effectively
and efficiently monitor, connect with, educate and care for patients. Each of the
articles in this Special Issue will provide readers with insights into the practice
of telemedicine that will hopefully inspire them to join the telemedicine community
sooner rather than later as it clearly is here to stay!