The Challenges for Telemedicine

The challenges for the future of telemedicine are going to be complex and require cooperation of government agencies (FAA, FDA, HHS, CMS,) added to some state government departments and state medical boards. This will be a complex web that may prevent some forms of telemedicine from getting off to a good start.


The medical establishment is buzzing about the concepts of telemedicine, telehealth, telecare, and mHealth. The question on everyone's mind is how long will we need to wait before they become a standard way of care and have reasonable guidelines for use. Another and maybe more important question is; how long will telemedicine benefit from the presently low barriers of entry before the regulatory machine limits what telemedicine can accomplish. Even the question should be raised about what impact the Affordable Care Act will have.


Next, we have the emerging mHealth (mobile health) industry, which is presently an undefined area in a fast developing technology climate. This is still waiting for FDA and other regulators to arrive at standards for the approval, market access, and reimbursement of those devices, applications and other healthcare software. Will the FDA, HHS, CMS, and other federal bureaucracies be able to step forward in a timely manner to prevent stifling innovation? Or will they threaten small business and new entrepreneurs that feed the market and delay important technology? To me there is little middle ground and action is needed now.


Here are some of the key issues:


#1. Technology Platform. Currently we do not have a network system that can accept images from CT scanners and MRI devices and transmit them straight to the doctor's smart phones. I have seen a secure computer network in the VA hospital that makes this possible, so I know it can be done on computer networks.


#2. Data Volume and Speed. Since I have seen this accomplished on secure computer networks and done in about one hour, from scan to viewing on the doctor's computer screen, I know it is possible. However, with mobile applications, there are some key points. The volume of data and the priority of moving this data will be huge and software developers need to be aware that the network infrastructure is aligned with the needs. In the diabetic platform similar to the recently launched Cellnovo in the UK (and hopefully shortly in the US), when a patient is hypoglycemic, the cellular bandwidth at which the device sends signals to the mobile phone needs to be somehow prioritized. Moreover, when similar devices come into the market, cellular urgency becomes an issue.


#3. Data Security. Data security is the last concern as it affects all of telemedicine. As more devices come to market, and the public or patient sector considers them, the assurance of privacy and protection of the data will need to be answered. Will HIPAA be able to cover this in advancing technology market? There are some real doubts at present as slowly as Congress is acting.


Yes, in the ever-expanding chronic disease arena and projected physician shortage, mHealth and telemedicine may have a role to play. This will be tested by state medical boards trying to prevent new technologies and there will be many other challenges along to way to a more productive and lasting improvement in medical care. Will efficiency win the day? We can only hope!

Telehealth, Telemedicine, mHealth - ????

With the explosion of technology today, it is difficult to see what is in store tomorrow much less five or ten years from now. Yet many people are attempting to predict and declare what will happen in the next five to ten years. This is because of their obsession with having order in their lives and direction in what they do. I can understand and appreciate this, but as I grow older, I just want to wake up tomorrow and then I will worry about what I do and what will happen. Oh, yes, I have plans, live by a budget, but all these dreams are mote if I don't wake up tomorrow.

The definitions of the terms used today are complex and often confusing. I am not sure that I have them right, but I have asked three doctors and received three different answers. And in their own professional groups, each has their points and they all differed. Digital health technology seems to be accepted more than any other term and in some instances, this may be true, but then we need to think about the other terms that are gaining acceptance. And when talking about digital health and digital healthcare, there is not a national organization, that I am aware of existing.

Telemedicine, telehealth, mhealth, (Mhealth, m-health, mobile health all apply to the use of mobile health devices), are just a few of the terms being used widely. In a search of the internet, only one of these terms relates to a national organization and that is the American Telemedicine Association. At present, and I say this cautiously, this is the only group to have a national association and as such I need to consider this the overarching organization for all other terms.

Be careful and don't confuse this with telecommunications as this is represented by at least two national groups – the National Telecommunications Cooperative Association (NTCA) and the National Rural Telecommunications Cooperative (NRTC). The NTCA and the Organization for the Promotion and Advancement of Small Telecommunications Companies (OPASTCO) merged and beginning on March 1, 2013, the new organization will be called NTCA, The Rural Broadband Association.

Back to the use of terms in the health arena. The term “eHealth” is often used, particularly in the U.K. and Europe, as an umbrella term that includes telehealth, electronic medical records, and other components of health information technology. As this is a term more common to the European Union, I will leave it alone.

Another term similar to telemedicine is the term "telehealth," which is frequently used to denote a broader definition of remote healthcare not always involving active clinical treatments. Telehealth and eHealth are at times incorrectly interchanged with telemedicine. Telemedicine often refers only to the provision of clinical services while the term telehealth can refer to clinical and non-clinical services involving medical education, administration, and research.

Telehealth is not popular in some areas, but one company still pushes this. And remember, it does not take a national organization to drive definitions, but it helps.  Reading about the different terms in wikipedia can be of some help, but there is still confusion. I find it interesting just trying to wrap my head around all the terms. I may misuse them, but to me telemedicine will be for me the overarching term and may include some of the other terms as part of telemedicine.