Here’s what people imagine telehealth to be, an interactive real-time video consultation between a doctor and a remote patient.
Telehealth is that, of course.
It’s even better when the consultation is enhanced with instruments that let a doctor (or other provider like a nurse practitioner or physician assistant), examine a patient’s eardrum or listen to their heart from afar.
Access to a shared electronic medical record makes the encounter that much more powerful.
As a rural family doctor, I did telemedicine many times every day, a decade before I owned a computer, let alone a smartphone. In the days when there were only landlines, I gave medical advice to patients and sought advice on challenging cases from colleagues over the phone.
That was telemedicine.
I was practicing medicine from a distance. Likewise, when I called a prescription to the pharmacy or an order to the laboratory. After a few years, I was faxing some of those prescriptions and orders.
That was telemedicine too.
You may have noticed that I’ve used both words, “telemedicine” and “telehealth.” The word “telehealth” came along in the 1980s, about 15 years after “telemedicine” first appears in Ngram.
The word “health” is meant to convey a broader scope of practice than “medicine,” which implies just a physician-based medical practice. “Telehealth” includes for example: consultations with therapists or dietitians; support groups; and lately, self-monitoring and uploading of everything, from steps taken to blood sugar to mood.
Truth is, most everybody, including me, uses “telemedicine” and “telehealth” interchangeably.
In 1999 McGraw-Hill released a book I co-wrote with healthcare futurist Jeff Bauer, Telemedicine and the Reinvention of Healthcare. Jeff and I came up with this definition for our book:
“Telemedicine is the combined use of telecommunications and computer technologies to improve the efficiency and effectiveness of healthcare services by liberating caregivers from the traditional constraints of place and time and by empowering consumers to make informed choices in a competitive marketplace.”
That’s a mouthful. But it holds up pretty well, I think, considering it’s 190 tech-years (19 people-years) old.
For my book, Digital Healing: People, Information and Healthcare, published last year by Taylor&Francis and released in audio version by Audible, I wrote this streamlined definition, “Telemedicine is the use of electronic information and communication technology to overcome barriers of distance and time when delivering healthcare.”
It’s about using technology to subdue distance and time. Period. Which means that the questions and pictures about a rash that you send to me electronically or that I forward on to a dermatologist are telemedicine.
The care doesn’t have to happen in real time—it can be based on information that is stored-and-forwarded.
Whether you called me with your initial query or contacted me with pictures and questions via my practice’s patient portal, it’s all telemedicine. It’s all care at a distance.
Once we grasp that telemedicine is based on a broad set of communication tools, we can begin to solve real problems and meet real needs, usually at reasonable cost. The technology itself gets cheaper, more reliable and easier to use every day.
“Let’s get a cool interactive video system. Now, what’s the problem?” describes a process that is 180 degrees from what it ought to be.
It should go more like this, “We see patients with acute strokes at our rural emergency room. The sooner we get clot buster drugs into their system, the more stroke patients we could save from a lifetime of disability. But if we give this potent medication to the wrong patient, such as one whose brain event is the result of a bleed, not a clot, we could make things catastrophically worse. We need a neurologist to interpret the acute brain CT scan and advise us how to proceed; and we need them right away, because time is neurons. The longer the delay in administering anti-coagulation, the worse the outcome.”
Fortunately, I have in my rural ER a CT scanner and a stock of anticoagulant. I am present myself to interview and examine the patient. As a family doctor, what I need most of all is for a neurologist or a radiologist to interpret the radiology image. The hospital’s CT scanner must have a broadband connection so it can send the digital “films” STAT for expert interpretation.
Crucially, there has to be a protocol on the receiving end for a consultant to look at the images immediately and call me back with the results. We need a system. That’s the challenge. These days the technology is pretty standard.
Parenthetically, what we don’t need is for the consulting doctor and me to be able to see each other on a video monitor nor, for that matter, for the patient and distant doc to be in visual contact. That’s how one big hospital organization in my state sold their acute stroke management system, by featuring their fancy, new video system.
“Let us do a telemedicine consult,” they said. And people bought it.
The real-time video just made the whole interaction more cumbersome, especially in the old days of telemedicine when you had to wheel a cart bearing a big monitor and a heavy codec (the video equivalent of a modem) up to the patient bedside and hook it up to hard wiring that had been installed in the room.
Fortunately, this medical center does have excellent stroke doctors who give good advice and a well-oiled system for communicating with referrers. But it was the sizzle of *T*E*L*E*M*E*D*I*C*I*N*E* more than the steak of immediate expert consultation that made their program go, and also made it more expensive.
Whether you’re a provider or a patient, located in the city or in the country, try to think of telemedicine as a set of tools, no different than what you have in your shop. Sometimes you need a table saw to make a cut. Sometimes all you need is a razor blade.
Choosing the right tool for the job is critical. But first you have to understand what that job is.
In healthcare that means that sometimes you may need a high-end video system for talking a distant surgeon through a hairy procedure and sometimes you’ll just need the telephone to reassure a worried parent.
It’s all communication. And it’s all telehealth.