The Technology Transforming Healthcare
Technology has always played a strong role in healthcare. From X-ray machines to pacemakers to MRIs, technology has helped to diagnose, treat, and heal. Its use has expanded from purely medical applications to supportive roles in staff communications, digitizing and storing of patient records, and the processing of pharmaceutical orders. A natural extension is for technology to be applied in ways that enable telemedicine treatment (sometimes called telehealth) and remote patient monitoring using audio and video capabilities, including videoconferencing, store-and-forward imaging, streaming video, and wireless video communications. From clinics to doctors' offices to hospital operating rooms (see Figure 12-1), video is becoming as much a part of medical care as stethoscopes. Let's take a look at how we got to this point.
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Figure 12-1 Physician Using Video Consultation During a Surgical Procedure
The earliest recorded use of telemedicine was a 1950s Nebraska project using closed-circuit television to provide mental health services from a university medical center to a state hospital 100 miles (160 km) away. Then, in the early 1960s, the NASA space flight telemedicine program began so that medical personnel on the ground could monitor astronauts' biomedical responses to space flight.
These elaborate deployments are, of course, unique. Because of the expense of equipment and lack of available high bandwidth for video, it is really only within the past 15 years that telemedicine has become more widely available. The most common method for remote clinical diagnosis uses desktop, room, and portable videoconferencing units. Video telemedicine has been practiced most often in underserved rural areas or in situations where patient transport poses a hazard. In the case of the former, a rural doctor or nurse typically consults with a specialist physician based at a metropolitan or university hospital. Using videoconferencing technology and specially adapted medical tools, the remote doctor can see the patient, talk with the local healthcare practitioner, hear a heartbeat through a remote stethoscope, see images from ear/nose/throat exams, or examine skin conditions. Although enormously beneficial, this application has typically required leased T1 telephone or ISDN lines, which can be prohibitively expensive. In addition, telemedicine services were not always covered by patient insurance plans, further limiting early adoption. However, the Balanced Budget Act of 1997 and Benefits Improvement Act of 2000 finally made telemedicine eligible for coverage by Medicare payments, enabling many citizens in rural areas to receive video medical treatments of all types.
Because of a number of issues (legal, cost, patient/physician acceptance of the technology, payment issues), the most common use of video telemedicine has actually been to provide healthcare to prison populations. Prisoners have a legal right to medical treatment, but the cost and danger of transporting them to a medical facility is extremely high, because at least two guards and possibly an ambulance are required for transport. However, the high risk factor more than cost-justified using telemedicine in many states and paved the way for its use by other organizations.
Now that we have a better appreciation for video's past role in healthcare, let's take a look at how it is being used today. The first step toward the use of video in many medical environments has been to accommodate for digital video imaging (sometimes known as picture archiving and communications system, or PACS) and record storage. This typically requires a network and bandwidth upgrade to support the volume of information being transferred and stored. The offshoot for organizations who have done this is that they can now support full motion video for telemedicine and related applications. These new capabilities have a significant impact on the quality of patient care, allow staff to collaborate and communicate differently, help organizations to build and extend expertise, offer new services to patients and their families, and lower the cost of care. The ten case studies that follow provide real-world examples of the many innovative uses for video in healthcare today. Let's start with two that impact the medical staff directly.