Telemedicine: The State of Telepresence In Healthcare (robohub.org)

Hallie Siegel writes: Telemedicine can let doctors and nurses check in on patients who might be recovering at home, or monitor people in remote locations where it's hard to access physician services. This article gives an overview of the different systems that are out there, what are some of the legal obstacles, and how various countries are investing in the technology. From the article: "The Japanese government has allocated about $23M USD to the core technology market in an effort to develop products for its aging population. Toyota, for example, is focusing on home living assistance robots that will allow those with limited mobility the opportunity to live at home. While Japan might have the largest market in the world of 65+ citizens (over 30 million as of 2014), South Korea is estimated to be allocating nearly $6B USD to their own robotics research. The Koreans are taking a different approach, using robots for mundane tasks of delivering food, allowing humans to provide care."

Comments

Maine has been doing this since 1976

[cleara]

Folks: Maine has been doing this since 1976. The Central Maine Medical Center, Saint Marys Hospital, Maine General, and Eastern Main Medical Center got connected together via a terrestrial microwave network that was developed by a Maine television visionary named Robert Cowen. Bob worked with both the University of Maine television network as well as by boss at the time (WCBB TV's chief engineer Roland Disjardins. I was one of the transmission engineers who had helped put this together at the WCBB TV transmitter site in Litchfield, Maine.

It's interesting that just about all of us who worked on this project were also amateur radio operators and much of the technology was born from our skills we gained through the hobby of amateur radio. By the way, I am WA1SEY. If any of you went to WPI, I was active in their ham radio club W1YK.

All this long before the Internet was even a faint dream in our eyes.

Re:Maine has been doing this since 1976

[ColdWetDog]

Which is exactly why this field is so annoying. We've had 'telemedicine' for decades. We have been able to have a remote physician look at and talk to a patient and the local provider ever since closed circuit TV was available. The idiot TFA basically wants to talk about other things - patents and point of care robots, but really does nothing to discuss the lack of ubiquity that evangelists have been promising. Every couple of years, some new company wanders in and tries to demo their 'new'
and invariably proprietary gizmo that is typically a combination of Skype and a fax machine.

Every couple of years somebody gets a grant for these things, uses them for about six months and then stuffs them in a closet.

Telemedicine can work for a simple doctor / patient interview but falls apart for anything more complex because medicine is quite a bit more than simply a doctor / patient interview. The remote site typically doesn't have the diagnostic gear that the consultant needs. The consultant typically doesn't have access to all of the records. And the remote site may not have the staff or equipment to treat the patient, even if the diagnosis is clear.

So at anything other than the most basic level, it has been thrown together technological bits that have long sought out a reasonable use case. Yes, you can have remote teleoporated surgeries and other hi tech stuff if you really want to pay for it. No, that isn't going to make sense for anything other than edge cases for a very long time.

The other stuff TFA briefly mentions are devices to automate point of care - getting vital signs on a home bound patient, saying hi to them, checking on if they are breathing. All well and good but something that isn't exactly earth shattering and isn't going to cure cancer or bad breath.

Not much to see here, move along.

Re:Maine has been doing this since 1976

[ColdWetDog]

Yes I work in rural healthcare and no, I have not seen a 'telemedicine' system worth the time, effort and money. In my rant, I'm not including a number of things that you rightly call telemedicine because that isn't how the technology is being pitched to hospitals. But you are quite right that radiology is telemedicine in the truest definition of the word. I'm hard pressed to call faxing EKGs 'telemedicine' because if you go that route, everything since the telephone is telemedicine. The stethoscope recorders are an example of a discrete part of an exam that can be transmitted remotely that has very limited clinical utility. Pretty much any cardiologist is going to ask for a echocardiogram which takes an expensive piece of equipment and a highly trained operator. So off the patient goes. So you can do it but it's really not helping the patient in any sort of coherent fashion.

The stroke protocol is interesting. They have managed to take a simple, six step checklist and create a wonderfully expensive device and system (that can be billed for, natch). Providence Anchorage loves the things but pretty much every neurologist will tell you that it's totally unneeded. Any rural facility that is capable of using clot busting agents is capable of having a trained paramedic / PA / nurse practitioner that can do the exam and then call the neurologist on the phone.

So my rant is devoted to those complex, expensive systems that are trotted out routinely that try to do very simple things (basically your examples) in complicated, typically proprietary fashion.

I actually think we agree more than disagree. As usual, it's semantics (is a video camera really telemedicine?) The low hanging fruit has been harvested and now the industry is trying to get on a rather intellectually shaky ladder.

And anybody who says that you can just 'connect' EHRs to deal with the patient's chart has never seen EHRs. Despite federal law and three decades of work, it takes custom programming, time and angst to get two different EHRs to talk to each other.

Re:Maine has been doing this since 1976

[quintessencesluglord]

That's all very well and good. Now look at the cost of medicine today, compare it to just 30 years ago, and then tell me it hasn't been driven in very large part by technological advances, which hasn't significantly improved outcomes, but has driven medical care out of reach for many, keeping in mind telemedicine is seen as a cost-saving measure due in part to more spending on the technological aspect of medicine at the expense of the infrastructure.

For all your claims it isn't getting better, reality has a counter argument.

http://ije.oxfordjournals.org/...

Take a look at the reality for yourself then. It is less than clear-cut, except for the fact costs have risen dramatically.

Better Cameras

[kelemvor4]

My daughter is a Shriners' patient. I've taken her to the Tampa hospital for telemedicine visits on numerous occasions. I've discussed telemedicine with the doctors and other staff because i was interested.

For security, they aren't using internet - they're using ISDN lines and direct dial connections. Obviously this means the bandwidth requirements are tiny since it can work over ISDN.

Even the high end videoconferencing system they bought was insufficient in video quality. The camera just didn't draw enough light and have sufficient optical zoom for high quality zoomed in video. They had to buy an external video camera and cable it to an aux input port on the system. You could probably do what was needed using a modern DSLR with a good lens.

Further, we went to a hospital. This not only ensured the right camera equipment was available to the patient. It also allowed the specialist doctor to instruct local non specialists on how/what to do for minor procedures.

The whole thing worked out great, but it was slightly more involved than I thought it would be. Judging by other comments on this post, most people don't understand this.

. is the system that has been augmented with a better camera. The photo does not show the better camera.

Telemedicine is for edge cases for now

[sjbe]

I don't see you listing any barriers that can't be overtaken.

Then you have an insufficient understanding of the problem, particularly of the economics involved.

Get the remote site the equipment needed.

So you are going to send a bunch of expensive equipment to a remote location where it will be infrequently used and operated by people who have no expertise. What could possibly go wrong... Or are you suggesting we staff a quasi-remote location? In that case it isn't really telemedicine anymore is it? Then it's just a branch office with Skype.

Perhaps the staff can't treat the patient for every diagnosed condition, but they can get a better diagnosis

Sometimes yes, very often no. If you are going to have a remote site staffed with trained medical professionals then you don't need telemedicine except for the odd specialty consultation. We can do some fancy remote surgery stuff but we haven't worked out the technology completely and aren't even close to solving the economics of that technology. (hint: it's REALLY expensive) Telemedicine has its uses but they are going to be edge cases for the foreseeable future. It is NOT the panacea that many imagine it to be.

One imagines that you don't realize how complex the human body is, and how many things can be solved remotely.

Well I'm married to an MD who would be happy to explain it to you.

One thing I will never understand is why neo-luddites like yourself even bother to read slashdot. You are clearly against technological progress.

Nice. "Neo-luddites"? Seriously? Are you a medical professional or do you just imagine that you understand the problems involved in telemedicine better than those who are?

Real issue to Telemed

[jellomizer]

1. The big one: Most insurances wont pay for it. Lets face it, behind the marketing BS, a major driving factor is making a lot of money. Doctors get paid a lot of money, Big wigs at a large healthcare institution get paid a lot too. Money is a big driving factor. A few insurances are willing to pay for it. But not enough for wide distribution.

2. Health Care Technology is behind the time. There are a lot of reasons for this, Usually due to most of it being very expensive, having to buy a new multi-million dollar MRI just to allow for better transmission of data, or the millions spent on a new EHR system. After the investment they want to keep it for a while to pay off the investment. The bad part is they keep them for far too long and technology bypasses them. This aged infrastructure make telepresence hard because we need it integrated as part of the health record, otherwise it could come down to a point where the doctor said he saw the patient and the patient said no he didn't.

3. The ones who need it the most don't have the resources to use it. If you are in very rural locations, chances are you may not have the internet speed to take advantage of it. Or you are too poor to access transportation, that means you will be on the slowest internet connection (if you have one at all) with a slow hand me down computer.

4. IT Skills. For both Doctors and the Patients. Many of the older doctors are reluctant to learn technology, their Ego gets in the way of them learning something new, as they may look stupid in front of those normal people who didn't study for 8+ years in a particular field. Still even today most Doctors will make paper charts and hand them off to someone else to put in those damn expensive EHR that the government told them to use. As well for patients, many of the people needing health care are the older folks who are not so technology aware, where you suffer from watching them trying to move the mouse, and confused that scrolling down makes the text go up. Also how many times do you see someone struggling to start a web-ex session. Imagine how hard it would be for two people who don't use it regularly?

5. Image quality. It is getting better, however there are some odd things about telepresence... People look at the eyes of the people on the screen... So they look like they are looking down, giving a false non-verbal communication. Resolution at slower speed, or cheaper web-cams may not be good enough to see particular issues, a Rash may be a red blur or may not be picked up at all. Details such as sweating for flushness of face or swelling may not be picked up.

6. Security. Most health care systems have this approach to security. Go with a vendor who will take the blame if there is a problem. This means they will pick a big company with an army of lawyers who will find a way to differ the problem. This isn't security or choosing the best secure system. Just saving your butt. This is newer technology and trying to find a vendor who is willing to take the blame if some how that Dr. visit was captured and transferred to a scrupulous source due to a virus or some sort of malware on the home users PC.

7. Patient location may not be HIPAA safe or just safe for the patient to have a consult. Having that abusive other just outside the door or the child listening in and taking what is said out of context.

There are a lot of issues to be resolved