Telemedicine: Ready or Not, Here It Comes!

MONTGOMERY-The provision of health care is constantly changing to meet the varying needs of those it serves and to take
advantage of ever changing technology. Another dramatic change in the provision of and receiving of
health care may be on the horizon in Alabama, especially in rural areas. This involves the availability of
telemedicine.
What is telemedicine? There are currently three major types of telemedicine: store and forward, remote
(or high-risk) patient monitoring, and live video. Store and forward technology has been available and
widely used for some time. An example of this technology is having technicians in many of Alabama’s
rural hospitals complete x-rays, various types of scans, etc. and transmit these electronically to services
staffed by radiologists and other professionals, some even in other countries, where there is a rapid analysis
and reporting of findings.
Remote or high-risk patient monitoring has been tested in rural Alabama and is in current use. An example
of this technology is the current monitoring of vital signs for over 700 home care consumers by the
Alabama’s Department of Public Health’s Bureau of Home and Community Services. Regularly scheduled
telephone calls are made to or received from these consumers with special needs. They have selected vitals
monitored using special equipment and the telephone to identify whether special attention is needed or not.
This can help in avoiding unnecessary travel for patients in remote areas or with difficult transportation
concerns. This can also identify potentially serious conditions requiring fast intervention or treatment.
Live video is an emerging and rapidly advancing technology that involves a health care provider in one
location examining or providing other care for a patient in another location – possibly thousands of miles
away. This is done through the use of special equipment, sometimes located on a cart, including a screen
and phone connection allowing the provider and patient to see and communicate with each other. There are
numerous attachments such as a digital stethoscope, otoscope, etc., depending upon the specialty or subspecialty
of care that is being provided, that can be used with this equipment in examining patients or
specific conditions.
With the use of high quality broadband connectivity, the services of another health care provider who is
with the patient to follow the provider’s instructions in using the equipment, and high technology medical
instrument attachments, a health care provider can examine the patient and offer instruction on the required
treatment. The special attachments allow the provider to see images that can sometimes provide much
greater detail than is seen in face-to-face visits. This explanation of telemedicine is very basic and offers
limited detail in comparison to all services which are currently possible using this technology.
Georgia is a leader in adopting the use of telemedicine. Patients in Georgia can currently receive care
involving more than 40 specialties or sub-specialties through telemedicine. Primary care is available in
many retirement facilities, often avoiding unnecessary transport by ambulance for basic care. Children
who may rarely or even never see a physician have the ability to receive care through school based clinics.
Georgia, Tennessee, and Mississippi have all passed legislation mandating that private insurance
companies reimburse for telemedicine services. Private insurance reimbursement is not being mandated
through legislation in Alabama. This has been a major barrier to the use of this promising technology. A
second barrier is the need for high quality broadband access throughout Alabama. High quality broadband
access is a critical need for the expansion of remote patient monitoring.
The lack of reimbursement by private insurance companies in Alabama is being decreased as a barrier.
Alabama’s largest private insurance company, Blue Cross and Blue Shield, has announced that it will
voluntarily start reimbursing for selected services involving cardiac care, neurological care or stroke,
dermatology, infectious diseases, and behavioral health on December 1. Medicare already reimburses for
telemedicine services nationally. Alabama’s Medicaid program currently provides reimbursement for some
telemedicine services.
Even without private insurance reimbursement, several types of telemedicine are already being practiced in
Alabama. Alabama currently has tele-stroke care available in several rural emergency departments where
patients are examined by a distant neurologist with local providers being instructed in what time-sensitive
care should be administered. Tele-wound care is being provided at the Washington County Hospital in
Chatom to help local patients possibly avoid having to travel more than 70 miles one-way for this care.
Tele-anesthesiology, tele-cardiology, tele-HIV medicine, tele-psychiatry, and tele-child psychology are all
being utilized in Alabama.
The Alabama Department of Corrections is utilizing telemedicine in several prison clinics to avoid
transporting expenses for general care. The Alabama Department of Public Health is providing strong
support for the expansion of telemedicine by placing telemedicine carts in nine county public health
departments that can be used by local providers. Tele-HIV medicine is being provided in some of these
locations. Others locations are being considered for telehealth applications such as tele-prenatal care.
Positive potential abounds for all involved parties. This technology can allow health care providers to be
more like other businesses by exporting their health care services. Insurers have the potential to reimburse
for earlier and lower cost care administered through telemedicine, possibly avoiding greater expenses for
treatment received later. Consumers have the option of receiving care more conveniently and earlier.
What the future of telehealth and telemedicine will become is yet to be seen. However, the current
utilization is very exciting and promising, especially for such needs as providing specialty and subspecialty
care to patients in our rural areas. Talk with your health care providers and encourage them to
utilize this very promising technology.