By Judith Lamont, Ph.D.
Healthcare: anatomy of telemedicine systems
The advantages offered by telemedicine are so obvious that predictions of its imminent widespread adoption have been made for more than a decade. Yet technological, cultural and legal barriers have impeded the realization of its potential medical and economic benefits. Finally, the many forces that affect telemedicine are converging to create significant momentum, and the environment is now conducive to broad implementation.
Telemedicine is the delivery of medical services or information in situations where the patient and the healthcare provider are not in the same physical location. It uses many of the technologies typically associated with knowledge management applications, including collaboration, digital storage, process automation and records management.
According to the American Telemedicine Association (ATA), whose mission is to promote the use of telemedicine to improve healthcare delivery, telemedicine may involve patient consultations via videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, consumer-focused wireless applications and nursing call centers. Telemedicine can also include interactions among physicians, continuing medical education and other interactions that do not entail clinical activities.
Impressive forecasts
The varying definitions of the market produce large discrepancies in estimates of size and growth, but the growth is consistently predicted to be quite dramatic. IHS, a global consulting firm, predicts that worldwide revenue for telehealth devices and services will grow from $440.6 million in 2013 to $4.5 billion in 2018, a tenfold increase. According to a 2014 report from BCC Research, the global telehospital/clinic and telehome market reached $16.3 billion in 2013 and $19.2 billion in 2014, and should reach about $43.4 billion in 2019 with a compound annual growth of 17.7 percent through 2019. Those figures represent a significant increase in market size as compared to predictions made in a similar report two years earlier.
Among the key applications for telemedicine are:
providing medical care to underserved or remote areas,
leveraging the skills of specialists who cannot be physically present,
providing routine primary care for patients who do not need to be seen in person,
allowing rapid emergency diagnoses for patients suffering from acute episodes such as strokes, and
enabling efficient monitoring and treatment of homebound or chronically ill patients.
Mercy uses a large single-hub monitoring system called Mercy SafeWatch to support critical care across 15 hospitals in five states. The videoconferencing portion of the system is based on the VidyoWorks platform from Vidyo and allows centralized monitoring of more than 450 critical care beds. The system also allows medical staff to communicate via video with the patients, nurses or family members in the room. Mercy offers other telemedicine capabilities in addition to tele-ICU, including telestroke, telecardiology and teleperinatal services.
"The VidyoWorks platform powers video communications for clinical workflow, patient engagement and conferencing," says Mark Noble, VP of strategic marketing at Vidyo, "and is used in 36 of the top 100 integrated delivery networks in the United States."
Vidyo's technology has HIPAA-compliant encryption and can be integrated with many other healthcare ecosystem and workflow tools. Those include electronic medical records systems, telemetry management software, direct consumer care providers and ICU monitoring software systems such as Philips eCareManager, a patient management product.
Patients are using mobile devices increasingly to interact with healthcare providers. "The patient enters a virtual waiting room after clicking an icon on their screen," Noble explains. "The doctor has a list of patients and clicks to launch each patient's session. The doctor can show the patient content such as test results, update records and write prescriptions from within the application, which is integrated with the patient's electronic health record (EHR)."
Homecare is another growing area of use for telemedicine. Vidyo's APIs allow the integration of third-party software that can, for example, keep track of vital signs. If they show anomalous results, the system can alert the monitoring nurse who can then initiate a video session with the patient with a click of a button.
Patients who have chronic conditions can benefit significantly from telemedicine by having access to more frequent monitoring and intervention. Chronic care consumes 75 percent of healthcare dollars, so productivity gains in treating that population could have a significant impact on healthcare expenditures.
Customized components
Videoconferencing is a core element of many telemedicine systems but the other components are tailored to specific applications. The ClinicalAccess Station, for example, is a modular mobile exam station from GlobalMed. It integrates videoconferencing with a variety of medical devices and eNcounter software, GlobalMed's graphic interface for launching the applications used in its telemedicine systems.
GlobalMed's systems often incorporate specialized cameras for applications such as dermatology and pathology. "Each system is aimed at a specific area of medicine, rather than being generic," says Roger Downey, communications manager at GlobalMed. The video otoscope, for example, provides images of the ear that are easier to see than they would be in person. The imagery can be saved in the Digital Imaging and Communications in Medicine (DICOM) format, along with metadata that uniquely identifies the patient.