It’s about 4,400 miles from Charlottesville, Virginia to Conakry, the capital of Guinea. On its face, that’s an unremarkable fact. Everyone knows it’s a long way from the United States to West Africa. What is remarkable is that that distance was bridged when University of Virginia telemedicine professionals helped combat the Ebola Crises of 2014.
Ebola is a particularly difficult disease to treat hands-on because health care professionals can’t touch the patients unless they are wearing protective gear that takes 45 minutes to put on and take off. Ebola patients were unable to have any close personal interaction during their treatment because visitors also must wear personal protective equipment. The patients, however, still needed to speak to physicians, family and others.
UVA’s well-developed telemedicine program, consisting of both medical and technological professionals, assembled a system that, among other things, allowed health-care professionals in the hot zone to hold up vials of medical tests to a camera in Guinea so physicians in the US could see and make judgment calls on them, saving critical time during the emergency.
Back in the states, Donald Hixson, a retired highway patrolman and sheriff’s deputy, doesn’t remember much about his stroke, but Dr. Wayne Clark of the Oregon Health and Science University (OHSU) vividly recalls the night he was beamed via technology into the Mid-Columbia Medical Center Emergency Department and got the chance to exam Hixson as if he and Hixon were in the same room in Portland instead of miles away in The Dalles.
He could see his patient and the Mid-Columbia emergency-room physician clearly, and they could see him, enabling seamless communication. Dr. Clark, who directs the Oregon Stroke Center at OHSU, was able to determine that the stroke was caused by a clot in Mr. Hixson’s brain stem. Dr. Clark prescribed a clot-busting, brain-saving drug call t-PA , which was administered at Mid-Columbia and initiated Hixson’s rapid transfer to OHSU — likely saving Hixson from severe consequences. The mortality rate for that kind of clot can be as high as 70 percent.
Northern Oregon and western Guinea don’t seem to have a lot in common, but there are similarities. Although they are separated by an ocean and a continent, both are in largely rural areas and both have experienced the benefits of telemedicine.
As these examples dramatically depict, telemedicine allows health care professionals to evaluate, diagnose and treat patients in remote locations using communications technology. Patients in distant locations can access medical expertise quickly, efficiently and without travel, and it provides more efficient use of limited expert resources.
On the cutting edge
Telemedicine lies at the cutting edge of technology and medicine. A good example is the Apple Watch. In September, the company announced that it had received FDA clearance for both an atrial fibrillation-detecting algorithm and an ECG that are features of the new Apple Watch. What’s more, the device can also detect when someone has fallen and communicate that fact.
Advances in telemedicine like those used to combat the Ebola outbreak and save people from the death and damage from strokes span not just the globe but also the urban-rural divide.
I have a rural perspective. For 28 years I represented Virginia’s most rural congressional district with 27 counties spread across two mountain ranges. Long distances and vertical terrain separated lightly populated communities. A central focus of my work was the pursuit of rural opportunity through the use of the latest information technologies. I also came to appreciate that among the most pressing rural needs is the delivery of healthcare. Typically, it’s a very long trip from the most rural communities to the centers of medical specialization.
Rural areas have also been hit harder by the changing economy as people who live in the heartland often earn less and are in poorer health than their citified cousins.
Hospitals located in rural areas have been hit hard, too, closing their doors more frequently and at higher rates than urban facilities in recent years. More than 120 rural hospitals have gone out of business since 2005 (three in the district that I represented), and the trend has been accelerating since 2010.
These small hospitals are the very core of health care availability in rural counties, and among those most affected by hospital closings are elderly patients with chronic health conditions.
Filling the gaps
Telemedicine helps fill the gap. It eliminates distance through the innovative use of information technology. It opens the door to a new era of medical opportunity for people living in rural areas. In years past the only way to get specialized care was a costly and time-consuming trip to a metropolitan hospital, placing the receipt of that care beyond the reach of many rural residents.
Today, community clinics and small hospitals across the nation are being linked by telemedicine to teaching hospitals and other centers of medical specialization. Telemedicine technologies are also taking the experience into the field by mobile means and enabling patients to be connected from their homes or scenes of an accident to the doctors who can render the services they need.
Telemedicine reduces the cost of healthcare. The greater health care availability it affords improves patient outcomes. Studies have consistently shown that the quality of healthcare services delivered via telemedicine are as good those given in traditional in-person consultations.
We know telemedicine boosts people’s health, but it can also boost the economy. While it’s hard to say exactly how much, Market Research Future’s latest report finds that the global telemedicine market is expected to have a value estimated at $56.73 billion by the end of 2023. It’s currently growing by an estimated 17% annually.
The increasing adoption of electronic health records is poised to be a major telemedicine market driver as is its capability to allow physicians to communicate with their patients securely and effectively.
Barriers to telemedicine still exist
To be sure, there are barriers. Patients often are unaware of the services; or they fear for the security of their health records; there are health insurance reimbursement issues; apprehension, especially in older folks, of the technology; and despite the proven efficacy of telemedicine, some still question the quality of care.
And then there are structural, technological issues that need to be dealt with. More than a third of Americans living in rural areas — 23 million people — lack access to broadband, removing those homes from access to at-home telemedicine opportunities. And, of course, broadband is essential for connecting rural clinics with telemedicine links.
Rural areas are characterized by their challenging — often mountainous — terrain and long distances between thinly populated places. The costs of deploying fiber-optics (so-called “middle mile”) broadband services are far greater than they would be to deploy them in urban centers, and when fiber optics reach a community there may not be a lot of subscribers who will pay for the service.
Oftentimes in those rural areas — the Appalachian region, generally in the middle West and in smaller towns nationwide — the annual income is below the national average, and people are struggling. Even if you have 100 percent of the people in an area subscribe to the service, you might still find it challenging to justify the cost of stringing lines across those distances.
Telemedicine can do a lot to treat disease and keep us healthier, but like all technology, it doesn’t sit still. There are constant improvements that are allowing telecommunications companies to push broadband access deeper into rural areas, making high-bandwidth uses like telemedicine easier to get and use.
Older people are beginning to understand how telemedicine can help them monitor chronic diseases and are demonstrating greater acceptance of the technologies. Some 30 states have approved “parity” legislation requiring insurance reimbursement for telemedicine, and more are expected to approve similar laws.
A look into the future
As good as telemedicine technologies are now, they will only improve as we move into a 5G world. Much of the US is now in the fourth generation of wireless service. 4G ushered in wireless streaming video and the basics of interactivity, but 5G promises to supercharge our wireless universe.
Make no bones about it, the suite of technologies comprising 5G make it super-fast. With data rates that are up to 100 times faster than 4G, network latency lowered by a factor of five, mobile data volumes 1,000 times greater than today, and enhanced battery life for remote cellular devices, 5G will enable new capabilities and unlock innovation across the economy.
While all industries will feel the effects of the shift to 5G, it’s expected to have one of the most dramatic effects on healthcare.
With its superfast connectivity, intelligent network management, and the ability to move massive amounts of data, the 5G network opens up new healthcare possibilities that include imaging, diagnostics, data analytics and treatment.
The 4G world made the internet a visual medium. In the 5G world the internet will be tactile. Remote robotic surgery is among the exciting advances that 5G will facilitate. Although it sounds like something from the realm of science fiction, it’s real. With 5G speeds and negligible latency, surgeons can operate from a remote location and even manipulate more than one robot at a time.
As exciting as robotic surgery is, 5G may save more lives by keeping people out of the hospital. In the future 5G connected homes will routinely be as telemedicine equipped as today’s homes are with cable and telephone services. Real-time, continuous remote monitoring of at-home patient conditions will be a common service.
Health care is undergoing its biggest transformation since the introduction of Medicare and Medicaid. The traditional volume-based model with hospitals and doctors getting paid virtually every time patients walk through the door is being replaced with a model that reimburses for outcomes and improved care across the continuum.
Assumed in the transformation is the greater ability to keep patients healthy and out of the hospital. With its ability to handle massive amounts of data flowing from multiple points, 5G will allow healthcare professionals to monitor patients and identify those at risk much sooner and with greater accuracy than ever before.
As exciting as 5G is, telemedicine isn’t waiting for it — just look at what the University of Virginia did in Guinea and Oregon Health and Science University did in The Dalles. Telemedicine is here, and as communications technology improves, its future will only be brighter.