Telemedicine *
Author: Henry Metzger and William E. Halal
Latest Update: Jun 14th, 2011
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Summary

Medicine does not utilize computer systems effectively in many areas, and the emerging field of TeleMedicine is advancing to fill the void.  Computer technology is profoundly affecting health care through online medical records, video conferencing, computerized diagnosis, and robotic surgery. In areas such as imaging, CAT scans and MRI studies are now as routinely available as x-rays. These are complex challenges, facing institutional resistance of physicians and hospital administrators, problems of insurance coverage, etc. But there is a broad consensus that TeleMedicine could substantially improve medical care and reduce escalating costs. TechCast thinks these advances could enter the mainstream about 2015 to save hundreds of billions of dollars and provide better care.

Selected Adoption & Forecast Data
Growing fast to enter mainstream about 2015
 Driven by government financial incentives, the global electronic medical  records (EMR) market is forecast to grow 12% annually to reach over $9 B by 2016. (FierceHealthIT 3/1/2010) 
The North American EMR market will grow to $5.4 billion by 2015, and IDC expects 25% of Americans to use electronic medical records (chiroeco.com 1/26/2011)
For all applications, the field is growing 30%/year, and the CEO of Waterford Telemedicine expects it to cover 15% of all health care by 2015.



EXPERT SURVEY RESULTS
Event Being Forecast:

IT systems are used 30% of the time to diagnose illness, order drugs and tests, monitor patients, maintain records, and other health care.

 
Forecast Data Analysis
    Mean Std Dev N (# Experts)
Most Likely Year 2015 5 72
Market Size (1-10) 4.7 2.1
Confidence (%) 70 14
 
Frequency Distributions
 Most Likely Year Market Size (1-10) Confidence (%)

TREND ANALYSIS
 
PROS: Trends Driving this Event CONS: Obstacles Opposing this Event
ADVANTAGES ARE GREAT
•  Some think telemedicine could save 30% of the roughly $ 2 trillion the U.S. spends on healthcare annually, which is expected to reach 20% of the entire GDP soon.
• The Institute of Medicine’s landmark 2000 report "To Err Is Human" estimated that between 44,000 to 98,000 Americans die each year as a result of medical errors. The causes are complex, but computerized systems for electronic medical records (EMR) are critical to reducing them. (Advances in Patient Safety, Agency for Healthcare Research and Quality)
•  A study conducted by Johns Hopkins School of Medicine found that TeleMedicine improved health care 15-20% and reduced costs. (TechnologyReview 1/28/09)
•  Studies of EMR showed that annual benefits covered 76% of 1st year costs and 308% of following costs, although investments were not recovered in a few cases.(Telemed J. e-Health 16:963, 2010)
• Over 25 states use TeleMedicine to help sick prisoners get advice from doctors, eliminating costly visits to rural prisons, and enlarging the pool of medical providers to compete for  contracts. (TS-Si 12 May 2009)
• EMR provide vast amounts of medical data that can be analyzed to determine whether treatments are effective. For instance, Harvard is using 2.5 million computerized patient records to conduct medical studies. The professor in charge said "We want to use the healthcare system as a living laboratory." (Boston.com)
•  In a randomized trial comparing TeleMedicine with usual care, improvements were seen over 5 years in Medicare beneficiaries with diabetes. (J Am Med Inform Assoc. 16:446, 2009).
•  Business uses IT to improve health care and reduce costs. GM and GE, for instance, only patronize computerized hospitals because they are able to reduce costs by 30-40% while improving service, and Dell provides its employees an online health care system. "Every corporation is considering this," said the CEO of WebMD. (BusinessWeek)
THE TECHNOLOGY IS IMPROVING
•  IT systems are increasingly used for patient records, to make notes, prescribe treatment, order drugs, and enter charges. “IT is ideal for healthcare services,” said a physician, while 80% of patients think electronic medical records are a good idea. (Washington Post)
• 32 U.S. states have interactive video systems allowing physicians to examine patients and take diagnostic data. (carematrix.com; vitaliamages.com) Half of patients say they prefer virtual visits, and the quality of care remains the same. “This will soon be just another way to do healthcare,” said a physician. (healthtek.com)
• Personal sensor systems are being tested around the world to help care for the growing ranks of elderly. Japan’s top telecom is developing a wristwatch-like device using built-in camera, microphone, and accelerometers that measure hand and body movements. It can monitor what wearers are doing - from brushing teeth to vacuuming or making coffee. (Washington Times 2/2311) Also see Body Monitoring.
• MRI and robotic devices allow diagnosis without exploratory surgery. Colonoscopy is being replaced by CT scanners. Small remotely controlled robots are being placed inside the body to perform operations more precisely with less trauma. (nature.com)
IBM and Nuance, a leading maker of voice-recognition software, are putting Watson –the game show-winning computer-- to work in health-care. Watson will digest huge quantities of medical data and deliver useful real-time information to physicians, perhaps in response to voice. The system could help diagnose conditions and create treatment plans. (TechRev 2/23/11) 
• Google “Health” and Microsoft “Health Vault” software allow patients and health providers convenient access to medical information. Both offer links to medication reminders and programs that track blood-pressure and glucose readings. (Tech Rev July/Aug 2008) 
• G.E. built regional data-sharing hubs, or “Health Information Exchanges,” using a $564 million grant from the federal government. (NYT October 29, 2009)
• Smart phone capabilities are used to manage health. More than a quarter million doctors use Epocrates - a network of medical-reference apps on their phones. For consumers, apps provide drug information, hearing and vision assistance, first aid instructions, blood pressure monitoring, diabetes management, stress reduction, and fitness and weight control. (Harvard Health Letter/2010/November)
•  Computer diagnoses can be 99% accurate. The Quick Medical Reference is a Bayesian system that models 600 diseases and 4000 symptoms with 99% accuracy. One scientist said "I'd trust the computer more than the doctor."  A software system called Autonomy analyzes patient records to produce diagnoses. A system for classifying breast tissues proved highly competitive to expert pathologists. (IEEE Trans Biomed Eng. 2011 Feb 4; NY Times 11/16/2010)
• Emotion sensors are improving. The Center for Connected Health at Partners HealthCare System in Boston uses "Cogito" to predict mood by sensing voice over the phone, and "Affective" picks up emotional states by facial recognition or armband sensors. “Emotional sensors add a whole new dimension to the ... health story.” (Mobihealth news 1/19/2011) Also see Body Monitoring.
• Telepsychiatry is a growing trend in mental health, allowing doctors to observe a patient's facial expressions and body language while talking back and forth in real time. A grant from the US National Institute of Mental Health is supporting the first large federally funded clinical trial to determine the effectiveness of this approach in treating mental-health problems in childhood. (Time 3/22/10)
•  The Da Vinci robotic operating system now performs thousands of operations annually. A woman in France had her gall bladder removed by a surgeon in New York City.  In Italy, a surgeon operated from a Milan hospital on a patient in Boston. The world's first heart operation using a remotely controlled robot took place 2010. As of 2007, 795 units were shipped of the Da Vinci system, and about 50,000  prostatectomies were performed in the USA, representing 50% growth in 1 year. (Surg. Endos. 23:438 ,2009).
• The Center for Robotic Surgery at Roswell Park Cancer Institute and the University at Buffalo’s School of Engineering and Applied Sciences have developed a simulator that approximates the touch and feel of the Da Vinci system, allowing realistic training for robot-assisted surgery. (The Engineer 2/26/2010)
• The U.S. military is developing a "trauma pod" using remotely controlled robots to perform battlefield telesurgery. (LA Times)
HOSPITALS ADOPTING IT
• 64% of physicians used smart phones in '09 and 81% should by '12, providing constant access to electronic medical records and data. (Harvard 11/12/09) The number of American doctors using speech software to record accounts of patient treatments has more than tripled in the past three years. Doctors say the software transcribes all kinds of medical terminology letter perfect.(NY times 6/24/2010)
•  Electronic medical records are used by 20-30% of US physicans and by almost all physicians in other modern nations. (Scientific American 5/16/2011)
The Obama Administration's 2009 stimulus plan includes $19 billion for payments to physicians and hospitals to introduce electronic medical records. (TechnologyReview 2/20/09)
A survey found 70% of U.S. hospitals are planning to adopt various forms of telemedicine. Dr. David Brailer called the transformation to telemedicine "inevitable." (Businessweek)
Kaiser Permanente spent $2 billion to move 9 million patients at 362 hospitals to web systems served by 10,000 staff.  The Detroit Medical Center gives 6,000 clinicians online patient records, medical databases, and ordering drugs and tests. Brigham & Women’s Hospital uses 30,000 workstations to integrate health care for 700,000 patients.
• The Lahey Clinic uses robots with cameras to allow specialists and patients to see each other at under-staffed facilities in Massachusetts and Bermuda.  The robots also carry stethoscopes to provide doctors vital  signs. (fiercemobilehealthcare 7/7/2009)
• The US HHS awarded $923 M to states for helping health professionals use IT, $84 M for training 50,000 health IT professionals, and $60 M for resolving barriers (CRM Buyer 08/27/10)
• Sutter Health and UC Davis Health Systems, two of Sacramento’s largest providers, joined forces to allow their doctors to share confidential electronic medical charts.(Sacramento Bee 2/12/2011)
China’s Center for Disease Control has an IT system that allows daily updates from 16,000 hospitals. (BusinessWeek.com)
• The "Mashavu Project: Networked Health Solutions for the Developing World" is a computer system enabling doctors to care for children in developing countries. (Center for Health Market Innovations 7/14/2010)
MEDICAL EDUCATION   Physician training is now IT intensive, including the use of patient simulators. “The computer is the physician’s black bag of the future,” said the dean of a medical school.
SLOW IMPLEMENTATION Only 1.5% of US hospitals have comprehensive electronic medical records, and only 9% have basic electronic records. (N Engl J Med 360:1628, 2009) A survey of 61 ER departments found they have been slow to adopt IT except for lab tests. (J. Emerg. Med. 39:240, 2010) In rural America, only 60% of households have broadband Internet. Overall, 28% of Americans do not use the Internet at all. (NY Times 2/23/11)  “Medicine remains a paper-driven system,” said a professor at Stanford. (Technology Review 9/26/08)
OBSTACLES ABOUND Many hospitals are not interested, insurance usually does not cover telemedicine, physicians tend to resist computers, and patients guard their privacy.  Andy Kessler, a Wall Street analyst, thinks the US medical industry is so focused on profit that they have no interest in improvements. Incompatible data systems often lead to fragmented communication and incomplete records. (J.Healthc Inf. Manag. 24:22, 2010) EMR systems can produce medication errors, interruptions in work flow, and other problems due to limitations in the technology. (Health Aff. 29: 622, 2010) And the complexity of IT systems can discourage use. One physician complained, "A task that once took 3 minutes suddenly devoured half an hour."  A Harvard researcher claims there is no evidence that electronic medical records improve medical care or decrease costs. (Washington Post 3/17/09; TechnologyReview July/August 2009).
WEB COMPANIES EXEMPT FROM PRIVACY LAWS Google and Microsoft are providing online medical records, and because they are web-based, they do not have to comply with the US Health Insurance Portability and Accountability Act. Leading researchers in the field call this a "seismic change. Large companies could form larger patient databases than clinical research centers."  (NY Times 4/17/08)  
PRIVACY CONCERNS  About two thirds of consumers remain concerned about related privacy issues, a figure that has held steady since a 2005 survey. (Tech Rev 04/14/2010) Privacy is such limiting factor that policy-makers, researchers, and IT leaders must make it safe to electronically handle sensitive health information. (Sci. Transl. Med. 3, 69cm4, 2011)
ELDERLY A GROWING CHALLENGE Health care for the elderly is complex, requiring more than just technical solutions. Excessive data could burden already overworked health care professionals, and overly relying on technology could make the elderly miserable by reducing opportunities to interact with real people. “With the most sophisticated technology, if the response is not designed to [work] in a timely and efficient way, it's not useful,” says George Demiris, U of Washington, in Seattle. (Washington Times 2/23/11)
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Public Comments
(Edited and displayed in 1-2 days)
 
juan (10/30/2008 2:25:21 PM)
esta mierda no es asi soy colombiano perro.
Roger Cottam (3/23/2009 10:09:36 PM)
Record keeping and data mining are huge parts of medical care and computerizing them will streamline the system and improve care for everyone. The first live US federal foray into this technology comes with an e-health information exchange launched by the Social Security Administration in 2009. Creating secure and reliable electronic information storage mechanisms for medical information will assist the agency in deciding on 2.6 million claims per year. This efficiency means that effort and money that is currently used for overhead can be applied to better care. http://www.computerworld.com/action/article.do?command=viewArticleBasic&taxonomyName=IT+in+Government&articleId=9130144&taxonomyId=69&pageNumber=1
Patrick Rayburn (4/2/2009 8:11:58 PM)
The introduction of this technology will lower human error and hopefully lower insurance and medical care as whole with it. I say hopefully because introduction of technology will not make people honest. The adoption rate should be accurate, especially with younger professionals making their way up in medicine. Many of the leaders in this industry are from a generation, as a majority, are not comfortable with technology. As the younger generations take over, a higher level of technological awareness should be present in the industry allowing for many new systems to be introduced. I don't know about you, but I would much rather rely on a computer remembering my medical info than an aging Doctor.
Rudy Polo (8/1/2009 11:14:27 AM)
I agree telemedicine technology that is here to stay, but it will be met with various institutional obstacles. Insurance companies are not very receptive to releasing funds for services that may be administered inappropriately or not at all, with the onset of home health monitoring it would be almost impossible to determine if the correct person is getting the medication or treatment prescribed, thus the liability exposure will be huge on both the physician and insurance company. Regardless of how much monitoring and available contact the home monitor coaching system offers, it can not over-ride personal environmental and life style choices the patient will make each day.
Linda MacDonald Glenn (11/12/2009 3:35:18 PM)
Similar to the issue with genetic information, how we safeguard our protected health information will continue to be a concern.
Paul Haase (8/25/2009 8:06:14 AM)
As exploding expenses are dramatically deteriorating public and private healthcare systems alternatives must be found. This will be challenging for health insurers I do agree.l However, Telemedicine can be part of an alternative strategy.
Seth Shulman (11/23/2009 4:23:16 PM)
I think we are almost there. Much of radiology is practised remotely, and the storage of images from MRI, CT, etc. is computerized in most major hospitals (PACS systems). Expert systems are used to analyze images and to analyze many of the cell based assays that were formerly read by a technician looking through a microscope. Probably test results are already transmitted electronically from many labs. Once there is an established digital medical record standard, all information will quickly be generated and stored vailable in digital format.
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