Telemedicine: The State of Telepresence In Healthcare (robohub.org) 34
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."
Real issue to Telemed (Score:3)
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
Maine has been doing this since 1976 (Score:5, Insightful)
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 (Score:4, Insightful)
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.
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I don't see you listing any barriers that can't be overtaken. G
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Having seen telemedicine in practice over the past 10 years, I can tell you the clear and defining raison d'etre is a CYA mentality that at least some specialist was involved, and of course money. Lots and lots of money.
Of course any proof that patient outcomes were better is sorely lacking, but hey, who needs scientific rigour when there is money to be had selling a bunch of high-tech equipment to people who can barely afford it, let alone an actual doctor.
I don't see you listing any barriers that can't be overtaken
One of the largest obstacles to automated medicine
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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/... [oxfordjournals.org]
Take a look at the reali
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OK, the cost of medicine today hasn't been driven in very large part by technological advances (unless you consider HMOs and ObamaCare to be technological advances), and technological advances clearly have drastically improved outcomes. Any claim to the contrary is as absurd
Technology is a big driver of medical costs (Score:2)
the cost of medicine today hasn't been driven in very large part by technological advances
Twenty seconds on google would have disabused you of this incorrect notion [technologyreview.com]. Technology advances have played a HUGE role in the rapidly increasing cost of medical care. Don't take it from me, take it from The New England Journal of Medicine [nejm.org].
and technological advances clearly have drastically improved outcomes.
Often yes but not always. It's trivial to find cases where technology improvements have either minimal or no improvements in patient outcomes. Sometimes we use the expensive shiny new tool in ways that don't actually improve medical outcomes. Sometimes the tools are
Telemedicine is for edge cases for now (Score:3, Interesting)
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
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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.
This is probably the only part of your post that I agree with. Telemedicine is more than telepresence robots, but it's working right now for many people who wouldn't otherwise have access to care. I'm sorry that it's not doing more for you right now.
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.
I don't mean to attack you, but what you're saying suggests that you either don't work in healthcare, or have never worked within a successfully implemented telehealth program. Further, it sounds like you're confusing telehealth with m-health and home care.
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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 reco
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The failures that you have described, I have seen in several places. Telehealth equipment purchased with some sort of rural healthcare grant and dumped on a clinic by technical staff, and left to gather dust because it was not implemented properly. In my experience, it's really easy to get this wrong. As you know, tech people are neither providers nor managed care operators.
You are correct that when I use the term "telemedicine", I tend to use it in the broadest possible way. You alluded to this in you
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I think you're right about the discovery phase, basically it's a niche where you have a registered nurse on the remote site that can do blood samples, blood pressure, stethoscope, "say aaaaaah" and all the other really basic examinations but not enough demand to warrant a local doctor. I mean you wouldn't ever treat a patient via telemedicine if the patient was in the next room, it's an inconvenience you do if it's overall easier than getting the patient to the doctor. I think there's far more potential in
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"a combination of Skype and a fax machine."
Why does our medical system still depend on fax machines? Digital recordkeeping is a much more established technology than robotics or telepresence, and yet we still can't get our medical system to use it globally. We're at the islands-of-automation stage now: large hospitals form systems with local doctors and share information electronically among them, yet when you walk into a new specialist's office, you still see that goddamn wall of paper jackets behind the
Fax machines (Score:2)
Why does our medical system still depend on fax machines?
Several reasons. Among them:
1) Legal requirements. Believe it or not it is literally illegal to email certain types of documents. It is legally ok to fax these same documents. No it doesn't make much sense and the law hasn't caught up yet. HIPPA is a factor in this.
2) Fax machines are kind of a lowest common denominator technology and it works even if it isn't efficient. Staff know how to use them and every doctor's office has them, even ones that don't have email.
3) Electronic records systems are rout
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My point is that fax is a stupid legal requirement to paper over (with curly, fuzzy stock) the legal system's failure to adopt the perfectly good, more-secure-than-handrwriting electronic signature standard that we already have available. Staff know how to use fax because they're forbidden by 'policy' from using anything better.
Electronic record systems that are not compatible is the islands-of-automation problem. As medical groups adopt electronic records, it should be to a common standard.
Faxes are obsolete but still required (Score:2)
My point is that fax is a stupid legal requirement...
I doubt anyone would disagree with you about that. Nevertheless it remains a legal requirement and probably will for some time to come. Insane but true.
Electronic record systems that are not compatible is the islands-of-automation problem.
True but that is well understood. It does not appear to be in any danger of being resolved either.
As medical groups adopt electronic records, it should be to a common standard.
The beautiful thing about standards is that there are so many to choose from. There are few common standards for EMR systems. There also are minimal legal requirements for compatibility and few market incentives either. I agree that it SHOULD be to a commo
Nerds, the tech you develope today (Score:1)
I have been thinking on the side, what can I devise to make life later on easier for me. I was giving thought to natural buoyancy chambers. If I become so weak and feeble, would it not make sense to design a water tank in which to live. I got this idea years ago (1975), when sensory deprivation chambers were receiving a lot of attention
I just can't see it. (Score:1)
Robots are seen as cold and detached, humans are seen as warm and empathetic. Which would you rather have caring for you?
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Robots, obviously. Something I can relate to.
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The process certainly hasn't been completed; but there are some good examples to be found in areas of medicine that are(whether anyone is willing to say it in so many words or not) seen as largely futile cost centers: nursing homes seem to provide a lo
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Robots are seen as cold and detached, humans are seen as warm and empathetic. Which would you rather have caring for you?
Humans are supposed to be warm and empathetic, but doctors are seen as cold and detached. Who gives a shit at this point? Stick this probe in your ear, this probe in your mouth, and this one goes up your butt.
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I remember one time I was at a doctor's, and he was training a new doc. The newbie seemed to care, but the old timer acted like he didn't give a damn. This was quite a while ago, so I suspect the younger doctor has learned to be a pompous, uncaring ass by now. :-P
Better Cameras (Score:5, Informative)
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.
. [shrinersho...innati.org] is the system that has been augmented with a better camera. The photo does not show the better camera. [wpengine.com]
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our doctor (Score:2)
My Company is Trying This (Score:1)
My company is rolling out telemedicine this year. Starting in 2016, before we can see a doctor in person, we are required to have a tele-appointment with an approved online doctor, all of which, of course, are in India.
If that doctor approves (and by "approves," I mean "is unable to provide you medical care"), then you can see a real doctor in person.
I'm sure it's going to go over like a lead balloon.