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Telemedicine Comes Into Its Own

samzenpus posted more than 4 years ago | from the dial-a-doctor dept.

Medicine 50

goG writes "Telemedicine — providing care using advanced communications technology may be coming into its own with a little help from Uncle Sam. The Obama administration recently awarded $795 million in grants and loans for 66 new broadband projects. Most of these projects will involve using videoconferencing equipment to allow doctors to consult on medical procedures or examinations remotely."

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Thank God for Government Grant Moneys (0)

Anonymous Coward | more than 4 years ago | (#32915166)

It's cured cancer, among so many other things. It's because the way to get large Federal grants is by demonstrating that you are the most competent and innovative organization.

Re:Thank God for Government Grant Moneys (1)

Captain Splendid (673276) | more than 4 years ago | (#32918016)

Don't feed the trolls, I know...

But the reverse is also true: If private enterprise was as good as its cheerleaders say it is, then the tobacco companies would have cured lung cancer decades ago.

Straw Man (0)

Anonymous Coward | more than 4 years ago | (#32918316)

There is no logic to your statement and it has nothing to do with OP's claim that the Government does not solve problems and it does award grant money based on political connections.

Incoming incessant sopssa trolling! (-1, Troll)

Anonymous Coward | more than 4 years ago | (#32915188)

Sopssa is a fucking worthless troll. Remember it moderators!

Peace out!

why are my tax dollars paying for this? (1, Insightful)

Anonymous Coward | more than 4 years ago | (#32915192)

Medical practices bring in enough money to do this on their own if/when it is appropriate for their business to have the capability. I did some consulting work for a large medical practice like 9 years ago to give them this capability and they paid for it without having to spend tax dollars.

In a down economy with an enormous budget deficit, this is just completely irresponsible.

Re:why are my tax dollars paying for this? (0)

Anonymous Coward | more than 4 years ago | (#32916416)

if/when it is appropriate for their business

This is when business fails to innovate; when disruptive change is involved. I'm not saying tax money is the best way to do it - but external funding is one of the few ways that disruptive technologies ever see the light of day. It would be best if there were a competitive pressure that caused this to happen naturally, but it's hard to argue that science can't wait for pure capitalism to find a way to found a stable business model on it.

Hold on a minute.... (1)

Rooked_One (591287) | more than 4 years ago | (#32915200)

Government funding technology??? Maybe I was just looping back to a strange, twilight zone-ish 8 years for some reason.

And before you mark this as a troll or flamebait, just remember that during this 8 years I speak of, we stopped funding the UN for AIDS education in Africa because funding for abortion also came from that funding. So anyone want to chime in on how Africa is doing as a whole? Better or worse? I sound like an optician here...

Re:Hold on a minute.... (4, Insightful)

hedwards (940851) | more than 4 years ago | (#32915234)

Um, dude, there wouldn't be an internet were it not for US Federal funding. African health care is a non sequitor, it hasn't got anything to do with the technology funds, nor does it in any way demonstrate that they shouldn't be funding it.

Re:Hold on a minute.... (4, Informative)

Attila Dimedici (1036002) | more than 4 years ago | (#32915452)

You apparently are unaware that the Bush Administration spent a lot more money to fight AIDS in Africa then any President before or since. Oh what a shame, the UN kleptocrats didn't get their cut.

Re:Hold on a minute.... (0)

Anonymous Coward | more than 4 years ago | (#32916232)

Oh okay, we'll take your word for it with no link or backing information of any kind.

Re:Hold on a minute.... (5, Informative)

Anonymous Coward | more than 4 years ago | (#32916576)

Bush Has Quietly Tripled Aid to Africa [washingtonpost.com]

Wasn't a Bush supporter (I hate both D's and R's), but the facts are what they are.

Re:Hold on a minute.... (1)

drsmithy (35869) | more than 4 years ago | (#32923812)

You apparently are unaware that the Bush Administration spent a lot more money to fight AIDS in Africa then any President before or since.

Of course, most of that funding went into abstinence-only programs, which are at best useless and at worst directly harmful.

Outsourcing just came to medicine. (5, Funny)

maillemaker (924053) | more than 4 years ago | (#32915244)

Coming soon: Your insurance company will pay the maximum benefit if and only if you use their preferred tele-presence doctors from India.

Re:Outsourcing just came to medicine. (3, Funny)

schmidt349 (690948) | more than 4 years ago | (#32915292)

The kneebone's connected to the... something. The something's connected to the... red thing. The red thing's connected to my wristwatch...

HI doctor nick! (1)

Joe The Dragon (967727) | more than 4 years ago | (#32915606)

HI doctor nick!

Re:Outsourcing just came to medicine. (1)

Kepesk (1093871) | more than 4 years ago | (#32915656)

I can see it now... my next surgery will be from a robot controlled by a man overseas with an almost unintelligibly thick accent named "Mark Johnson".

Re:Outsourcing just came to medicine. (1)

operagost (62405) | more than 4 years ago | (#32919614)

Don't worry: insurance companies will all have been taken over by the government as "too big to fail" and we'll be under the single-payer system by then. Oh, we'll still have the Indian doctors, but the health care will be "free" so it'll be SO MUCH BETTER.

Outsourcing? (2, Insightful)

ascari (1400977) | more than 4 years ago | (#32915254)

OK, great but this initiative lays the groundwork to outsource certain medical specialities like radiology and pathology to lower cost countries. Why is this a good way to spend tax money?

Re:Outsourcing? (1)

pedropolis (928836) | more than 4 years ago | (#32915712)

Not sure where I see the logical leap you're to outsourcing our radiology or pathology to foreign countries. The article mentions that this is an emerging marketspace in many countries, but doesn't indicate any multi-national linkage of these telemedicine facilities.

Re:Outsourcing? (1)

guruevi (827432) | more than 4 years ago | (#32915714)

First of all, outsourcing to other countries is difficult to do for some/most cultures as you have import/export restrictions and delays that could be unacceptable. Besides, a bit of competition is always healthy. Do you really think it costs $1000 to test your stool sample? I work in research but our organization also does translational medicine and also contains a hospital. Sure the machines cost $3m but we charge researchers only $125 for a procedure while private companies pay a flat rate of $700 but insurers are charged $1000 or more for the same procedures.

Re:Outsourcing? (0)

Anonymous Coward | more than 4 years ago | (#32916066)

I'm guessing that's why GP suggested radiology and pathology? (Those are things that are easy to digitize and send down the wire so you won't have to send physical samples.) My guess would be that the biggest barrier wouldn't be import/export restrictions but laws regulating medical practice in different countries. Also, medical liability issues. IANAL but if say a US company employs radiologists in Bangladesh it could possibly be bypassed through some loophole?

Re:Outsourcing? (1)

queequeg1 (180099) | more than 4 years ago | (#32917500)

That would be very difficult (if not impossible) given most state laws. However, it does vary. If a doc is going to remotely treat or diagnose a patient in Oregon (except perhaps for so-called "curbside" consults), the doc must be licensed in Oregon. This is the general rule in most (if not all) US states, although some states have oddball statutes that might provide some limited about of leeway. For example, Washington has a statute that gives the appearance of allowing remote diagnoses without a Washington license so long as the doc doesn't have a physical location anywhere in Washington. This appears to open the door wide open but I think this is an unintended consequence of a law that was intended to address a different issue and if widespread unlicensed remote consults without Washington licenses were to occur, this problem would be remedied very quickly. To the best of my knowledge (which is pretty good with respect to Washington health law), no WA providers have ever suggested reliance on this statute for any remote diagnostic service agreements with docs not license in WA because they all know they would get in big trouble.

Additionally, you have CMS and the Joint Commission to deal with. These accrediting bodies (among others) generally require that hospitals credential such providers before allowing them to remotely diagnose and treat patients. The credentially and licensing process for certain types of remote providers can be streamlined compared to the normal process but is definitely still there.

Ultimately, off-shore telemedicine might routinely happen someday. But not before a lot of statutes and bureaucratic rules have been changed.

Re:Outsourcing? (2, Interesting)

maxume (22995) | more than 4 years ago | (#32915964)

Why is it good? Because each dollar of medical spending can then consume a greater amount of medical care.

There are lots of distortions where individuals don't get a full range of choices, but unless you keep a rather large garden and like to saw your own lumber, you actually love trade.

Re:Outsourcing? (1)

ascari (1400977) | more than 4 years ago | (#32916122)

Or maybe just increased margins for health insurance companies! ;-)

Re:Outsourcing? (1)

phantomlord (38815) | more than 4 years ago | (#32917126)

My mom works in the radiology department of a small hospital in the middle of nowhere that transfers pretty much anyone that needs more than a bandaid (ie, it's not a big, fancy hospital with loads of special services). All of their various radiological machines are hooked up to the department's LAN and outside M-F,9-5 the images are sent to one of the radiologists to read and report on. The chief radiologist has an office at home and then there's a service they hire out when he's on vacation or not available. The tech has been available for years, you just need a large enough pipe to deliver the data in a reasonable amount of time.

To give you an idea of the size we're talking about, the iso of my dad's brain MRI and MRA weighs in at 282 MB. And yes, if you want a copy of your scans for yourself, generally all you have to do is ask them to burn you a CD.

Re:Outsourcing? (0)

Anonymous Coward | more than 4 years ago | (#32920150)

Firstly, the converse would then also be true; Indians would be able to outsource some specialization to American doctors, whom we can hope are more skilled and can therefore charge a premium.

Secondly, if cheaper healthcare can be source from India, you end up with more Americans who can afford to live long, more productive lives.

That's win. And win.

Already happening (0)

Anonymous Coward | more than 4 years ago | (#32924828)

Outsourcing Radiology overseas is already happening:

http://www.msnbc.msn.com/id/6621014/

Already being used (4, Informative)

Yold (473518) | more than 4 years ago | (#32915464)

I was a research assistance for a study conducted in 2007, which surveyed the usage of Telemedicine in Minnesota. http://www.mti.umn.edu/mti.html [umn.edu] , (be kind, it was my first web application ever, and it has since been broken by the people maintaining it).

The primary usage, IIRC, was for psychiatric health. In particular, mental health facilities in northern Minnesota seemed to favor this approach; it is much cheaper to employ councilors and "out-source" a MD rather than have a full-time psychiatrist on staff.

Telemedicine may be more cost-effective, but IMHO it will probably be abused and doctors (like radiologists), whom are already very busy, will be pushed even harder. Computer-Aided-Diagonsis tools, like those in existence for detecting microcalcifications in breast tissue, will become essential. Over-worked doctors miss things, and sometimes a computerized second opinion can improve the quality of diagnoses while holding down costs.

DISCLAIMER: I am not in the medical industry, but I did some research as an undergrad on the things mentioned above.

Re:Already being used (1)

ColdWetDog (752185) | more than 4 years ago | (#32916118)

The primary usage, IIRC, was for psychiatric health. In particular, mental health facilities in northern Minnesota seemed to favor this approach; it is much cheaper to employ councilors and "out-source" a MD rather than have a full-time psychiatrist on staff.

This appears to be the 'state of the art' as far as telemedicine goes. Essentially a videophone with some measure of security. w00t. It's hard to get excited about this from a technology standpoint. It's been used for years in a few areas and works OK. TFA seems to conflate getting some grant money as 'coming into it's own' which makes little sense. Seems like this is mostly a financial boon to a couple of companies that set these systems up.

Part of the problem is the definition of telemedicine - is it a video screen to video screen consultation? Reading of xrays? Faxing EKGs? Pretty mundane stuff from a technology standpoint. The bigger issues are billing and licensing but these are slowly getting worked out. Mostly it's turning into another government boondoggle for a few contractors that will allow insurers to 'minimize costs' by offshoring what has traditionally been a cottage industry. And it will have the same problems that offshoring everything else had and likely the same experience - a few examples where it works, a lot of examples where cost containment trumps quality.

And beware those hidden costs. Even though it's COTS technology, that stuff can cost a bunch. When our small hospital went from film to digital we spent close to $250,000 in upgrading everything. The network, the Internet connections, the PCS, software, techs, support contracts. Virtually all of it was picked up by (US government) grants but the ongoing costs are pretty significant and we have to pony up with the money for that. When all is said and done, it isn't clear at all whether or not it would have been cheaper to hire a pair of radiologists as opposed to stuffing the department full of expensive gear. But that's progress, I suppose.

Pardon the rant, I'll just go out and stand on my lawn for a bit.

Call center doctors (5, Informative)

Animats (122034) | more than 4 years ago | (#32915838)

Someone suggested that insurance companies might direct their customers to call center doctors in third-world countries. That's already happening. This is the real world of "telemedicine". This is a real ad:

Doctors needed for a Call Center Jobs in Pakistan [jobpaperpk.com]

MBBS [wikipedia.org] Doctors needed to work in our Call Center

  • Should be flexible to work in Night Shifts & be able to communicate with foreign patients (Excellent Spoken English Skills required)
  • Lucrative Salary package
  • Final Year MBBS students can also apply

Contact: Mr. Aftab Ibrahim (aftab@catcos.com)
Mr. Wasif Balouch Ashrafi (wasif@catcos.com)
Or Call on 021-34549291 - 021-34529748

Irony check? (5, Insightful)

ErikTheRed (162431) | more than 4 years ago | (#32915958)

Am I the only one who grasped the dissonance between the words "comes into its own" and "$795 million in grants." Have we really stooped to the point where people have mentally redefined success and functionality as the ability to successfully lobby the government for cash?

You keep using those words. I do not think they mean what you think they mean.

Re:Irony check? (0)

Anonymous Coward | more than 4 years ago | (#32916862)

Why do you hate America?

Re:Irony check? (1)

Entropius (188861) | more than 4 years ago | (#32917736)

That's what the military contracting industry has been doing for years...

Re:Irony check? (0)

Anonymous Coward | more than 4 years ago | (#32919322)

which has clearly saved us so much money...

Re:Irony check? (0)

Anonymous Coward | more than 4 years ago | (#32919384)

Have we really stooped to the point where people have mentally redefined success and functionality as the ability to successfully lobby the government for cash?

(snark) Yeah, DARPA did this with networking back in the 20th century and look how badly THAT turned out. Come to think of it, didn't Oracle start off of a fed-grant funded project? (/snark)

But seriously, in rural areas telemedicine would be awesome. Handing a working system to a regional medical center and deploying compatible feeder/satellite systems to a clinic every hour or two towards the wilderness is going to be wickedly cost-effective. The stable, working, best-of-several-breeds answer has (like you said) not yet come into it's own. But it will leap ahead thanks to 700M in grants.

Stuff like this is why I approve of taxes and the cool shit they fund.

Telemedicine can have significant cost savings (3, Informative)

Anonymous Coward | more than 4 years ago | (#32916166)

I've been a developer on a Telemedicine project for the last 4.5 years. One thing that really surprised me was just how much money can be saved by using telemed.

Ear tubes are a great example, where I live there is a high incidence of ear tubes in young children. The surgery to install the ear tubes are only a part of the overall total cost. One of the biggest costs if follow up care. So the patient and a guardian travels a great distance to the hospital for a 15 minute appointment to have the doc say that everything is OK. Total direct cost for that is upwards of $3000 (airfare, hotel, per diem), that doesn't count lost wages for the guardian.

Using telemed, the patient goes into the local clinic, they snap a few pics of the tympanic membrane using a video otoscope and the health aide sends that information to the doctor for review. Total cost to the patient, about 15-30 minutes.

I've posted this anonymously for a couple of reasons, the biggest being I don't want readers to think I'm stumping or trying to spam my employer.

Re:Telemedicine can have significant cost savings (0, Offtopic)

0100010001010011 (652467) | more than 4 years ago | (#32917364)

You're saying ears are like a series of tubes?
So your children have the internet in their heads?

And the result is... (0)

Anonymous Coward | more than 4 years ago | (#32916168)

Now they will be able to ration and deny care at a much faster pace, while keeping the patient at home since we won't have any oil to power our cars. Great plan.

Re:And the result is... (2, Informative)

timonak (800869) | more than 4 years ago | (#32916372)

Actually, thats not true. I have experience with telemed having worked on a telemed project for the last 4.5 years. Telemed actually decreases response time and improves costs. One group that I'm familiar with, makes it a requirement for their doctors to check the telemed case queue when they have down time. This particular clinic when from having a waiting list 4 months long to get an appointment, to now its typically less than 1 week. And telemed is responsible for this because the doctors can take and review cases when they have a few moments free, instead of the patients having to travel in to the clinic and occupy an exam room.

Joking aside this works really well (1)

mctee155 (862932) | more than 4 years ago | (#32916478)

I work for a small mental health company in Utah that serves 3 counties. When we setup our telemedicine system we significantly reduced our costs. We no longer have to pay as much for travel and hotels for our doctors, they just see clients over telemed no matter which county they are in. Their workload hasn't increased much but now they spend less time traveling and more time with clients. Our clients aren't weirded out by fact they are talking to a tv and camera because the cameras are very high quality and that allows both sides to pick up on facial queues which goes along way for trust and understanding. Most clients say they are extremely happy that they can see their doctor and get the help they need.

The system was paid for, and is maintained, communication lines and all, with federal grants. I am amazed at how much we save just on the T1 lines alone which comes close to 100K a year.

This is something that the government got right, finally.

Re:Joking aside this works really well (0)

Anonymous Coward | more than 4 years ago | (#32917128)

>When we setup our telemedicine system we significantly reduced our costs.

If it significantly reduces costs, why do you have to take the money from taxpayers to implement it? Won't the firms that recognize and best utilize it reap the benefits without taking from taxpayers? Won't their golf buddies hear about it and try it in their offices too?

I've personally, in the last 10 years, seen the state of Florida spend millions on telemedicine (buying equipment, setting up nodes, maintaining lines, etc.), but it was for the child abuse investigators/docs to get specialist consultations more readily. Identifying child abuse isn't really a profit industry, and if the investigator in Gulf Breeze can consult with a doc in Jacksonville without anyone having to travel it is helpful.

Re:Joking aside this works really well (0)

Anonymous Coward | more than 4 years ago | (#32919254)

With all respect, that's because you do mental health.

It takes a skilled second party to do a proper physical exam, take labs and biopsy specimens and perform basic procedures.

Let's not ask patients to do a Romberg test on their own, unless we're aiming for a thriving market in repeat head CTs... :)

Good thing to do when employment is low. (1)

poofmeisterp (650750) | more than 4 years ago | (#32916740)

I'm sure that's exactly what the new broadband network is for. You know, 'cuz that makes so much sense. WTFoftheWTFs?!?!?!???!!!1

How about using Skype? (2, Insightful)

flyingfsck (986395) | more than 4 years ago | (#32917254)

I have worked in multiple places with one thing in common: Gawdawful ridiculously expensive video conference systems. We are a bunch of engineers and we cannot get the fscking things to work, so how would a bunch of doctors manage with it?

In contrast, the cheap/free Skype works without any issues.

Re:How about using Skype? (1)

Entropius (188861) | more than 4 years ago | (#32917776)

I was wondering about that, too. International scientific collaborations use it without problems (although CERN recently cooked up an in-house system that apparently doesn't work as well).

Re:How about using Skype? (0)

Anonymous Coward | more than 4 years ago | (#32927456)

Skype doesn't provide anywhere near diagnostic grade images....

Here in Ontario Canada we have Ontario Telemedicine Network in pretty much every hospital or clinic.
Their systems include medical grade camera's and other equipment such as networked Stethoscope's and Otoscope's that stream the Audio/Video over the network to the doctor.

Don't think Skype has those features yet

Is this new? (1)

slick7 (1703596) | more than 4 years ago | (#32923338)

Back in the 90's, I talked to the people who were setting this system up between Russia and the US. It was a NASA project using the TDRS satellites. The guys that I talked to had RED passports (diplomatic immunity?).

We've had this in Canada for years (0)

Anonymous Coward | more than 4 years ago | (#32927280)

"The Ontario Telemedicine Network (OTN) is one of the largest telemedicine networks in the world. Using two-way videoconferencing, OTN provides access to care for patients in every hospital and hundreds of other health care locations across the province. In addition to clinical care, we facilitate the delivery of distance education and meetings for health care professionals and patients."

http://www.otn.ca/

Telemedicine is common in canada (1)

mhawkins090883 (1857750) | more than 4 years ago | (#32927558)

The Ontario Telemedicine Network (OTN) is one of the largest telemedicine networks in the world. Using two-way videoconferencing, OTN provides access to care for patients in every hospital and hundreds of other health care locations across the province. In addition to clinical care, we facilitate the delivery of distance education and meetings for health care professionals and patients. http://www.otn.ca/ [www.otn.ca]
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