The idea and practice of “tele-“, meaning at, to, or from a distance, remote, as in telephone and television, have been growing in medical and health care for quite some time.  Each has a significant potential for cost-effective benefit to payors, providers, and patients in health care.  And all can work together for added synergistic and symbiotic benefits beyond what any one can deliver alone.

Tele-Medicine

Delivering medical care from remote places to remote places has been growing apace as medical care has specialized and technology become unaffordable for providers in remote areas.  The essence of tele-medicine involves patients being able to obtain diagnostic, medical, and even surgical care without having to go to where the provider of these services is located.  Audio-visual links, and, in the case of surgery, remote robotic technology enable care to be delivered literally around the world.

Tele-medicine can be a boon to remote and rural providers, in general, for specialist and high-tech services for which there is no nearby provider.  Patients in remote and rural can go to a local provider, aided by a hook-up with major medical centers in urban areas, and be diagnosed and prescribed care by urban even overseas providers without the necessity of time, costs, or delays that would be required to travel to where the necessary providers are located. And local care is usually far less expensive to payors, in lost time of employees, higher cost for insurers, or both.

Telemedicine can also enable providers to achieve 24/7 diagnostic capabilities, by sending digital scanning results to remote radiologists or other specialists in countries in different time zones.  As tele-video capabilities improve, remote diagnosis in “live” hookups, together with authorized prescribing of drugs or other care by remote providers will no doubt increase, adding value to providers and patients alike in rural and other underserved areas.  Tele-medicine can also promote the recruitment of physicians and the survival of hospitals in remote areas, where otherwise patients would have to travel elsewhere for care.

Tele-Monitoring

Tele-monitoring is equally advantageous to providers, payors and patients.  This includes both remote devices that can monitor or detect health problems at a distance, therefor enabling workers to be monitored at work, and patients at home, while providers in their own locations can watch for any problems that call for either patients’ or providers’ interventions.  It also includes self-monitoring by patients, of weight, blood pressure, and similar health indicators that can be reported by phone or online to enable provider monitoring without expensive devices.

Tele-monitoring is equally valuable for providers such as hospitals who can rely on intensivists at their homes or practices to monitor patients in intensive or cardiac care units, for example.  This can save travel time, and enable hospitals to have coverage that otherwise might not be possible to arrange, or affordable to pay for.  Remote intensivists can then convey instructions for needed interventions to hospitalists or emergency physicians on staff and present at the hospital.

Tele-monitoring, using devices or patient self-reporting, is equally valuable in sickness care, disease and lifestyle/health management programs.  Patients can report symptoms or as questions of providers, saving the time and costs of making face visits.  Patients can report, and providers can ask about health behaviors, compliance with medications and lifestyle changes by phone or online, saving travel and added face visit charges, as well as enabling closer monitoring of conditions such as congestive heart failure and diabetes, that need daily monitoring.

Tele-Health

Measuring and managing patients’ health and lifestyle behaviors is a logical, though more recent addition to the remote set of health care options.  Communications from providers to patients, via phone from health coaches or nurse practitioners, can be employed by payors or the health management (HM) providers they contract with.  And communications from patients to providers, reporting barriers encountered to lifestyle change or medications use, side effects of medications, etc. can save the time delays, money and travel burden of face visits.

Remote communications, between patients and their providers, coaches, or peers, can promote personal health and reduce costs to patients literally from the cradle to the grave.  Prenatal coaching and peer support, as well as similar support for baby care and child development can increase the amount that parents learn about their own and children’s health and its management.  Ongoing health promotion, risk reduction, and disease management links, by phone, online or wireless communications, in both directions between providers and patients can help achieve reductions in disease incidence and prevalence, as well as in crises, complications and worsening of existing chronic diseases.

While applying the label “tele-health” to the end of people’s lives may seem an odd juxtaposition, the use of similar remote monitoring and communications can enable death with dignity at home, should patients and family members desire.  This can save the need to make house calls for providers, and the outlier levels of sickness care use and expense that often accompanies heroic and futile efforts to prolong life. [“Growth in Telehealth Market Related to More Home-Based Care” iHealthBeat.org Sep 5, 2007]

The challenge to the healthcare “system” is to encourage and enable payors, providers, and patients to work together in integrating tele-medicine, tele-monitoring and tele-health for mutual as well as common benefit.  As remote communications technologies improve in quality and expand in quantity, the potential for identifying and employing remote communications methods that meet the needs and preferences of all three stakeholders increases accordingly, and the cost-effectiveness, as well as adoption and use rates of such technologies figures to improve as well, to the benefit of all concerned.