Scanning a story in the Kansas City Star provided a nice change of pace from the Google & gadget fever surrounding CES. The topic, one dear to my heart since the mid-80s, was telemedicine.
The article discussed a number of intriguing telemedicine applications, but it also made clear that, while telemedicine-enabling technologies have come a very long way in the past 20 years, its advocates have not made much progress when it comes to dealing with our nation’s dysfunctional healthcare system (having recently spent nearly a week dealing with a family health emergency, I can personally testify to this dysfunction, the system’s impressively high-tech elements notwithstanding).
Supporters seeking to accelerate the use of these new technologies say they will not only make health care more accessible, but also improve treatments and reduce costs.
[Robert E.] Litan, vice president for research and policy at the Kauffman Foundation and senior fellow in the economic studies program at the Brookings Institute, said that telemedicine benefits “are as substantial as what the federal government is likely to spend on homeland security over the next 25 years.” He said under the right policies, savings “could exceed what the United States currently spends annually for health care for all its citizens.” Health care currently consumes 16 percent of the nation’s gross domestic product…A scholar with the Ewing Marion Kauffman Foundation and the Brookings Institution estimates savings of nearly $1 trillion.
The story underscores the importance of ubiquitous, high-capacity and affordable broadband networks, suggesting to me that telemedicine’s potential impact on our healthcare system should become a significant part of the broadband policy debate.
While independent experts confirm these savings are realistic, they also complain the U.S. telemedicine revolution lags the rest of the world. Most Americans still don’t have access to broadband, smaller hospitals can’t afford the technology and current laws slow the approval process of the technology for medical use or make it hard to use across state lines. In short, they say there is an urgent need for a national policy on telemedicine.
“It’s absolutely essential to get broadband to more citizens,”…said Russell Bodoff, executive director of the Center For Aging Services Technologies, which last month made a presentation at a White House conference.
Current U.S. laws also run counter to the technology. For instance, Americans can’t use Asian equipment that allows diabetics to use cell phones fitted with blood testing kits. The reason? A cell phone is not an approved medical device. Medical licensing laws also don’t allow a specialist in certain states to monitor the health of a patient in another state, shutting off some patients from a specialist. In addition, the technology is so new that most insurers won’t reimburse hospitals for the costs, so most health providers absorb it as a cost of doing business - at least for now.
Mitch Shapiro at 12:53 AM|Comments(1)
Mitch, is your focus more on telemedicine direct to the patient, than other uses in medicine? There's considerable increase in telemedicine for hospital-to-hospital applications. I understand that many, if not most, smaller Australian hospitals do not have in-house radiologists at night, but transmit the images to the US and elsewhere for interpretation.
I think I'd need some convincing that the medical device licensing process, especially with the accelerated FDA approval mechanisms, is bad for something like a glucose test meter and phone. Speaking as both a diabetic and someone with experience engineering lab telemetry, there's enough that can go wrong with just a test meter implementation that I want QA checking. Now, if the manufacturer took an existing test meter less the display and put into the phone, my experience is that you may very well have FDA ask not for full clinical trials, but a 2-3 month validation process.
As for interstate monitoring, that again depends on what is being done. It's most difficult when it's direct to patient -- not insoluble, but with difficuties. I've mentioned teleradiology. There is at least one company that does off-hours physician coverage of ICUs, but it is required there be an advanced practice nurse in the ICU,
Based on real-world experience, I get very nervous about any direct medical monitoring done with a computer that isn't under tight configuration control. We've had bad experience with applications intended for physicians, in both desktops and handhelds, when we run Windows. This isn't a dig at Microsoft, but at the users, especially of handhelds. They almost always start treating the device as a general-purpose computer, and start loading on such things as golf recordkeeping or stock brokerage -- and suddenly the clinical application crashes because we hadn't allocated resources for the other apps. By running LINUX on such devices, we much reduce the "pollution" problem.
Posted by: Howard Berkowitz at January 6, 2006 2:20 PM
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