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Show conditions, e.g., exposure to pesticides. In this way, urban providers could learn from rural providers, as well. In addition, telemedicine can assist rural providers in expanding their own scope of practice and, thus, treat more patients locally. Telemedicine consultation sessions can be viewed as a form of continuing medical education. Suppose a rural practitioner consults with an ear, nose, and throat (ENT) physician regarding a specific ear condition via two-way interactive video. As part of that consultation, the ENT physician teaches the rural provider a procedure to deal with the ear condition. After a few such sessions, the rural practitioner may not need to call the ENT specialist. Instead, the rural practitioner can treat that condition using the newly learned procedure on his/her own. Telemedicine can also assist rural patients in minimizing the amount of time spent in urban centers receiving treatments. Urban specialists are finding that a great deal of follow-up care and evaluation can be done via telemedicine (Reid, 1994). This has the advantage of not only minimizing the time rural patients may have to spend in urban centers receiving treatment(s) and/or evaluations, but also encouraging the local provider to become reinvolved in their case at an earlier date. While these are exciting claims, telemedicine can also impact rural providers in less positive ways. For example, rural providers typically see more patients per day than do urban providers. If, for example, a patient comes in with an unusual skin condition, the rural provider can recommend that the patient see a specialist (although a lot of rural providers may be expected by the patient to deal with the problem even if it is beyond their expertise). However, with telemedicine, the rural provider would have the option of spending more time with the patient in a direct consultation with the remote dermatologist. Because this could take more time out of the rural providers' already busy day, it could be perceived as increasing their work load. Not all providers may be willing to make this change. Continuum of options: There is a spectrum of possible technologies that can be applied to this area, ranging in their capabilities and in their installation, maintenance and operation costs. In designing a telemedicine system flexibility, scaleability, responsiveness, reuse/reconfigure capability, and ability to integrate into the local telecommunications systems are all important issues to consider. For the community, choosing, installing, using, and maintaining a telemedicine system, even a fairly simple system, requires the orchestration of components and equipment that must function within the local infrastructure limitations. Planning, patience, and a good grasp of the technical issues are crucial for a successful system. Open vs. locked applications: While locked applications can offer exclusive high performance features, they have the effect of locking the buyer into a system that may not be compatible with the large state-wide picture. This is a particularly critical issue in Utah given that the State Government is proceeding in the development of a state-wide frame relay telecommunications backbone. No rural health care provider or institution has money to waste on a system that only allows communication with a limited number of sites. Thus, it is critical that buyers be informed about systems that are compatible on a state-wide basis. Redundancy/dependability. The importance of this issue varies with the types of health care applications a particular telemedicine system is designed to address. For example, for a simple, non-emergency use of teleradiology, a single inexpensive system is probably sufficient to meet most of the needs. However, if a rural hospital is planning to use two-way interactive video to manage real-time critical procedures, not only must the primary system be of high quality, but a comparable back-up system is required in case the primary system fails during a procedure. Requirements of telemedicine networks: For telemedicine networks (i.e., connections between two or more sites) to be successful they must (1) be reliable, (2) have a common protocol suite (i.e., are electronically compatible), (3) be secure (since medical data is confidential), and (4)be easy to use. KISS (keep it simple stupid) - especially for new users. A lot of fancy bells and whistles tend to scare off potential users. Such features can be intimidating to use and expensive to maintain. To avoid these problems, it is advisable to use the least expensive technology to meet the identified needs and to create a flexible system. It may not be wise to lock into large capitol investments that could be out of date in two or three years. Several states have developed revolving loans or leasing agreements to avoid purchasing equipment outright. Telemedicine networks can be complex to create and operate: a comprehensive information base, good planning and coordination are essential. Must be cost effective: Calculating whether a telemedicine system is cost effective for a community is not a straightforward "the equipment costs this much and the hospital/clinic/ provider will save this Utah's Health: An Annual Review 1994 97 |
