THE FUTUER OF MEDICINE 1

RUNNING HEAD: THE FUTUER OF MEDICINE

Can Telemedicine Shape 21st Century Health Care

Cameron von Kannewurff
Glen Allen High School

THE FUTUERE OF MEDICINE 2

Introduction
With the current rate of 21st century technological expansion and the ever increasing need
for healthcare professionals, it is evident that out heal care system needs to be updated. Previous
advancements such as Electronic Medical Records are simply not cutting edge enough to enact
such a change. Americas health care system is in dire need of a system that can lower costs of
hospital operation, while at the same time allowing those same systems to admit and care for
more patients at a time. Telemedicine has been hyped up to be the end all be all solution to our
healthcare systems problems, such promises have lead me to my essential question. What are the
advantages and disadvantages of incorporating telemedicine into emergent, geriatric, and I.C.U.
settings of health care?
Telemedicine Application in Emergent Settings
While telemedicine is still a relatively new way to facilitate interdisciplinary
communication in the Emergency Department, preliminary tests and pilot programs are yielding
promising results. These programs are increasing the quality of patient care though building up
the amount of communication between Emergency Medical Services (EMS) and hospital staff
prior to arrival. Additionally, the telemedicine programs allow free standing Emergency
Departments to increase their capabilities though collaboration with larger more qualified
facilities. Telemedicine programs have been shown to have the greatest impact in rural settings,
where EMS transport times and the distance to definitive care is much longer.
The ability for patients at a local hospital to be seen by a specialist in a timelier manor is
a major reason hospital systems are pushing for telemedicine integration. When a patient has an
Ischemic Stroke it is critical that they receive treatment for it in quickly. The only known FDA

THE FUTUERE OF MEDICINE 3

approved treatment for this is a tissue plasminogen activator, more commonly referred to as tPA.
TPA is and expensive and dangerous treatment that does not always work, this makes some
doctors hesitant at administering tPA if they are not one hundred percent sure that the patient is
having an Ischemic Stroke. Products such as Advisa that healthcare systems like Henrico Doctors
Hospital in Richmond Virginia is utilizing are help to bridge the gap, The Advisa care systems
allows all of our hospital systems access to neurologists at any hour of the day. This is great
because neurologists are extremely hard to come by these days. (D. Gomersall,, personal
communication, March, 29, 2016). Programs such as the Advisia are being welcomed with open
arms because,
One of the barriers to intravenous tPA treatment is the lack of availability of
neurological expertise on an emergent basis. Emergency physicians are often not
comfortable making the decision to institute tPA treatment without this guidance.
(Schwamm, L. et al., 2009, p 2617).
The ability to save time on the administration of tPA for stroke patients though increasing the
amount of communication between physicians is vital considering tPA only has a 4 hour window
for administration. Seconds truly do count in these types of situations so any way to speed up a
hospitals door to needle time is welcomed with open arms. Current research is showing
Telemedicine can make a positive impact on patient care in Emergent Settings.
Telemedicine Application in Geriatric Settings
Virtual doctors visits are being coming commonplace among most large healthcare
systems today. While some people claim that a doctor cannot create a solid diagnosis through a
video camera, the Arizona Palliative Home Care program is quickly changing these false

THE FUTUERE OF MEDICINE 4

perceptions. Using the Avizia system they are able to thoroughly test telemedicines application
in geriatric care with over three hundred and fifty patients. The system is not completely
electronic, as the physicians first visit with their patient is in person and each session has a
registered nurse in attendance. The nurse helps with the technology, angling cameras while also
helping in the assessment through taking vitals and providing other assistance as they are a fullfledged medical provider. David Lumb the author of Building a better doctors visit through
telemedicine suggests that results with the program are promising as, I can have a nurse us an
examination camera to look at a mole, and the doctor sees a high-definition picture thats frankly
better than theyd see normally (Lumb, David, 2015). The ability for a physician to perform a
more detailed assessment than in person is a phenomenal benefit to telemedicine. These
consultations usually take about an hour to complete; however, the doctor is only present for the
fifteen minutes fallowing the nurses forty five physical exam. This more personal exam provides
a much more cost effective system for the physician as he or she can see other patients during the
nurses exam and truly maximize their time throughout the day. While the idea of doctors using
telemedicine to target geriatrics is great in principle, there is still a lot of un-know variables
regarding it as the idea of using telemedicine for geriatric care has not yet been fully explored.
Telemedicine Application in Intensive Care Settings
Patients who are staying in the Intensive Care Unit of the hospital or I.C.U. often are in
severely critical conditions. These patients often do not receive the exact level of monitoring or
care they need due to the critical conditions of other patients on the floor. When a patient goes
into cardiac arrest the physicians and nurses on that I.C.U. floor have to leave their duties to
attend to resuscitating the other patient. Gaps in care such as these, in I.C.U. settings, can lead to

THE FUTUERE OF MEDICINE 5

providers missing the early signs of deterioration of their patients condition making it
impossible for hospital staff to fix problems until it is too late.
mortality after intravenous tPA recommended by a telestroke-supported stroke unit or by
emergency department consultation appears to be similar to that in previous trials and
clinical practice. A prospective, randomized controlled trial of telemedicine versus
telephone suggests that similar intracerebral hemorrhage rate and functional outcomes
can be achieved in comparable acute stroke populations. (Schwamm, L. et al., 2009, p
2625).
The ability for patients to receive a higher level of care due to the extra support that they get
though telemedicine teams, is drastic to the patients overall outcome. Facilities who are
implementing telemedicine programs are all praising its effect on the care process and the
redundancy it brings to the table. In the Health Affairs Medical Review Study, All ten
respondents from eICU hospitals were enthusiastic about the technologys impact on ICU
performance, particularly on quality and safety. They all emphasized the benefits of redundant
processes in the care of critically ill patients, whose clinical conditions can worsen rapidly.
(Berenson, R. A., Grossman, J. M., & November, E. A., 2009. P 942). With multiple studies
praising telemedicines impact on patient care in I.C.U. settings through remote monitoring, it is
hard to believe that there could ever be a downs side to the implementation.
Unfortunately, the remote monitoring systems which were so highly praised in the studies
above have also received some flak from hospital staff members. Many hospital nurses and
doctors felt the program made them feel incompetent and as if they were not trusted as medical
providers. In a study conducted at the University of Texas Medical School in Huston, the New

THE FUTUERE OF MEDICINE 6

York Times found that patient family members and hospital staff saw that there was a clear
perceived increase in the quality of patient care when telemedicine practices were implemented,
due to the, extra set of eyes on the patient at all times. (Chen M.D, 2010). However, even these
obvious positive impacts did not sway the attending physicians and nurses into loving the
telemedicine program in fact the New York Times found that, the majority of doctors in the
study chose to have as little remote involvement for their patients as possible. Many were
worried about telemedicines effect on their relationships with patients and that it might
adversely affect care. (Chen M.D, 2010). The fear of having other doctors stepping on each
others toes is a very real one. If doctors stop supporting telemedicine programs due to the fact
they would have to share their autonomy with other physicians telemedicine programs could be
very short-lived.
On the contrary, the E-Watch telemedicine program that has been rolled out at Henrico
Doctors Hospital has been met will minimal complaints from hospital staff with some providers
who even, welcomed the program with open arms due to the positive impact physicians and
nurses saw the program would make on patient care. (D. Gomersall,, personal communication,
March, 29, 2016). The drastic difference between the acceptance of telemedicine programs,
between the University of Texas Medical School in Huston and Henrico Doctors Hospital in
Richmond Virginia, suggests that ego plays a large role in whether or not program will be
accepted as the norm. Smaller facilities which dont conduct large scale research projects are not
afraid of trying new ways of increasing the quality of patient care which is what our health care
system needs to strive to do.
Summary

THE FUTUERE OF MEDICINE 7

In conclusion, telemedicine has a promising future in the health care system and as time
goes on and its practices become more widely accepted the growth for telemedicine will be
exponential. Research on telemedicine programs is still limited but the majority of the studies
which have been conducted to date show positive trends for telemedicines future to continue to
grow on. Emergent, Long Term Geriatric, and I.C.U. settings of care seem to have the most
potential for telemedicine due to the varying needs of each system. My Research is leading me
to believe that telemedicine will become the future of our healthcare system and were are on the
cusp of having the next big medical breakthrough.
References
Berenson, R. A., Grossman, J. M., & November, E. A. (2009). Does telemonitoring of patients
the eICUimprove intensive care?. Health Affairs, 28(5), w937-w947.
Chen M.D., Pauline. (2010, 01, 07). Are Doctors Ready for Virtual Visits? The New York
Times.
Retrieved from http://www.nytimes.com/2010/01/07/health/07chen.html?_r=0
D. Gomersall,, Personal Communication, March, 29, 2016
Hertz, B. T. (2013). Telemedicine: patient demand, cost containment drive growth. Joining the
trend may not be as expensive or time-consuming as you think, experts say. Medical
economics, 90(3), 37-39.
Kahn, J. M. (2015). Virtual visitsConfronting the challenges of telemedicine. N Engl J
Med, 372(18), 1684-85.

THE FUTUERE OF MEDICINE 8

Levine, S. R., & Gorman, M. (1999). Telestroke The Application of Telemedicine for
Stroke. Stroke, 30(2), 464-469.
Levine, S. R., & Gorman, M. (1999). Telestroke The Application of Telemedicine for
Stroke. Stroke, 30(2), 464-469.
Lumb, D. (2015, July 23). Building A Better Doctor's Visit Through Telemedicine. Retrieved
April 05, 2016, from http://www.fastcompany.com/3048219/innovation-agents/buildinga-better-doctors-visit-through-telemedicine
Schwamm, L. H., Holloway, R. G., Amarenco, P., Audebert, H. J., Bakas, T., Chumbler, N. R.,
... & Mayberg, M. (2009). A review of the evidence for the use of telemedicine within
stroke systems of care. A scientific statement from the American Heart
Associasstion/American Stroke Association. Stroke,40(7), 2616-2634.
White, Dan. (2013, 04, 24) Telemedicine and EMS: The future is now. EMS 1.
Retrieved from https://www.ems1.com/ems-products/cameras-video/articles/1437503Telemedicine-and-EMS-The-future-is-now/
Whitten, P. S., Mair, F. S., Haycox, A., May, C. R., Williams, T. L., & Hellmich, S. (2002).
Systematic review of cost effectiveness studies of telemedicine
interventions. Bmj, 324(7351), 1434-1437.