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Nationally known neurologist Theresa Myers, MD is conducting rounds at the Community Hospital in Coffee Creek, Idaho, as she does every two weeks. After pulling up the latest x-rays and lab results on a computer for her patient Barbara Collins, Dr. Myers asks the local
Physician's Assistant to describe Barbara's worsening tremor. Dr. Myers then asks
Barbara to walk across the room, touch her finger to her nose and write her name. After watching Barbara, the doctor and the PA are able to make a firm diagnosis, discuss a plan for treatment, and arrange for a follow up visit. Her patient appointments completed for the
morning, Dr. Myers looks out her office window at downtown Salt Lake City, thinking about
her "visit" to Alaska tomorrow, while Barbara Collins drives back to her ranch in rural Idaho.
Dr. Myers visited Coffee Creek through a video conferencing link, and before the day's end, she will be reviewing charts and providing consults to physicians located in North Dakota and Washington state through the use of electronic mail. These linkages are part of a far reaching
network that provides rural citizens access to the best specialists in the region. And although the meeting between Dr. Myers and Barbara Collins has yet to take place, projects are now underway that would make such meetings a reality.
Each Western Governor knows only too well that people living in rural areas have limited access to basic health care and uncertain prospects for the future. Access is limited by geographic isolation, the relative scarcity of rural physicians, limitations on physician reimbursement, poor public transportation to larger cities, and even vagaries of weather that
impede travel.
Efforts to encourage physicians and other health professionals to establish practices in rural under served areas have been only partly realized. Many western states continue to look for solutions to the problems of access to and quality of health care for rural citizens, particularly when health professionals are not available in rural communities.
Although not a panacea, telemedicine holds great promise to enhance health care delivery in rural areas by allowing a physician or other health professional to examine a patient while linked by video or other means to an expert consultant at a distant medical center. Radiologists and other specialists can review medical images transmitted over telephone lines. And university-based pathologists can review biopsies done in a rural hospital
while the patient is still under anesthesia. Without telemedicine, these services would require travel on the part of either the patient or the consultant, or would simply not be available at all.
Rural health professionals who use telemedicine are also likely to feel less isolated from medical colleagues and resources, thanks to the specialty "backup" and educational
opportunities now available. Continuing education and consultations via telemedicine are expected to improve recruitment and retention of health professionals in rural areas, many of which would otherwise be without any local medical care.
Telemedicine's potential goes beyond improving the health of individuals. Telemedicine has been used effectively to improve public health in rural communities by providing timely
information and training for rural county health departments. Several projects will use telemedicine to assist local citizens' organizations to improve the overall health of their
communities by supporting anti-smoking, accident prevention, prenatal care, and other public information programs. Interest in telemedicine is also growing among private physicians, other health care practitioners, and managed care organizations as a way to provide high quality care in a more cost effective manner.
Today, telemedicine holds more potential than ever to fulfill its promise of improved access to health care for under served rural citizens. Previous high costs and technical limitations on telemedicine technology have been significantly reduced and are no longer a primary barrier The most significant barriers to telemedicine are:
- inadequate information infrastructure and uncoordinated infrastructureplanning;
- regulatory distortions, limitations on competition, and fragmented demand;
- public and private reimbursement policies that do not compensate for telemedicine services;
- physician licensing and credentialing rules that discourage physicians from practicing telemedicine within states and across state lines;
- concerns about malpractice liability associated with telemedicine; and,
- concerns about the confidentiality of patient information.
If it succeeds in improving access and quality, telemedicine is likely to increase health care costs for society. On the other hand, telemedicine is expected to improve health outcomes, reduce patient travel and time off work, and retain more health care dollars in rural communities - all likely to result in savings. Given our limited experience with telemedicine to date, these costs and savings, and their distribution throughout the economy, cannot be
estimated accurately.
Western Governors, united by the need to improve medical services in remote areas common throughout the region, are well-positioned to develop, advocate, and implement strategies that can address telemedicine barriers and foster experimentation. The purpose of
the Telemedicine Action Report is to describe telemedicine barriers and to provide the Governors with steps they can take to help reduce these barriers and to stimulate the development and utilization of telemedicine networks in the West. Close examination
of the telemedicine activity that results will enable us to answer critical policy questions about costs and benefits.
Additional information on the telemedicine barriers discussed in the Action Report is provided in background papers to this document under separate cover.
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