Telemedicine/telehealth: a national development tool and economic engine.
Stachura, Max E.
Telemedicine, or more broadly telehealth, is no longer an
experiment. To different degrees, almost all nations are exploring its
place and potential in national systems of healthcare. In addition,
because telecommunication technology is at its core, it can transcend
national boundaries to impact, and be impacted by, globalization. It is
a tool that nations can use within their borders to address their
internal health, societal, and economic issues. It also has the
potential to help shape collaborations to assist resource-challenged
nations with internal issues of population health and the economics of
healthcare. Further, it can facilitate international approaches to
global issues of aging, infectious disease, health care disparities,
public health, and the health-related problems that result from natural
and man-made disasters or from conflicts.
This symposium explores this multidimensional concept of telehealth
and its potentials focusing on a case study of an European country with
a long and successful history of using information technology (IT) in
healthcare; two European countries collaborating for mutual interest;
and, an Eurasian country with a vast territory over which healthcare
issues must be addressed. Together, the contributors provide insight
concerning the questions of telemedicine/telehealth as an economic
engine, and of the barriers between unrealized and achieved potential.
The first article by Bergmo and Johannessen focuses on telemedical
dissemination of expertise and Health Information Technology, exploring
if they "... have met the expectations and fulfilled the potential
for improvement in health ... " and examining the slow ness of
telemedicine's diffusion into mainstream use, but also documenting
areas of stimulated economic activity attributable to telemedicine. The
second article authored by Cholewka reviews the collaboration between
Lithuania's Kaunas Medical University Hospital and Sweden's
Lund University Hospital/Uppsala University in leading a team aimed at
improving Lithuanian pathology, with the potential for program expansion
to other Baltic and post-Soviet countries, as well as for extension into
other disciplines. Khasanshina and Stachura's article highlights
the socio-economical impact of telemedicine in the Russian Federation,
in particular the impact of Sovietera medicine, recent national
decisions to accelerate telecommunication infrastructure deployment, and
the shift in resource requirements that occur when health policy focus
includes chronic disease management.
All authors point out that telehealth diffusion is slowed by
several issues: (a) the capital intensiveness of the industry, (b) the
fact that existing healthcare and healthcare institutions have legacy
organizational systems in place whose change, even if beneficial, would
require substantial investment in training and procedural
re-organization, (c) the confidentiality, privacy, and responsibility
issues that complicate data banking, distribution, and access in
healthcare when compared to other business applications of information
technology, and (d) the current state of published literature which
demonstrates telemedicine-improved healthcare quality, but lacks
substantial documentation of improvements of enhanced quantity and
decreased cost issues.
Unquestionably, more quantitative information is needed to answer
the question posed in one of the articles, that "... telemedicine
for diagnostic and treatment purposes has reached its potential or that
the potential is less than anticipated." The major future impact of
telemedicine may, on the other hand, come from a direction cited in
another of the articles. "Aging of the Earth's population w
ill dramatically increase the number of patients who will require
increased and often continuous monitoring by medical personnel."
Telemedicine technologies should have a large positive impact on the
resource requirements arising from this global development.
How does one ask whether telemedicine/telehealth is diffusing,
being adopted, or exhibiting qualitative and quantitative
cost-effectiveness? The problem is that there is not one single answer
to these broad questions. Rather, the questions must be asked
specifically, about individual applications, with careful testing of
whether defined programmatic goals were met. Telemedicine/telehealth is
a multi-faceted tool with great potential to benefit both the individual
and society as well as both the individual nation and the global society
of nations. As highlighted in the three articles, evaluation must be
quantitative and specific, but must also recognize that
telemedicine's individual, societal, national, or global adoption,
diffusion, and success will be as much a question of value as it is of
cost. Cost can be acceptable if it exceeded by value.
Max E. Stachura, MD
Center for Telehealth
Medical College of Georgia
Augusta, Georgia, USA
