Communications technology is being used increasingly for telemedicine applications to improve access to medical care in rural areas. The most costeffective applications are those that are paid for by insurers, such as the use of telemedicine for radiology, prisoner health care, psychiatry and home health care. Other applications enhance access to care but are not cost-effective because third-party payers do not pay for related costs for professional fees or the implementation of the technology.
Before implementing telemedicine programs, healthcare providers should determine whether they would receive a reasonable return on investment by evaluating all associated costs and estimating the amount of payment they can expect. As the use of telemedicine services increases, it is expected that third-party payers will pay for more of these services to control medical costs.
Telemedicine, one of the communications technologies that will figure significantly in healthcare delivery in the future, also should figure prominently in the strategic plans of healthcare organizations. Telemedicine uses electronic information and communications technologies to provide medical diagnosis and/or patient health care when distance separates the participants. The electronic information and communications technologies include the use of wire, radio, optical, or other electromagnetic channels to transmit or receive signals for voice, data, and video communications via audio equipment, audiographics, computer systems, video systems, and high-grade dedicated lines that allow for voice data and/or video transmission. These technologies allow for tele-imaging using image transmission and receiver units that operate over communication facilities where the transmission unit includes a direct digital imaging device or film digitizer and the receiver has basic image-processing capabilities. However, even the use of a cell phone by a specialist to talk to a patient and/or the patient's care provider constitutes telemedicine.
Before implementing telemedicine technology providers should assess its return-on-investment potential. Telemedicine participants may disagree about the efficacy and efficiencies of a telemedicine application. For example, while physicians or the hospital may find an application costeffective, rural end users may not. Some applications provide efficiencies for access to care but are not cost-effective. Several demonstration programs, however, have shown that using telemedicine technology for radiology prisoner health care, psychiatry and home health care is cost-effective and enhances access for patients and physicians alike.
Radiology. Areas in which access to radiologists is limited will benefit from the use of teleradiology technology because providers in these areas can receive radiologic diagnostic results more quickly and at lower cost by teleradiology than from courier services or awaiting a visit from a radiologist. The quality of transmitted images is clinically equivalent to the quality of hard-copy images. Small hospitals are using teleradiology to provide 24-hour-a-day service at less cost than hiring a radiologist. Of course, teleradiology will never totally replace on-site radiologists, who are needed to perform procedures such as barium studies. Many routine procedures, however, do not require immediate interpretation and can be provided cost-effectively through teleradiology. Teleradiology technology is most cost-effective for rural providers that have high-bandwidth communications, because they are able to access specialists in a distant urban area....
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