March 7, 2015
Telemedicine and Tele-consultation
Telemedicine and Tele-Consultation technology in health care has become increasingly valuable in providing means to overcome challenges for both patients and providers. In particular, the use of telemedicine serves to improve, at minimum, two important benchmarks of patient satisfaction: one being access to care, the second being the provision of quality of care. Tele-consultation serves as a platform to connect primary care providers in various locations with specialists for case consolation pertaining to complex, obscure, or rare medical conditions in which they may have limited experience.
One example of the successful utilization of telemedicine and tele-consultation is demonstrated at the Veterans Health Administration (VHA). The VHA has led the way in telehealth, through the application of video-assisted technology connecting providers to patients and providers to specialists. For example, to address the limitations of access to care to those patients with chronic disease conditions living in rural settings or urban settings who do not have adequate transportation to see their provider on a regular basis, there have been telemedicine programs established at various VHA facilities. The telemedicine program allows a patient to either connect to their provider from their home via secure video technology and connectivity, or the patient presents to their local VHA community based outpatient clinic (CBOC), and is connected to their provider utilizing a videoconference available within that center. The provider is located off-site, remotely, and is able to provide care to the patient directly. The interaction is virtual face-to-face care. The provider has access to the patient’s medical records in real time, and is able to treat the patient as if the patient were physically in the clinic with them. There are numerous technologies available, whereby the provider can obtain vitals and complete particular physical assessments, all done remotely. In this case, a patient who would otherwise not be seen on a regular basis due to travel concerns or need for specialty or focused care, now has access to care. In addition, this also tackles the issue of the provision of quality care. The patient is being seen by a provider specifically trained in the chronic disease condition for which he/she is being treated. Care is not only comprehensive but also competent.
Another aspect of the successful utilization of telehealth technology in the VHA setting is the use of tele-consultation. This program is noted as the VHA SCAN ECHO, which was launched in 2011 and modeled after the University of New Mexico’s Project ECHO (1,2). The VHA has 11 specialty-care SCAN-ECHO teams for common chronic conditions, such as diabetes, heart failure, hepatitis C, and chronic pain management (3). Sites use VHA videoconferencing technology to train primary care providers in remote locations (CBOC’s). In this way, the more specialized expertise of a larger medical center can be expanded to regionally proximate medical centers and remote clinics. This model aims to improve care provided to the Veteran close to the Veteran’s residence by provider’s known to the Veteran, thereby reducing the need for the Veteran to travel to receive direct specialty care. Training is delivered from the hub site to primary care providers over multisite videoconferencing equipment for several months. The format is case-based discussion, with didactics, offering continuing education hours (2). Over time, learners become more experienced in the specialty-care area and are more likely to follow practice guidelines, conduct necessary screenings, and make appropriate referrals (2,3).
The discussion on this paper titled “Narrative Review of telemedicine consultation in medical practice” was chosen due to its significance in providing background and