An Insider's Look at the Health Distance Learning Community

Distance Learning in the health sector is of particular interest to me, both professionally and personally.

Having worked in healthcare for 30+ years, it does not surprise me to read that experts have long thought that healthcare is something like 10-15 years behind other industries in computing. (HRSA, 1998). But the recent surge in support for a new focus on health information technology is exciting on multiple levels . The new Obama Administration has included healthcare technology as one of its major platforms, giving hope to many in the health field that access can be improved and expenses reduced .

Telemedicine, which is the use of electronic devices to deliver healthcare to patients that are geographically separated from physicians and other health professionals, is an exciting aspect of telehealth. More and more physicians are communicating with patients via email to discuss test results and answer questions, leading to better patient compliance with treatment recommendations. (Mandl, Kohane & Brandt, 1998). Some physicians in my community even offer online consultations, where several specialists (from both our community as well as other geographies) consult with patients and families about complex cases.

There are also exciting developments in PACs, picture archiving and communications systems, that allow digital images to be stored and shared among care providers. I was impressed with the use of PACs and teleradiology this past summer, when I fractured several bones while on vacation a few hours from home. The closest medical center in this rural area did not have an orthopedic service, but was able to digitally transmit my xrays to an orthopedic surgeon at my home hospital for consultation. The orthopedic specialist was able to advise the rural emergency department on interim stabilization, and saved both cost and aggravation by avoiding an overnight hospital stay. PACs allow patients to have access to highly trained medical specialists independent of geography, which is especially important for rural areas without a robust medical community.

Another exciting advance in telemedicine is the use of robotic-assisted surgery, with the DaVinci Robot. This technology is applauded as being safer and more precise than traditional scalpel surgery. Today the robot is controlled by a surgeon in the same room, but surely it’s not too far down the line to expect that a highly trained specialist might control the surgery from another location across town, in another state or even another country.

There are also great advancements in interventional procedures that allow imaging without surgery. The virtual colonoscopy, where the patient actually swallows a tiny camera device, is attractive to many patients who are nervous about the more invasive traditional procedure that is uncomfortable and embarrassing. Digitzed stethoscopes are being used to transmit heart and lung sounds to specialists at remote locations. (White, Krousel-Wood & Mather, 2001).

The early field of Telemedicine has expanded to the broader general field of “Telehealth”, defined as “the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration.” (Kumekawa, 2000).

In addition to telemedicine techniques, distance learning is used for professional education with realtime teleconferences and virtual classrooms using satellite downlinks to recreate a traditional classroom environment. The savings in travel expense and time make it possible for physicians, nurses and other health professionals to maintain their credentials and stay up to date on new techniques. This is especially valuable for rural practitioners on a domestic and global level.

The evolution of the Internet also expands access to self-study courses and other asynchronous education options focused on health topics, just as in other fields of study. A quick Google search for “Online Healthcare Master’s Degrees” produced a listing of 52 online programs where I could have gotten my Master’s Degree without being limited to prescribed classroom meetings for 4 hours a week over several years. (eLearners, 2009). I am now hoping that these programs will offer new employment opportunities for me to teach online courses in these programs, aided by my new training and anticipated Distance Education Certificate from University of West Georgia after June 2009!

Patient Education is another area where Telehealth is has the potential to change lives. According to the Pew Internet and American Life Project, some eight million people do online searches for health information in the U.S. every day. (Lohr, 2007). While patients have an almost unlimited appetite for health information, there are drawbacks to the abundance of online health offerings. Many of the physicians I work with say almost every patient visit now includes the dreaded comment about something “I saw on the Internet …”

The physicians say it wastes valuable visit time to explain that the information may not be credible, and they would rather have patients using specific sites in which the doctor has more confidence. Some of my physician colleagues prepare a list of recommended websites that they give to patients – others have pre-printed handouts with patient follow-up information on various diagnoses, reprinted from websites. A few of the physicians in my community include patient-friendly medical information sites on their practice website, and the hospital where I work includes a patient-oriented medical search engine on its own website. (DH, 2009).

While telehealth and technology solutions hold great promise in the health industry, it is not without major challenges. Upfront expense is the obvious major barrier – the short term expense to acquire equipment and train the users can be overwhelming to the smaller medical communities where telemedicine is most needed.

There are also major issues around developing standards and regulations to ensure that systems have interoperability. Developing a common vocabulary is a huge task – one nephrologist told me that while the average primary care physician might order two or three basic kidney function tests and use a couple of diagnosis codes, the nephrology community has hundreds of tests and codes to pinpoint a patient’s exact condition. An electronic medical record database that doesn’t recognize the full scope of coding might indicate an incorrect diagnosis.

Privacy issues are also huge barriers to widespread adoption of electronic medical records. Various congressional actions dating back to the mid 1990’s (such as HIPPA) seek to ensure privacy and portability of protected health information, but the debates continue over how to protect sensitive information. Many consumer groups (including AARP and the American Civil Liberties Union) are reluctant to embrace personal health records because of privacy concerns. (ACLU, 2008).

On a personal level, the various aspects of telehealth give me great hope that patients will benefit from technology advances to improve the patient experience. I have observed the healthcare system from the inside out for many years, and I see how frustrating our systems are to patients and families who are often frightened and almost always frustrated by a lack of communication and limited access to care. As a patient myself, and a family caregiver for others, the medical system is at once wonderous and baffling.

Access to patient information and other tools are key steps in motivating patients to be more accountable for their own health, and evolving social networking sites could go a long way to encourage folks to eat better, exercise more and reduce risky behaviors. Even nursing homes and senior communities are getting in on the Wii Fitness movement. In Pennsylvania, Allegheny County and state grants of $400,000 supported a new senior center equipped with Wii Fitness and other machines that are senior-friendly to encourage exercise. (Cristiano, 2009).

I believe the advances in telehealth and telemedicine will improve the quality and consistency of both care and communications. I am hopeful that the new Obama Administration will make good on its promises to facilitate better funding for health technology initiatives.

An excellent resource for more information on telehealth and telemedicine is the Telemedicine Information Exchange (http://tie.telemed.org).

Also see The Association of Telehealth Service Providers at www.atsp.org.



References
ACLU (2008). “Medical Privacy and Electronic Records”, American Civil Liberties Union, July 22, 2008. http://www.aclu.org/privacy/medical/36069res20080722.html

Cristiano, M. (2009) “Technology Enhances Senior Center’s New Fitness Area,” Monroeville Times Express, January 15, 2009.
http://www.yourmonroeville.com/timesexpress/article/technology-enhances-senior-centers-new-fitness-area

DH (2009). Doylestown Hospital website. http://doylestown.photobooks.com/?oTopID=323

eLearners (2009). Healthcare Masters Degree Programs Online. http://www.elearners.com/online-degrees/master/health-administration.htm

HRSA (1998). “HRSA Focuses Agency Resources on Telehealth.” Health Resources and Services Administration Press Office, Rockville MD. May 22, 1998.

Kumekawa, J. (2000). “Telehelath and the Internet.” Office for the Advancement of Telehealth, Health Resources and Service Administration, Health Resources and Services Administration. http://telehealth.hrsa.gov/pubs/inter.htm

Lohr, S. (2007) “Microsoft to Buy Health Information Search Engine,” The New York Times, February 27, 2007. http://www.nytimes.com/2007/02/27/technology/27soft.html

Mandl, K., Kohane, I. and Brandt, A. (1998) “Electronic patient- physician communication: Problems and promise”. Annals of Internal Medicine. 1998. 129:495–500. http://www.ochsnerjournal.org/perlserv/?request=get-document&doi=10.1043%2F1524-5012(2001)003%5B0022%3ATMHDLA%5D2.0.CO%3B2&ct=1

White, L., Krousel-Wood, M. and Mather, F. (2001). “Technology Meets Healthcare: Distance Learning and Telehealth,” The Ochsner Journal. Vol. 3, Issue 1, Winter 2001. http://www.ochsnerjournal.org/perlserv/?request=get-document&doi=10.1043%2F1524-5012(2001)003%5B0022%3ATMHDLA%5D2.0.CO%3B2&ct=1