The Skyping Surgeon

Telemedicine — exchanging medical information between sites over electronic communications equipment to improve a patient’s clinical health status – lets patients access providers without spending time and resources commuting to and from the appointment site.

Methods of telemedicine include voice-over Internet protocol (VoIP) and video (e.g., Skype). Telemedicine, while changing how healthcare providers interact with patients, holds promise for patients worldwide.

Telemedicine has been gaining traction. Last May, the US Department of Agriculture committed $19 million to develop telemedicine and distance learning programs. Their goal was to expand healthcare system access for the 20% of Americans who reside in rural communities.

Studies indicated that patients were equally or more satisfied with telemedicine appointments.

Recently, telemedicine has expanded to surgical settings. A new systematic review, published in Annals of Surgery, assessed the use of video telephony systems in surgery. They found that in general, most studies report highly favorable results within surgical subspecialties.

One distinct advantage was that regional centers could consult with tertiary units, delivering timely specialist assessment and reducing inappropriate transfers.

As with any new technology, there are concerns about telemedicine.

First, there are technological barriers (e.g., access to bandwidth), so infrastructure development is critical. Also, smaller facilities, rural users, and the elderly may be handicapped in terms of access. It's critical for all systems to be secure and hack-proof.

Second, healthcare providers and patients worry about the lack of direct contact. Since many patients would need hands-on contact and examination, surgeons would need to screen appointments carefully.

Third, there are some legal concerns. Some states still require physical contact for a consultation to take place, which affects payment, insurance, and prescribing. While more and more insurance companies are accepting virtual appointments, Medicare does not include electronic contact as a remunerable service.

In the future, it is hoped telemedicine will expand to developing countries. Additional studies are needed to determine if current video-conferencing and telehealth platforms are both effective and acceptable to all stakeholders.