Telehealth (sometimes called telemedicine) is using telecommunications equipment to facilitate health care service from a distance. This rapidly expanding technology holds much promise for access to health care throughout Alabama, especially in our rural areas.
There are three major types of telehealth services: store and forward, bio-monitoring and live interactive encounter with a provider.
An example of store and forward is when an image, such as an x-ray, is completed locally and evaluated by a specialist at a remote location, sometimes as far away as Australia or India.
An example of bio-monitoring is the monitoring of high-risk patients in their homes. Special equipment is used to obtain selected vital signs on high-risk patients in their homes, including many with serious transportation limitations. These vital signs are monitored by practitioners remotely to identify those who may need special attention.
Live interactive encounter with a provider involves the use of equipment with the patient and a care attendant, such as a nurse or social worker, at a local clinic and a care provider at a distant location. The distant care provider can see and talk directly with the patient in real time. There are numerous medical devices including stethoscopes, otoscopes, ultrasounds, examination cameras, etc. that can be used with telehealth equipment. This enables the distant care provider to conduct a thorough examination or provide specialty care not locally available.
The possibilities for telehealth technology to facilitate access to health care are unlimited and constantly expanding with technology. Potential cost savings through early detection and lower transportation costs are encouraging. Applications of telehealth such as telepharmacy, teledentistry, teletherapy, and teleprenatal care are being successfully practiced throughout the country.
The practice of telehealth has been implemented to a much greater extent in Georgia. Telehealth care has been practiced in more than 40 different specialties and sub-specialties in that state. In school-based clinics, telehealth allows visits with physicians for children who may not regularly have physician care. Unnecessary transport of nursing home residents, sometimes by ambulance, is being avoided.
Telehealth technology is being adopted slowly in Alabama for two reasons: lack of universal broadband coverage and lack of reimbursement for the provision of telehealth services. Medicare, the Alabama Medicaid Agency, and Blue Cross and Blue Shield of Alabama only reimburse for some telehealth services. Georgia, Tennessee, and Mississippi have passed legislation requiring that all private health insurers reimburse for telehealth service.
Despite the lack of comprehensive reimbursement, the use of telehealth is expanding in Alabama. Alabama has telehealth programs for many services including primary care, psychiatry, AIDS/HIV, neurology, wound care, anesthesiology, dermatology, nephrology, cardiology, and mental health.
The Alabama Department of Public Health is serving as a leader in increasing awareness of the potential of telehealth by having telehealth clinics in 21 county health departments. By the end of this year there will be more than 40 operational telehealth sites at county health departments.
Telehealth offers an exciting and promising new source of access to health care throughout Alabama. The poor health status of Alabamians should encourage faster acceptance and use of this promising technology to assure access to care for all.
Dale Quinney is executive director of the Alabama Rural Health Association, 1414 Elba Highway, Troy, 36081.
