Friday, September 18, 2009

Telemedicine and healthcare reform

by Peter Yellowlees

It is clear that most stakeholders in the health industry now support President Obama's view that it is essential that we have substantial healthcare reform, and soon. The arguments around the issue are not whether this should happen, but how and when it will occur. An excellent white paper has just been written on how national telemedicine initiatives are essential to that reform. The whole paper, primarily authored by Rashid Bashshur PhD and Gary Shannon PhD, is available for free download at

In brief the paper makes the case that the need for reform stems from long-standing problems in our health system, and demonstrates that the central role of telemedicine derives from an ever-expanding body of research-and experience that attests to its merit in addressing these problems.

The paper notes that "despite the fact that the United States spends more on health care than any other country, both in absolute numbers and on a per capita basis, the health status of Americans ranks relatively low when compared with that of people in other developed nations. Moreover, the general discrepancy between expenditures and health status indicators in the U.S. masks significant differentials among segments of the population, based on socio-economic, geographic, cultural, ethnic and other factors."

The consequence of these factors is that we continue to suffer from inequities in access to health care, inefficiencies in the delivery of care, escalating costs and the prevalence of adverse life styles that exacerbate these problems.

I have just spent been on call over the last weekend working in a major Academic Medical Center Emergency Department managing acutely psychotic patients transferred there as a place of last resort because the only local locked inpatient psychiatric facility was closed to admissions because it was full as a result of major financially driven cuts to local outpatient mental health services. This is the sort of concrete evidence that the American healthcare system is broken, inefficient, disorganized and inequitable.

Why is this relevant? Simply because we must improve our system of care, make it more integrated, and start using electronic healthcare more intelligently and more frequently. Electronic health records represent a means to improving the health care system but are only a partial solution to the problems we face. The practice of telemedicine, where patients are treated by videoconferencing or email in real or asynchronous time, incorporating electronic medical records, is a much better way of working, and allows many of the geographical and cultural inequities we face in health care access to be overcome. The white paper argues effectively and strongly for those involved in planning healthcare reform to take a broad view of the use of health information technology, and to think beyond electronic health records to a time where we will be using telemedicine incorporating electronic health records.

Peter Yellowlees MD is the author of "Your Health in the Information Age - how you and your doctor can use the Internet to work together." The book is available at

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