Telemedicine and Its Role in Sleep Medicine

Health Professional, Medical Reviewer
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In the United States, close to $3 trillion is spent on health care every year. In spite of this vast sum, there are serious questions about the actual value of the health care that each of us receives. Too many providers are in large cities with too few in rural, outlying, and lower socioeconomic communities. Even in cities where there _is_an excess of providers, increased competition has resulted in increased costs.

What everyone does agree on is that the way to improve the value and the availability of health care is not by spending more but rather by becoming more efficient in the way we deliver health care. The solution? _Welcome to telemedicine. _

The concept of providing care to individuals in isolated communities via telemedicine is not new. It’s been around for about three decades. But the rapid change in technology has made telemedicine more widespread and available.

One format of telemedicine, "synchronous care," involves the use of video-mounted computers called “Tandberg Units” and robots that are moved around hospitals, examining patients and then transmitting the results in real time to doctors. Another variation, “store and forward,” allows for stored information to be transferred from one site to another site. This can involve images or video and often involves the need for a specialist to weigh in on a diagnosis. Synchronous care is vital to providing remote healthcare services.

What is the difference between telehealth and telemedicine?

Tbe terms telehealth and telemedicine are often used interchangeably, but whereas telehealth is a broad term that includes all heath services using telecommunications, including medical education, health statistics, monitoring, and sharing of medical reports, telemedicine is a term that is restricted to “delivery of clinical services.”

The pros of telemedicine

Telemedicine provides more convenient, accessible care for a number of patients who might otherwise never have access to healthcare. It’s also used around the world to provide services in developing countries, and it allows elderly patients with mobility issues to see their doctors from home. Telemedicine also extends access to consultations from specialists who are not always readily available and opens up possibilities to specialists working on cutting-edge medical solutions around the world.

A lack of opportunity to interact with the care provider is the main reason for non-compliance with treatment. With telemedicine, even if you do see your provider for an initial visit, follow-up care can occur from the home. Thus, you will likely be more compliant with accessible ongoing care.** The cons of telemedicinhis new approach to health care requires significant technical training and equipment. The various software programs needed to support telemedicine also are quite expensive and sophisticated, and a taxing number of guidelines and regulations from the federal government must be followed.In certain cases, telemedicine interactions may actually reduce care continuity**, as it may involve a random doctor who doesn’t know the patient well. That can make it harder to initially diagnose the patient, especially without on-site physical interaction. The patient may also be reluctant to continue care with different doctors, as telemedicine may involve whoever is available for the long-distance interaction.

Telemedicine at its best

The following are specific, specialized services which help to optimize the telemedicine interaction:

_Tele-radiology**:** _ This allows X-rays, CT scans, and other images to be sent to and interpreted by radiologists at a distant site.

_Tele-psychiatry**:** _ This allows an interaction with a psychiatrist from remote distances and typically does not require a physical examination.

_Tele-dermatology: _ This allows a photo of a rash, mole, or other skin lesions to be assessed remotely.

_Tele-pathology**:** _ This allows a view of slides to be sent to a pathology expert for discussion and diagnosis.

_Tele-neurolo: _ In this case hospitals contract with groups of neurologists offsite who can observe EEG monitoring in real time during surgery on the brain, so that a staff neurologist need not be available onsite and on short notice.

Ongoing challenges

Federal regulations for engagement compliance, billing for a telemedicine visit, standard of care, informed consent, privacy issues and compliance with HIPPA (Health Information Privacy Protection Act), and the potential for hacking all pose problems for successful implementation of telemedicine on a regular and global basis.

A doctor’s view on telemedicineMy own personal experience involves telemedicine and sleep issues. Once patients are diagnosed with sleep apnea and are prescribed use of a CPAP machine, follow-up monitoring and care is challenging.** Studies have shown that good follow-up is the best way to assure compliance with treatment**.

A telemedicine interaction between doctor and patient can ensure that CPAP machine settings are correct and well-tolerated. Readings from a data card in the CPAP machine also can be read, assuring nightly compliance. In short, telemedicine can improve compliance and oversight in sleep apnea care.

Telemedicine will likely become a mainstream tool in the future, providing solutions to current delivery-of-care and cost challenges in the health care sector.

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Eli Hendel, M.D. is a board-certified Internist and pulmonary specialist with board certification in Sleep Medicine. He is an Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations. His areas of expertise in private practice include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases.