Viewpoint: Telemedicineʼs Lasting Change for Nursing Home Patients (and EDs)
Abstract
ImageThe use of audiovisual communications to enhance medical care for patients remote from physicians is not new. Radiologists have been reviewing films this way for many years. Even in the 1980s, I had a telemedicine connection to an island in Lake Erie supported by emergency physicians at a Toledo hospital some 60 miles away. In that application, we used a paramedic on site who helped take care of summer vacationers who experienced a medical emergency. The paramedic had been trained in our department to suture, take simple x-rays, and perform EKGs. The electronic connection was via “slow scan” technology. Images were transmitted by plain old telephone service. It took about 90 seconds for them to appear on the screen, and the resolution was imperfect at times. Still, we were able to deliver reasonable service to the ill and injured and to authorize using drugs such as antibiotics. Patients with fractures were usually sent by boat to a mainland hospital just a few miles away. Unfortunately, the system failed because the board of trustees on the island wanted us to dispense medications more liberally, which would have violated Ohio's pharmacy laws. The board also wanted us to transport all patients needing hospital treatment by helicopter rather than boat. I was unable to justify this unnecessary expense for injuries such as a fractured wrist. One of the earlier experiences in telemedicine health care failed for different reasons. Massachusetts General Hospital had a…
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