More than 40 years ago, large urban hospitals extended care to rural areas via an electronic communications system called telemedicine. Think of it as the ultimate reality show on closed-circuit TV, where a patient with, say, a skin disorder can show a doctor her rash and the doctor can call in the perfect medication to the local Walmart pharmacy.
Telemedicine has been rapidly changing the way health care is delivered in the United States, giving doctors the ability to communicate with their patients through text and video messages from thousands of miles away in the event that an in-person consultation is either unnecessary or unattainable.
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Like most of today's mainstream technology (i.e. the internet, robotics, GPS), telemedicine was first widely used by the military. The Department of Defense has utilized the technology for decades in order to provide what officials call cost-effective care to soldiers on and off the battlefield.
Now, as budgets tighten and technology evolves, the military has continued beefing up its telemedicine initiatives, which have expanded into the private health care system as well.
"There is a fair amount that is applicable to domestic uses," said Jonathan Linkous, executive director of the American Telemedicine Association.
In Iraq and Afghanistan, for example, hospitals rigged with high-bandwidth satellite can send doctors in the United States X-rays and high-resolution pictures of soldiers' injuries or conditions in order to perform long-distance consultations and surgeries. Soldiers can even use programs similar to Skype to speak with doctors in real time over secure networks. Officials estimate the average teleconferencing system costs about $200,000 — roughly the same price as transporting a patient back to the United States.
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Doctors in the United States have used telemedicine to provide services to people in rural areas that would otherwise have to travel for a consultation that could be done using a screen. Other providers use telemedicine technology like email or mobile phones to do a tele-consultation to save time and money.
According to a study by the Affiliated Workers Association, more than 36 million Americans have already used telemedicine in some way, and as many as 70 percent of doctor visits can be handled over the phone — which typically cost much less than an in-person visit.
The military has focused on using telemedicine to treat behavioral health issues like post-traumatic stress disorder in soldiers returning home from combat. About 55 percent of the Army's telehealth programs are aimed at behavior health. One initiative also allows soldiers to communicate with counselors over text message in order to track their moods.
"We'd send a secure message, a text that's HIPAA-compliant, which means the message is encrypted and sits on the dedicated server. So if you lost your phone, there's no evidence you're talking to a psychiatrist," Dr. Ronald Poropatich, deputy director of the Telemedicine and Advanced Technology Research Center in the U.S. Army, told Fox News. "(Then), case managers can send patients a text saying, 'Overall how is your mood today?' and I'd trend that over time, and it shows if (their) mood is getting better or worse."
The Army has also developed a series of mobile phone applications including Mcare, an app that sends messages to soldiers reminding them about doctor appointments, health tips, and other general announcements. It also has Text4Baby (T4B) which is a free mobile health information service that provides health information to young military mothers.
"One of the universal findings of studies of teleheath is that patients love it," Dr. Jaime Adler, chief of the Clinical Telehealth Division of the military's National Center for Telehealth and Technology at Joint Base Lewis-McChord, told Stars and Stripes. "They value the convenience and don't feel like it's cold or impersonal."
Lawmakers in Washington have been eyeing telemedicine for some time and have cobbled together several pieces of legislation to ease the transition into telehealth as the technology becomes more prevalent across the country for both military and civilians.
President Obama signed the 2014 National Defense Authorization Act in January, which expanded telemedicine services specifically designed to help military members transition back to civilian life. The law is focused mainly on providing mental health services to those suffering from PTSD.
A separate bill introduced in the House earlier this year would require Medicare to cover telemedicine services regardless of where they are located.
"Technological advances have created new opportunities for enormous advances in health care delivery. However, this progress is stymied by an outdated statutory regime that restricts the use of telemedicine under Medicare," the bill's sponsors wrote in an op-ed published by Roll Call in February. They added that states that already required Medicaid to cover telehealth consultations have created a "pathway to expand telemedicine on the national level."
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