Role of telemedicine in the health care delivery system.

The concept of caring for patients remotely using telemedicine applications has intrigued computersavvy physicians for years. Although telemedicine implementation remains in its infancy, interest appears to be growing, perhaps fueled by the Internet bubble that led investors into new heights, only to come crashing to the ground within the last year as financial expectations were not met. Though medicine is somewhat sheltered from business and financial trends, the concept of widespread telemedicine use by means of Internet portals was obviously affected. Despite skepticism of widespread applications that involve the delivery of medical care using computer-based technology, the rural base of the telemedicine movement appears to remain afloat. In this issue of the JABFP, Norris and colleagues provide further evidence that telemedicine consultation is well accepted and generally receives high marks for patient and physician satisfaction. The study by Norris et al shows high levels of both patient and physician satisfaction in rural settings when consulting with a specialist located in an urban, academic medical center. Another recent study on the introduction of telemedicine in rural communities confirms this satisfaction. Campbell and colleagues found a greater acceptance of telemedicine by those practices already affiliated with a university academic medical center than by traditional private practices. In both studies there were few participants, a common flaw noted in many telemedicine studies. In addition, the costs to the patient and physician were not included and could have a major effect on the patient’s level of satisfaction. I would comment that low-bandwidth links with switched 56 (112 kB/s) lines or especially ISDN (128 kB/s) lines (compared with plain ordinary telephone system, or POTS) are not widely available, and acquiring them would require substantial planning and bandwidth availability. In our areas ISDN (integrated service digital network) is available only in certain locations and is rather expensive (about $100 per month). Our own experience at the Mayo Clinic leads to the following concerns about widespread telemedicine use in the current environment. First, the ultimate success of telemedicine will depend heavily on third party reimbursement. Recently, with the passage of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, some additional provisions have been made promoting telemedicine reimbursement: