Cecily O'Connor
RedwoodAge.com

At a time when the health care industry is ailing, telemedicine holds out the hope of a cure. 

Telemedicine, which enables physicians to treat patients from their homes or rural areas through communications technologies, just took a big step forward when Congress rejected President Bush's Medicare bill veto. While that bill is best known for shielding doctors from cuts in Medicare reimbursement rates, it contains a provision that makes Medicare telehealth services available at more health facilities, including skilled nursing facilities, in-hospital dialysis centers and community mental health centers. 

Opening up these types of centers, and allowing  more patients to interact with physicians through telemedicine is "huge," said Dr. Elizabeth Krupinski, president of the American Telemedicine Association. 

Access to quality health care is a big concern for boomers who are tending to elderly parents, as well as thinking about their own future health needs. Telemedicine is especially important for adults who will retire in rural or remote areas that lack advanced geriatric healthcare services. Many boomers and their doctors will use telemedicine to fill in health care gaps.

Rural Care 
Telemedicine can be carried out in a number of ways, Krupinski said. This includes: "real time," in which a patient in a rural clinic could connect with a physician in a surrounding major city to engage in a live visit via videoconference. The "store-and-forward" system would enable a general practitioner, for example, to collect clinical data through digital pictures, and then forward them to a specialist for an-depth diagnosis. Another option enables patients to wear remote monitoring systems that transfer medical data to doctors about blood pressure and other vital sign. 

The aim is to improve a patient's access to care and increase the frequency of appropriate diagnosis and subsequent therapies. 

A physician at a rural clinic can "send me photos and clinical records. I look at them, evaluate and create a consult back to the referring physician that lists problems and recommended therapies," said Dr. Marc Goldyne, a San Francisco dermatologist who estimated he' s seen more than 2,000 telemedicine cases in the last six years. 

"I am not dealing directly with the patient," he said. "I am dealing with the patient’s primary care provider. The advantage for the patient is that if they are 250 miles from San Francisco, they don’t have to travel all that distance, go to doctor's office and wait for 15 minutes. But if the patient wishes to talk to me directly they can do that."

Growing Pains
Even with these conveniences, some barriers need to be addressed to make telemedicine more mainstream. Goldyne, who in addition to his practice acts as a telemedicine consultant, said some physicians feel there's little "economic incentive" to make telemedicine work. 

"The biggest problem is moving away from a paper-rich bureaucratic system to a system where there is no paper," he said. The questions facing some doctors and facilities are "How will that affect our personnel?" and "Will you be taking patients away from other doctors?"

Krupinkski feels the big barrier is integrating telemedicine into a physicians' regular practice. "Physicians in all sorts of specialties are saying this is a viable and important way to make contact with patients and provide patient care," she said.

The ATA plans to work with the Center for Medicare and Medicaid Services as part of implementation of telemedicine at the various sites before the law goes into effect on January 1.