“Medicine and technology are intrinsically linked. Many advances in health have been contingent upon synonymous advances in technology. This has become particularly clear in recent times when considering the extent to which to technology has helped to substantially improve not only understandings of disease processes, but also the ways in which they can be managed.
Before I started medical school, I did research in the area of telemedicine. The Department of Health and Ageing defines telemedicine as the use of ‘advanced telecommunication technologies to exchange health information and provide health care services across geographic, time, social and cultural barriers’ (Department of Health and Ageing, 2012). There is now a substantial range of telemedicine systems available for research and clinical purposes, including health apps for phones, tablets and computers, as well as specially designed devices, such as equipment that utilises the Internet for improved accuracy in the remote monitoring of patients with chronic diseases.
The evidence for how telemedicine impacts on care is growing at a rapid rate. A myriad of benefits have been recognised. In particular, some studies have shown that telemedicine systems can improve key clinical outcomes in chronic conditions, such as lowered mortality and morbidity in certain heart failure patients (De Simone et al., 2015). Others have demonstrated that telemedicine can help in leading patients to choose comfort-focused care instead of life-prolonging care when making advance care plans (El-Jawahri et al., 2016; Volandes et al., 2009).
Despite the exciting potential of telemedicine, I have often encountered caution and concern when discussing the subject with colleagues and clinical supervisors. The reasons for resistance are always very similar. Issues raised usually include cost, implementation barriers and a lack of needed unified leadership from health professions and stakeholders. In addition, there is also some literature indicating that telemedicine may either make no difference to clinical outcomes or in some cases, even result in harm, such as increasing waiting times in emergency departments (Mohan, Bishop, & Mallows, 2013; Takahashi et al., 2012).
Issues such as these are undoubtedly significant and should not be ignored. However, they are not insurmountable. Of course more money may help. However, there are simpler strategies that can be more readily instigated with a lasting impact, particularly at the medical school level.
Aside from my research and personal interests, throughout my medical degree, I have heard very little about telemedicine. Yet all of my colleagues and I are constantly surrounded by technology in a range of contexts that can be used as part of telemedicine systems, such as smart phones and tablets. A proportion of this generation of future doctors has even seen the transition from a world where smart phones were a novelty to one where their absence seems unusual.
Medical students should be encouraged to synthesise their growing knowledge and skills in medicine with their experiences of technology. Focused teaching of telemedicine alongside existing clinical education right from the beginning of medical school will help empower future doctors to truly recognise and realise the ways in which technology can enhance health care. Perhaps then discussions on telemedicine will include not only an understanding of its problems, but also a strong drive and capability to be a part of the solutions that lead to its benefits.”
Christopher Lemon is a third year medical student at the University of Notre Dame in Sydney. He is also the Chair of the New South Wales Medical Students’ Council.
Department of Health and Ageing. (2012) Telehealth Technical Standards Position Paper. Retrieved from:
http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/6 3CDBE743351A0CCCA257CD20004A3AC/$File/Telehealth%20Technical%20St andards%20Position%20Paper%20-%20Final.doc.
De Simone, A., Leoni, L., Luzi, M., Amellone, C., Stabile, G., La Rocca, V., . . . Buja, G. (2015). Remote monitoring improves outcome after ICD implantation: the clinical efficacy in the management of heart failure (EFFECT) study. Europace, euu318.
El-Jawahri, A., Paasche-Orlow, M. K., Stevenson, L. W., Lewis, E. F., Stewart, G., Semigran, M., . . . Volandes, A. E. (2016). Randomized, controlled trial of an advance care planning video decision support tool for patients with advanced heart failure. Circulation, 134(1). doi: http://dx.doi.org/10.1161/CIRCULATIONAHA.116.021937
Mohan, M. K., Bishop, R. O., & Mallows, J. L. (2013). Effect of an electronic medical record information system on emergency department performance. Medical Journal of Australia, 198(4), 201-204.
Takahashi, P. Y., Pecina, J. L., Upatising, B., Chaudhry, R., Shah, N. D., Van Houten, H., . . . Hanson, G. J. (2012). A Randomized Controlled Trial of Telemonitoring in Older Adults With Multiple Health Issues
to Prevent Hospitalizations and Emergency Department Visits. Archives of Internal Medicine, 172(10), 773-779.
Volandes, A. E., Paasche-Orlow, M. K., Barry, M. J., Gillick, M. R., Minaker, K. L., Chang, Y., . . . Mitchell, S. (2009). Video decision support tool for advance care planning in dementia: randomised controlled trial. BMJ, 338(b1964). doi: 10.1136/bmj.b2159
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