"The main limitation with the teleradiology VPN is the complexity of ensuring the software is correctly installed on radiologists' computers and the connection is properly working. It's a big pain," says Doug Torre, director of networking and technical services. "Further, our radiologists don't like that our VPN isn't accessible via the Internet."
Placing a bet
But Catholic Health System is betting a new network technology it's recently deployed will improve information access internally and resolve its teleradiology predicament. The delivery system in October implemented the Instant Virtual Extranet application from Neoteris Inc., Mountain View, Calif.
The software created a level of secure sockets layer technology between Catholic Health System's information systems and the Internet.
This security layer provides internal and remote physicians with secure Web-based access to Catholic Health System's network without adding any extra software or networking technologies to the doctors' PCs, Torre explains. Now, instead of implementing and maintaining VPN technology at each physician office, the delivery system centrally creates user names and passwords to enable clinicians access to applications.
Catholic Health System eventually will offer the technology to its remote radiologists to use for telemedicine services. And the delivery system hopes the instant virtual extranet will enable it to expand its telemedicine services.
"One of our radiologists hates our current VPN because it's so difficult to use. He wants the ability to use a Web browser for teleradiology services," Torre says. "The virtual extranet is a simpler, easier system than our VPN because it helps shift the burden off the physicians and onto the technology."
Like the Instant Virtual Extranet, many new or developing information technologies could have a significant impact on telemedicine. Also like the virtual extranet, many of these technologies-such as telemonitoring applications, wireless technologies and increased Internet access speed-are being designed to help expand overall networking capabilities in various industries, including health care.
These technologies could help extend the reach of telemedicine networks and reduce the cost and time required to perform telemedicine services.
While the future of these technologies in telemedicine may sound promising, there are several hurdles that prevent health care organizations from fully adopting them. One long-standing hurdle for telemedicine-reimbursement-also is delaying the use of new technologies in the field.
In a nutshell: Medicare and most private insurance companies only reimburse providers for medical care that's delivered face to face. There are some exceptions, primarily teleradiology and telemedical services offered as part of grant programs. Still, this financial barrier leaves provider organizations conducting telemedicine in a lurch.
"It doesn't matter what technologies are introduced for telemedicine if society prohibits health care organizations from using them," says Doug Perednia, president of the Portland, Ore.-based Association of Telehealth Service Providers. "For physicians, telemedicine often requires more time and trouble because of economic barriers. No I.T. will help expand telemedicine services until there are changes in the way the industry-and society-views telemedicine."
Low-cost options
Given the financial difficulties, many telemedicine providers are looking to lower-cost technologies to further their telemedicine efforts, says Jonathan Linkous, executive director of the Washington-based American Telemedicine Association.
Use of low-cost applications that help ease or expand basic telemedicine services-such as teleradiology or teledermatology-will surge soon, Linkous contends.
Technologies such as wireless applications that enable remote cardiac or fetal monitoring also have great potential in telemedicine, he adds. To help drive costs down and increase adoption of such technologies, specialized telemonitoring vendors might integrate their technologies, he speculates.
In the next three to four years, telemonitoring applications will become so inexpensive and standardized that consumers will be able to purchase disposable monitors at their local drugstores, predicts David Balch, director of The Telemedicine Center at East Carolina University, Greenville, N.C.
Another future application for telemonitoring equipment could enable provider organizations to place sensors in cars to monitor passengers' health or direct them to the nearest hospital, he adds.
Such wireless telemonitoring technologies may catch the attention of managed care organizations, who should easily see preventive care and disease management opportunities, some experts say.
These payers could conclude it would ultimately be more cost-effective to reimburse physicians for real-time wireless monitoring that transmits patients' vital signs to a provider's network, says Bob Watson, co-founder of Telemedicine Technologies Co., a Wilson, N.C.-based telemedicine consulting firm.
"In the end, it's difficult for vendors to show telemedicine technologies to physicians because the physicians don't know if they can receive reimbursement when using them," Watson says. "And payer organizations often don't see the positive patient outcomes to be had via telemedicine technology to make the reimbursement decision."
But after March Networks sponsored a six-month tele-home care study this year that demonstrated the time and cost savings Web-based wireless telemonitoring can offer, some provider and payer organizations began to take notice, contends Bob Webster, a vice president at the Ottawa, Canada-based vendor.
The study focused on March Networks' new Home Telehealth Service. Using broadband, Web and wireless technologies, the provider-based service is designed to replicate a nurse's home care visit. The service enables interactive video, voice and data to be securely transmitted between a patient's home and a health care organization.
For its part, the study is helping some payers understand that to reduce costs, health care must be delivered differently, Webster contends. Further, other technologies used in the Home Telehealth Service-including wireless devices and broadband Internet connections-also can help improve and extend telemedicine services, Webster predicts.
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