SCALE Leadership Vol. 7

In its broadest sense, telemedicine is the provision of healthcare at a distance, meaning the patient and the provider are separated by some distance and that clinical information is shared over that distance. Technically, transmission is usually thought of as involving electronic information and communication technologies such as high speed digital networks, the internet and cellular systems. But there isn’t any reason you couldn’t use semaphore or jungle drums if the provider and patient can meaningfully communicate. Practically speaking, it is happening electronically mostly over the internet or cellular networks. 

A common usage of the term embraces two-way synchronous audio and video, store and forward technologies, and remote monitoring but there are no hard boundaries so it is extending to include artificial intelligence and predictive analytics in addition to apps and devices. The devices run full gamut. Everything imaginable from computers, smart phones, tablets, spirometers, thermometers, oximeters, ultrasound, invasive surgical machines like Da Vinci and robots to haptic lips and hands—all are in use and/or being developed. 

And it involves tremendous creativity. Sometimes just pairing of devices or technologies is a leap, such as otoscope extensions for smartphone cameras or the use of light bulbs to candle peritoneal dialysate in a clear container held between the bulb and a smartphone camera to provide a quick check for infection. It just needs to balance clinical judgment or standards with needs. In the examples I just cited, the otoscope might be acceptable to many clinicians just about anywhere. But the candling of dialysate would not likely be accepted in many first world places even though it is in use in some third world locales to monitor the patients receiving dialysis at home—often there is no other practical way to manage renal disease patients. That said it also needs to balance against technical limitations, including bandwidth. There are places in the US where our clients often struggle to get a connection stable enough for basic two-way video. In such circumstance remote robotic surgery will not likely be done soon. But in East Africa for example, where many parts are limited to low-level connectivity but cell phone distribution is high, Nestlé recently conducted a pilot to deliver nutrition and wellness counseling where there was little to none before. High performance is relative. 

We should also probably differentiate telemedicine from telehealth. Generally, telemedicine refers more to remote clinical visits and telehealth to the multitude of services and data, including non-clinical ones, which can be delivered remotely. So in this sense, a doctor’s exam at a distance would be telemedicine, while the use of an Apple watch or a diabetes app would fall more toward telehealth. The diagnostic or prescriptive use of the data from the watch or app by a physician would be a hybrid but more toward telemedicine. I believe common usage is merging them and I use them here mostly interchangeably