Telemedicine describes the use of technologies that allow the practice of healthcare using telecommunication equipment. IT developments have enabled instant access to specialist knowledge. Traditionally, access to care is provided via GP surgeries, hospital and community teams, and this involves travel, either on the part of the patient or the clinician to engage in a face-to-face consultation. Using new tech- nologies allows the clinician and patient to engage from two separate locations and may allow a clinician access to a highly specialist opinion without the need to travel long distances. Engagement in this area has been utilized and developed extensively by military organizations requiring specialist input out in the field and transfers effectively into civilian circumstances (Tyrell 2002). The technology offers advan- tages for isolated rural communities and some specialities lend themselves better than others to telemedicine (e.g. dermatology). Development has been ongoing in many specialities including radiology and pathology using sophisticated imaging equipment. Telemedicine can be utilized in both synchronous and asynchronous circumstances, depending on the urgency of the situation. Asynchronous commu- nication is likely to be appropriate in an outpatient scenario, whereas in A&E syn- chronous communication may be necessary. Many widely available technologies support telemedicine, such as video cameras, video or teleconferencing, mobile tele- phone devices, the internet and computers themselves. The NHS Direct telephone and internet service is a well-known example of a large, widely used telemedicine project. It comprises a telephone helpline, staffed by trained health professionals, and a website that provides accurate and up-to-date information. It provides remote access to healthcare professionals who are equipped to provide the caller with ad- vice and are able to direct them to the most appropriate service. Other examples include ambulances enabled to transmit data (such as ECG readings) to A&E depart- ments ahead of their arrival to ensure the correct treatment is ready and waiting.
Activity
Arrange to go and visit a telephone advice service such as NHS Direct.
r Discuss the advantages and limitations of such a service with the staff.
r Undertake an internet/library search to find studies on the use of telephone services in healthcare.
r Read these and reflect on them in the light of your experiences.
Telemedicine offers benefits for many areas of healthcare, such as providing pa- tients with remote access to care and enabling clinicians to access specialist ad- vice. It potentially saves time, money and the environmental impact of travel.
Disadvantages include the lack of face-to-face interaction and the impact of this upon the clinician–patient relationship. There are ethical and security issues that must be addressed and a need to train staff and adapt working practices to uti- lize telemedicine, as well as a need to develop contingency plans for equipment failure.
Conclusion
Technology has a vital role to play in the delivery of modern healthcare and in sup- porting robust and effective communication platforms. This chapter has explored a range of issues relating to the use of IT in healthcare and has encouraged nurses to consider the following issues.
r Developments in technology have changed the ways in which humans interact and communicate in all areas of daily living and now facilitate communication beyond the constraints of fixed time and place.
r Access to healthcare staff and healthcare delivery has been transformed by the integration of IT into the NHS.
r The use of mobile technology needs to be carefully managed by individuals and organizations to avoid potential stress.
r Effective use of the different technologies such as email and mobile phones requires training and quality management to avoid breaches of confidentiality.
r The internet provides a rich source of information to both health profession- als and service users. This can support professional development and patient care, but individuals must ensure they verify the quality of the information and validity of its source, ensuring it has a sound evidence base.
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