Pediatric Informatics: Computer Applications in Child Health (Health ...

290 C. Sable et al.
presence of consulting physicians in local hospitals. Technical challenges include
the complexity of many different software, hardware, and telephone line options
in different locations (all of which may function normally in isolation but not in
concert) which may pose difficulties in locating system malfunctions. Essential to
any effort is planning for “down time” and for disaster recovery.
The legal ramifications and licensure requirements of using telemedicine are
still evolving. 24 There have been no telemedicine lawsuits to date, but as the field
grows, this likely to change. Patient confidentiality must be secured as data is
transmitted across various types of telecommunications tools. Legal questions may
also arise when a tertiary care center provides equipment or support to a referring
hospital or practice. The legality of such arrangements depends on the details of the
arrangement; it is advisable to seek legal counsel when developing a telemedicine
program and contractual agreements with telemedicine partners. Licensure requirements
for telemedicine vary by state and may also pose limitations.
Reimbursement for telemedicine consultation is limited in the United States
and may discourage many physicians from participating. 25 Tele-cardiology and
tele-radiology are often profitable due to professional interpretation fees and downstream
revenue from patient referrals, especially those requiring invasive procedures.
However, reimbursement for telemedicine consultation in most other fields is limited
and may discourage many physicians to participate. Not all states in the United
States provide Medicaid reimbursement for telemedicine services, and those that
do only provide reimbursement for a limited number of procedures. Medicare reimbursement
for telemedicine has been limited to live interactive consultations in rural
health professional shortage areas. Telemedicine advocates are seeking legislation
that would broaden the coverage to include any type service and include “store and
forward” technology.
20.8 Vision for the Future
Moore’s law states that technological capability will double approximately every
18 months. The implications of this for the exponential growth and widespread
acceptance of telemedicine are tremendous. The line between traditional health
care and telemedicine will continue to blur as computing speed becomes greater,
storage space becomes less expensive, and options for high speed bandwidth
become more universal. The vision of being able to open up a computer (or hand
held device) at anytime in anyplace and have full access to any type of medical test
(including full motion video) and any education content with wireless technology
at acceptable speed is not far off. Of course the ability to maintain confidentiality
and security will need to expand at the same time.
Virtual diagnostic and therapeutic health care centers could be established in
community hospitals without access to subspecialists, rural areas, and third world
countries. These centers could also serve as education hubs for nurses, physicians,
and the public. A parent could take their child to one of these centers and