Although telemedicine is not really a new science, it is now receiving much more attention than ever before in U.S. history. Much of this added attention is a by-product of the prolonged national debate on healthcare reform, which brings promise of greater funding and momentum to the entire field of healthcare, including telemedicine – which, basically, is a system used to treat patients by communicating medical information from one site to another through the use of electronic communications and IT (information technology) systems and equipment. In recent years telemedicine has also been considered an important component of other healthcare communications efforts that are variously referred to as HIT (health IT), tele-health, and ehealth.
In the overall field of medicine it is easy to understand why rapid developments in medical science are and almost must be complemented by the equivalent (or perhaps greater) development of new standards and technology that allow the precise transmission of medical information through different media and between different communications systems and devices. More than 40 years ago, emergency management and emergency response were the initial drivers of telemedicine, but the field has come far since its beginnings as primarily an audio- communication – i.e., voice-grade technology – system linking emergency responders and physicians. Today, telemedicine also includes, but is not limited to: (a) the remote monitoring of vital signs; (b) the transmission of distant “reads” from body sensors; (c) the transmission of medical instruction documents to health workers in the field; (d) videoconferencing/video-consulting meetings and communications; and (e) the transmission of a broad spectrum of “images” of various types.
Most telecommunications messages are high-data-rate digital electronic bursts transmitted over wireless mesh networks (broadband) and public internet connections (Wi-Fi), moving data ranging in volume from hundreds of kilobits to an astounding number of megabits per second. Moreover, emergency management is no longer the sole or principal driver of telemedicine, but has been joined by such other intangible drivers as public health, quality care, efficiency, and access.
Challenges & Solutions; Recommendations & Initiatives
Despite and in some ways because of previous progress, there are today a few particularly challenging aspects of telemedicine that require thoughtful consideration not only from the rapidly growing community of telemedicine professionals but also from senior decision makers at all levels of government. From the perspective of emergency responders themselves, for example, the governance and management of privacy and security have become major issues, primarily because confidential patient and/or event information can be exposed both in broadband transmissions and over the net.
Another challenge is technology interoperability – or, more precisely, the lack of interoperability – which was a problem encountered by emergency responders during the sometimes uncoordinated local, state, and federal responses to the 9/11 terrorist attacks in New York City. Eight years later, interoperability continues to be a problem, especially in rural communities, for those involved in almost any aspect of telemedicine. (One reason for the seemingly interminable delay in solving that particular problem, it is hereby suggested, is that vendors of information systems often do not incorporate national standards into their systems.)
Yet another challenging problem is that emergency responders must quickly embrace, learn from, and train others in a professional milieu of rapidly changing telemedicine technology in such areas as interoperability modifications, information compression systems, and continuous advances in the more accurate transmittal of images (particularly with regard to color fidelity and the resolution of detail).
A Golden Opportunity for an Optimum Mix
One potential but at least partial solution to these challenges (and others in the field of telemedicine) could be that those involved in the often slow standards-development processes of the National Institute of Standards and Technology (NIST) – and/or the leaders of the nation’s standards development organizations (SDOs) – must themselves become better drivers. Not only generically, but specifically as drivers who are knowledgeable of the national standards development processes spelled out in the National Technology Transfer and Advancement Act – and detailed in Circular A-119 (which governs “Federal Participation in the Development and Use of Voluntary Consensus Standards in Conformity Assessment Activities”).
Those leaders and other senior officials today have a unique opportunity to motivate many interested volunteer stakeholders to give more time and pay greater attention to standards-development efforts. By doing so, they would arguably be able to move decision-making, validation, and the finalization of standards at a faster pace. Improved efforts such as this would be entirely in keeping with the National Standards Strategy (which encourages faster standards processing), while these highly knowledgeable drivers also maintain the integrity and transparency of the process.
Involving more, and a greater mix of, telemedicine stakeholders would be helpful in other ways, if only because it would ensure that those involved in emergency management would be able to include themselves in telemedicine standards development efforts to ensure that the systems developed are interoperable, remain relevant to the subject, and can be used effectively by emergency responders in the field.
Those who want to know more about telemedicine standards development, and/or who desire to participate in the upgrading efforts, should understand that NIST has already been working for many years with the American Telemedicine Association (ATA) and other SDOs – as well as other public- and private-sector stakeholders – to develop and improve standards in the field of telemedicine. Under the American Recovery and Reinvestment Act (ARRA), NIST already has received $220 million – and another $20 million from the Department of Health and Human Services (HHS) – for its telemedicine standards-development efforts.
Numerous private-sector standards groups and coalitions also are involved in various telemedicine initiatives. At the end of this article is a list of some (but not all) of the agencies, sub-agencies, and other entities that have been recipients of ARRA stimulus funding for telemedicine – and are therefore in an excellent position to provide grant funding and/or other resources to other organizations in need of outside funding for their telemedicine training, equipment, standards-development, and technological-development efforts.
Following is a list of some telemedicine standards-development stakeholders, many of which have received stimulus funding for the development of telemedicine technology and usage. For additional information about:
The American Telemedicine Association (ATA) – a primary SDO that has for years been a leader in telemedicine standards development – click on www.ata.org;
The Department of Commerce/NIST, which received $220 million for research, standards development, competitive grants, fellowships, and supplies, plus $20 million from the Department of Health and Human Services (aka DHHS or HHS), click on www.nist.gov/recovery;
The Department of Health and Human Services (DHHS or HHS), which has received $2 billion of stimulus funding for various telemedicine-related programs, click on http://healthit.hhs.gov/;
The Department of Agriculture (USDA), which has received $2.5 billion in stimulus funding for telemedicine, click on www.usda.gov/rus/telecom/dlt/dlt.htm and/or on www.usda.gov/wps/portal/?navid-USDA_ARRA;
The DHHS/Social Security Administration (SSA), which received $500 million in stimulus funding for telemedicine, click on www.ssa.gov/recovery;
DHHS/The Agency for Healthcare Research and Quality (AHRQ), which received $1.1 billion, click on www.ahrq.gov;
DHHS/Health Resources and Services Administration (HRSA), which received $2.5 billion in stimulus funding for telemedicine, click on www.hrsa.gov; and
The National Institutes of Health (NIH), which received $8.2 billion, click on www.nih.gov/recovery.
Diana Hopkins is the creator of the consulting firm “Solutions for Standards” (www.solutionsforstandards.com). She is a 12-year veteran of AOAC INTERNATIONAL and former senior director of AOAC Standards Development. Most of her work since the 2001 terrorist attacks has focused on standards development in the fields of homeland security and emergency management. In addition to being an advocate of ethics and quality in standards development, Hopkins is also a certified first responder and a recognized expert in technical administration, governance, and process development and improvement.