Mobile telemedicine holds promise for rural, emergency care

Joseph Kim

The American Telemedicine Association (ATA) defines telemedicine technology as "the use of medical information exchanged from one site to another via electronic communications to improve patients' health status."

As mobile technology becomes more affordable, the health care industry is buzzing about applications that bring together mobile health and telemedicine. Physicians and other health care professionals are using mobile devices such as smartphones and tablets to engage other health care professionals and patients in the evolving world of telemedicine and interactive audiovisual media.

Mobile telemedicine to aid patient-provider communication

In the past, traditional telemedicine was limited to physicians who had access to videoconferencing equipment. Major medical centers had videoconferencing equipment to correspond with rural hospitals that lack access to medical specialists. Though limited, this was quite effective.

In May 2011, for example, the University of Arkansas for Medical Sciences (UAMS) earned a national award for its use of broadband technology to provide health care to rural Arkansans. In 2009, the UAMS Antenatal & Neonatal Guidelines, Education and Learning System, or ANGELS, conducted nearly 2,100 telemedicine consultations and facilitated more than 1,000 high-risk maternal transports.

Today, though, physicians who have a mobile device equipped with a built-in camera have the capability to engage other physicians and patients using photos and real-time video streams. As a result, this mobile interaction is opening new ways for physicians to engage in telemedicine through the use of rich multimedia.

If a mother wanted to speak to on-call physician about a child’s rash, she used to have a dialogue such as this:

Mother: Doctor, I’m calling because my child has a rash on his back.
Doctor: How large is the rash? Is it raised? Is it blotchy?
Mother: Well, I just see a bunch of raised red dots all over his back.
Doctor: How big are the dots? Do the dots have white centers? Are they all the same size?
Mother: The dots don’t have white centers. The biggest dot is about the size of a dime.
Doctor: Does the child have the rash anywhere else?
Mother: He has a few red spots developing on his arms and legs, but they look different.
Doctor: How do they look different?
Mother: I’m not sure, they just look different. The rash on the arms and legs are not as red…

"What did we do before parents had iPhones that took pictures of their children’s maladies that could be forwarded to you day and night? It really does come in handy for a visual of skin related rashes and infections," Sue Hubbard, M.D., wrote in a recent post on The Kid's Doctor.

Mobile technology also allows hospital physicians to monitor patients en route to the hospital while paramedics send patient information from the ambulance.

Advances in modern telecommunication technology are facilitating patient-provider communication. This, in turn, is empowering patients. In the example above, the mother can send photos and videos of her child's rashes or other lesions to the on-call physician, who no longer has to ask the mother to describe the rash as red, raised, blotchy and so on. This leads to a more accurate diagnosis.

Improved emergency, disaster response with mobile telemedicine

Mobile telemedicine can also play a key role in emergency response. In the past, paramedics at the scene of a major accident had limited access to cardiologists and emergency department physicians. Since ambulances were not equipped with mobile fax machines, paramedics did not have the capability to fax a copy of an EKG to the on-call cardiologist at the hospital.

Today, these paramedics can send real-time videos and wireless EKG tracings and other vital sign measurements to hospital physicians, who can then guide patient care. Mobile technology also allows hospital physicians to monitor patients en route to the hospital while paramedics send patient information from the ambulance.

And vendors are preparing to meet that demand. Last year, for example, AirStrip Technologies and Physio-Control Inc. announced a joint partnership to deliver integrated lifesaving mobile telemedicine technology, which would help first responders, emergency department physicians and cardiologists collaborate.

Meanwhile, physicians working in disaster relief settings -- as well as volunteers or others assisting in patient evaluation and triage -- are now relying heavily on mobile technologies such as smartphones with video cameras to communicate with specialists or other off-site health care professionals.

Dr. Enoch Choi, an urgent care physician at Palo Alto (Calif.) Medical Foundation and medical director of Jordan International Aid, a California-based Christian aid organization, provided medical relief in Haiti after the January 2010 earthquake. He explained how mobile phones were used in a disaster relief setting: "SMS (text) and access to the Internet helped us email to coordinate with those at the shelters what they needed and where we could help."

Global, rural health care also poised to improve

The spread of mobile telemedicine is also changing rural health care. Let's say the on-call physician in the above example tells the mother to admit her child. Once they arrive at the hospital, the physician can take additional photos of the rash and send the images to a dermatologist for immediate diagnostic information.

In the near future, nearly all phone calls will incorporate video chat. As physicians and patients become more comfortable with mobile technology, they will both find opportunities to leverage real-time multimedia to enhance patient encounters. Here the dermatologist and physician could conduct a video chat so that the dermatologist can observe the young patient from afar.

Thinking globally, the mobile health industry is actively pursuing opportunities to bring health care to developing nations. Two factors motivate this push -- a mobile phone is much more affordable than a laptop in many developing countries, and the majority of developing countries have the wireless network infrastructure to support these mobile devices. Locals in rural areas can therefore gain easy access to remote health care.

ClickMedix, a global mobile health social enterprise founded by faculty and students from Massachusetts Institute of Technology and Carnegie Mellon University, aims to use mobile phones to address global health care challenges related to lack of access, lack of funds and lack of medical resources. To that end, Qualcomm Inc. and Mobinil, Egypt's largest mobile service provider, recently announced a pilot program that will use 3G mobile broadband to remotely diagnose patients with skin conditions.

As we witness exciting transformations within the mobile health industry, we are seeing a growing number of mobile telemedicine applications that remove the barriers associated with diagnosing and treating remote patients. As physicians embrace mobile technology and recognize the power of utilizing this in clinical practice, they will find ways to improve remote patient care.

Dr. Joseph Kim is a physician technologist and the founder of NonClinicalJobs.com and the Society of Physicians with Non-Clinical Careers, or SPNCC. He also blogs about smartphones, mobile computing, and the intersection of medicine and technology. Let us know what you think about the story; email editor@searchhealthit.com.

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