"There are some great telemedicine services in Indianapolis, such as outpatient cardiac care at Riley Children's Hospital, continuing education opportunities at St. Vincent Hospital and daily monitoring of chronic diseases for outpatients at Roudebush Veterans Administration Medical Center", stated Pamela Whitten, a professor of communication and faculty scholar at Purdue's Regenstrief Center for Healthcare Engineering. "But these are not enough to reach the patients in the rural corners of the state that often represent the most underserved populations."
Telemedicine is a more efficient method of health care delivery that uses communication technologies via the Internet and videoconferencing. Pamela Whitten says Indiana's telemedicine capabilities lag behind other states. In October she organized the Indiana Telehealth Policy Conference, which was sponsored by Purdue's Regenstrief Center, to start a conversation among 50 health care providers, vendors and representatives from state offices about how to enhance state services.
The working group focused on challenges for telemedicine, such as privacy and confidentiality, licensure and credentialing, reimbursement for services, and the necessary infrastructure for technology, such as broadband computer lines. Purdue's Regenstrief Center for Healthcare Engineering will facilitate partnerships to improve and promote the services, according to Pamela Whitten.
"Telemedicine, such as virtual visits from doctors via the Internet or recording and transmitting heart patients' blood pressure daily, can improve and save lives by providing access to health care specialists that patients would need to drive hours to see", Pamela Whitten stated. "Improving Indiana's telemedicine services now can enhance the efficiency and efficacy of health care delivery, especially in providing care to our rapidly aging population that will require an unprecedented amount of care for chronic conditions such as diabetes and heart disease."
Before more Indiana patients can benefit from these technologies, the state needs to invest in its technological infrastructure, Pamela Whitten noted. The working group proposes that I-Light, a fiber optic network connecting the campuses of Indiana University in Bloomington, Indiana University-Purdue University Indianapolis and Purdue in West Lafayette, be made available for health facilities around the state.
Dr. Peter Woodbridge, the ambulatory care executive at Roudebush Veterans Administration Medical Center who oversees telemedicine services used to care for about 140 outpatients daily, was among the participants in the telehealth policy discussion. He says technology is the key to providing effective telemedicine services. "The technology infrastructure is the backbone of telemedicine. With wide availability of broadband, much of the care of many chronic diseases, like diabetes and heart failure, could be shifted from clinics and hospitals to the home. Through wide access to home telehealth, not only would patients be able to be more active participants in their own care, but they would achieve better outcomes."
The group's other recommendation focuses on working with the state government to encourage reimbursement with the Medicaid office for Indiana and, if needed, seek legislation to support payment for telemedicine services. Currently, some of the services are not reimbursed by Medicaid, the state-approved health insurance programme, so providers are not as likely to use these services. The Telehealth Advisory Committee, formed in May by a variety of Indiana telemedicine groups and Health Care Excel, a corporation working in several states to improve the economical delivery of health care, is working on the reimbursement issue. "Lack of payment impedes the development of telemedicine services in many places, so implementing reimbursement policies in Indiana is a must", Pamela Whitten stated.
The working group also would like to see telemedicine introduced into the curriculum of universities in Indiana to prepare nurses, physicians and other health care providers to use telemedicine daily. Telemedicine services provide current health care providers a venue to earn continuing education credits without the need to travel to a conference in a faraway city or state. "A great dialogue has started between Purdue's Regenstrief Center and Indiana health care providers", Peter Woodbridge stated. "And couple that with the critical mass of expertise in telemedicine and state support, Indiana is poised to move forward and excel in telemedicine."
Telemedicine services, often using primarily real-time videoconferencing, have been around since the 1960s, but its use exploded in the late 1990s thanks to digital technologies. The federal government will spend close to $1 billion on telemedicine research, according to Pamela Whitten.
Pamela Whitten has studied, evaluated and launched telemedicine projects in rural hospitals, school nurses' offices in inner-city elementary schools, patients' homes, community mental health centres and jail settings in Kansas and Michigan. Pamela Whitten joined the faculty at Purdue in August and is now focusing her attention on advancing telemedicine in Indiana.
Support for this project is from the Regenstrief Center for Healthcare Engineering at Purdue. Purdue's centre brings together researchers from fields such as communication, sociology, epidemiology, engineering, nursing, management, pharmacy and technology to work with representatives of the health care industry to find ways to improve access to and delivery of health care. The Purdue Regenstrief Center is a sibling organisation and partner with the Regenstrief Institute at Indiana University Medical School. The Purdue Regenstrief Center is administratively housed in the e-Enterprise Center in Discovery Park at the West Lafayette campus.
The October 2005 meeting report will be available on the Regenstrief Center's Web site.