"Telemedicine" usually refers to the use of sophisticated communication and information technologies (often with imaging or video capabilities) to support improved access to and delivery of health education and medical practices. Telemedicine as defined by the American Telemedicine Association is the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or health care provider and for the purpose of improving and extending the availability of patient care.
 

One report stated that "driven by managed care, telecommunications reform and new reimbursement possibilities, telemedicine is exploding." The goal of capitated managed care systems is to provide the best care to people for the lowest cost. Program administrators give close attention to the bottom line and to the "medical loss ratio", i.e., that portion of the premium dollar which is actually paid out for medical services.
 

The following list demonstrates the potential relevance of telemedicine:

• Improves access to care by providing health care to underserved areas, increasing speed of diagnosis and treatment, and allowing access to specialty care;
• Reduces costs (i.e., travel, equipment, etc.) by avoiding duplication of services, staff, and specialties, providing backup services, and providing a method for centralizing resources;
• May improve quality of care, increase consultation decision making through collaborative technologies and may increase patient involvement; and

The web sites reviewed below will define and further describe telemedicine and its application to medical care. The preceding summary attempts to introduce the reader to telemedicine as it relates to managed care and cost savings.
 
 

AMERICAN TELEMEDICINE ASSOCIATION ***** (5 STAR RATING)
 
 
 

This is the official web site for the American Telemedicine Association. The mission of the organization is "to promote professional, ethical, and equitable improvement in health care delivery thorough the application of telecommunications technology." The purpose of the web site is to inform the reader of the definition of telemedicne and about its application in the practice of medicine. In addition to providing updates in this area, the site provides conference information. The news and events section provides links to current legislative, clinical, and legal issues. Links are available for general resources and publication, legal issues, telemedicne applications in academic medical centers, and federal agency activities. This web site is very user friendly. Browsing through this site and the available links provides the user with a very good understanding and knowledge base as it relates to telemedicine.
 
 
 
 
 

TELEMEDICINE INFORMATION EXCHANGE ***** (5 STAR RATING )
 
 

Telemedicine Information Exchange (TIE) is operated by the Telemedicine Research Center (TRC) with funding by the National Library of Medicine (NLM). Its stated purpose is to provide unbiased information about telemedicine. The home page notes that inclusion of items in the TIE does not necessarily imply endorsement by the Telemedicine Research Center or the National Library of Medicine.
 

TIE provides the NLM with telemedicine citations for their online databases and telemedicine program listings for their online Health Services Research Projects database. There are searchable databases including the following:

•Bibliographic Database: A searchable database of over 4,000 citations (many with abstracts) of articles on telemedicine; the most comprehensive collection of telemedicine literature anywhere, including all major telemedicine publications;

•Active Telemedicine Programs: A searchable database of over 200 programs worldwide providing telemedicine services;

•Meetings: A list of important telemedicine-focused meetings for the next year. Search by location, subject or date;

•Funding: A list of funding sources for telemedicine activity including government, state and private agencies. Timely announcements of telemedicine RFPs;

•Journals: A separate section for articles from current issues of all major telemedicine publications, including Telemedicine Today, the Journal of Telemedicine and Telehealth, Telemedicine Journal, etc.;

•Legal Issues: A database of literature citations specific to legal issues and barriers to telemedicine, plus links to important legal telemedicine sites and information on licensure and reimbursement;

•Vendors: A list of over 200 vendors of telemedicine equipment;

•Home Health: A list of home health programs, a selection of important home health articles from the bibliographic database as well as home health equipment vendors;

•Links: Links to other web sites of interest to the telemedicine community;

•Forum: Experts on various subjects answer questions on telemedicine applications and issues; and

•Classified Ads: Jobs open and jobs wanted are posted free.
 

This web site is easy to use. Link to databases are comprehensive and provide current information.
 
 
 

FEEDBACK RESEARCH SERVICES **** (4 STAR RATING)
 
 
 

As described on their web site Feedback Research Services is a commercial business offering market research products and services as well as free information to expand awareness and understanding of issues, trends, and forecasts that affect high-tech health care delivery systems. Their services include: *Market Research and Overview Reports *Consulting Projects *Free Services- it provides free information about telemedicine and telephone triage systems for the general public, and simple referrals to a particular article, publication, or Web site.
 

The site is for informational and commercial purposes. Feedback publishes a monthly magazine called TeleMed-E-Zine and a news letter for free. Archived issues are available on line. The site includes a telemedicine glossary and a search feature. There are also web site links, market reports and clinical reports, and conference information. The August 1998 issue provides the reader with basic information about the definitions and numerous applications of telemedicine. Although the site is easy to use and the information provided is useful, access to certain information and databases require payment for services.
 
 
 

TELEHEALTH MAGAZINE **** (4 STAR RATING)
 
 
 

Telehealth Magazine' mission is to provide objective, reliable, and thought-provoking coverage of collaborative healthcare communications and information management strategies. According to the website, the magazine focuses on the implementation and management of medical communications technologies and related information networks. "Telehealth Magazine covers communications and information technology in the context of adoption, financing, network design, implementation, and integration with legacy systems."
 

The site provides access to search the magazine's archives, virtual symposium archives, a telemedicine reference desk, resource links, and hot telehealth topics. The publication encompasses all aspects of healthcare network development relevant to clinical image and data distribution. It covers the latest news and trends in: telemedicine and teleradiology, including multimedia technologies for patient outreach and healthcare provider support medical image transmission, archive, and retrieval systems for radiology, cardiology, pathology, and other mission critical applications; development and implementation of electronic patient records; networking and infrastructure issues; information systems software for patient management; expert systems for clinical decision support; internet-based networking design, infrastructure, and maintenance; point-of-care devices and strategies; disease management systems, patient monitoring products, and home-based healthcare delivery; patient-centered access to care models; and enterprise-wide integration strategies for all of the above.
 

The web site is easy to use, in addition to having good links and up to date information.
 
 
 
 
 

TELEMEDICINE & HEALTH CARE INFORMATICS LEGAL ISSUES **** (4 STAR RATING)
 

The increasing computerization of health care data, combined with the emergence of new

telecommunications applications and technologies, creates vast opportunities for the provision of health care, but raises serious legal questions concerning the privacy of medical records, physician licensure, reimbursement issues, and quality of care issues. How some of the legal and regulatory issues are resolved will determine the availability of telemedicne. One of the limitations of this web site is that it was last updated in 1997. However, some of the links, in particular the links to federal web sites such as HCFA, remain current.
 

This page of The Health Law Resource is devoted to discussing some of these issues and to providing links to other related sources on the WWW for the interested practitioner, scholar or consumer of health care or legal services. Some of the legal issues addressed by the web sites whose links appear here include: * Medicare Managed Care And Telemedicine Services *Telemedicine Reimbursement *Telemedicine And The Law: Overview of Legal Issues Presented by Telemedicine *Physician Licensure Issues *FDA's Statement on Telemedicine Software And Devices- From the FDA Center on Devices and Radiological Health *Clinical Data Management and Privacy Issues *Confidentiality and Computers *Digital Signatures *The Privacy Protection Act in Cyberspace.
 

Although there is not much information directly on the web page, the links to other sites and articles are useful.
 
 
 

ASSOCIATION OF TELEMEDICINE SERVICES PROVIDERS ** (TWO STAR RATING)
 
 
 

The organization was created to meet the information, management, and policy needs of providers or potential providers of telemedicine services. Most members are Service Provider Organizations. The Association of Telemedicine Service Providers supports and stimulates excellence and innovations in the business of telemedicine, and strengthens the effectiveness of promoting public understanding of telemedicine. The site contains information for membership, application, etc. Membership is open to companies involved in the telemedicine industry and to students with an interest in this area. Very little information regarding telemedicine is provided directly by the site. There are a few useful links. It is less comprehensive than other sites reviewed.
 
 

This article is the Operational Policy Letter #41, of the Department of Health & Human Services, Health Care Financing Administration, Medicare Managed Care. The question asked by plans was if they can provide telemedicine services under Medicare Health Maintenance Organization (HMO) or Competitive Medical Plan (CMP) contracts under Section 1876 of the Social Security Act.
 
 
 
 
 
 

FDA regulation of telemedicine devices may include software and hardware. For now, FDA continues to regulate the hardware and software associated with telemedicine systems on a case-by-case basis.
 
 
 
 
 
 

The article, "Taming Liability of Telemedical Transactions", discuss some of the malpractice and other legal aspects providers using telemedicine may come up against.
 
 
 
 
 
 

"The Role of Nursing in Telemedicine" is a study of information reported by nurses employed in telehealth/telemedicine. The article stated that findings indicate that nurses are involved in and knowledgeable about the telemedicine programs in which they work.
 
 
 
 
 
 

TELEMEDICINE REPORT TO CONGRESS-- This is a report on the use of advanced telecommunications services for medical purposes. The Telecommunications Reform Act of 1996, requires a summary of the Joint Working Group on Telemedicine's (JWGT) activities as well as findings from federally-funded telemedicine studies and demonstrations. In addition, the report examines questions related to patient safety, the efficacy and quality of services provided and other legal, medical, and economic issues.

Note: The information below may contain additional relevant materials and documents. Some of the information may be duplicate. The evaluations depend on both the student doing the review and the information contained at the time of the review. Sites are subject to change!

• Telemedicine
• Telemedicine