National Telemedicine Initiatives: Essential to Healthcare Reform
National Telemedicine Initiatives: Essential to Healthcare Reform
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DOI：
10.1089/tmj.2009.9960
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发表时间：
2009-08-01
期刊：
影响因子：
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通讯作者：
Tracy, Joseph
中科院分区：
文献类型：
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作者：
Bashshur, Rashid L.;Shannon, Gary W.;Tracy, Joseph
本文档反映了来自全国各地的各种医疗保健学者、研究人员、提供者和行业代表的强烈观点和观点，他们都相信医疗保健改革的必要性以及远程医疗或信息技术增强的医疗保健在该改革中的中心地位。改革的需要源于我们卫生系统中长期存在的问题，远程医疗的核心作用源于不断扩大的研究和经验，这些研究和经验证明了远程医疗在解决这些问题方面的优点。尽管美国在医疗保健方面的支出比其他任何国家都多，无论是在绝对数量上还是在人均基础上，但与其他发达国家相比，美国人的健康状况相对较低。此外，美国支出和健康状况指标之间的普遍差异掩盖了基于社会经济、地理、文化、种族和其他因素的人口各阶层之间的重大差异。因此，我们继续遭受在获得保健服务方面的不平等、提供保健服务的效率低下、成本不断上升以及普遍存在的不良生活方式加剧了这些问题的困扰。电子健康记录（EHRs）作为改善医疗保健系统的一种手段，已经引起了人们的广泛关注。然而，尽管有潜在的好处，电子健康档案只能部分解决我们面临的问题。更广泛地关注结合电子病历的远程医疗（也经常被称为远程医疗或电子医疗）是一种更谨慎和有效的方法。我们认为，专注于开发全系统的电子病历，虽然在改善医疗保健服务的一个部门方面值得称赞和潜在的价值，但最终会增加医疗成本，而不会对系统的其他部分做出必要的改变。远程医疗技术体现了信息的电子获取、处理、传播、存储、检索和交换，目的是促进健康、预防疾病、治疗病人、管理慢性病、使残疾人康复以及保护公共健康和安全。远程医疗系统由协作卫生网络、设施和致力于实现这些目标的组织组成。在过去的几十年里，远程医疗系统已经证明有能力做到以下几方面：改善对各种疾病（包括但不限于心脑血管疾病、糖尿病、癌症等内分泌紊乱、精神疾病和创伤）的各级（初级、二级和三级）医疗保健服务的可及性；还有放射科、病理学和康复等服务。以较低的成本和在当地环境中促进以患者为中心的护理，这也有助于稳定当地的医疗保健和经济。提高临床决策、处方订购和指导的效率。在长期护理机构和家庭中提高慢性病管理的有效性。促进个人采用健康的生活方式和自我保健。远程医疗有成本也有收益。然而，对提供者、客户和整个社会产生的好处远远超过了成本。这些好处包括：为初级保健医生提供随时接触专家同事的机会；扩大三级保健中心的专家服务范围；跨多个交付地点整合医疗服务；避免病人不必要地去看遥远的专家；使患者能够合理分诊；尽量减少诊断测试和临床服务的重复；稳定农村供应商和地方经济；并在降低成本和加强公共安全的同时，增加被收容人群获得护理的机会。通过医疗体系的重大改革来改善美国人的健康状况，这个国家面临的任务是艰巨的。这一改革必须确保在控制成本的同时改善获得适当和高质量医疗保健的机会。这项改革的一个必要组成部分是为保险不足或没有保险的人提供保险。然而，健康保险并不能保证适当获得不公平分配的医疗保健。因此，我们承认远程医疗不是医疗改革的万灵药。相反，它是一种具有成本效益和临床效果的解决方案。远程医疗发展的基石在于同时要求远程医疗和现场护理在报销方面对等。目前的改革背景为将远程医疗全面纳入卫生系统提供了一个理想的机会，为这一代和子孙后代带来深远的利益。
This document reflects the strongly held views and perspective of a diverse group of healthcare academicians, researchers, providers, and industry representatives from across the country who share a belief in the necessity of healthcare reform and the centrality of telemedicine or information technology-enhanced healthcare-in that reform.The need for reform stems from long-standing problems in our health system, and the central role of telemedicine derives from an ever-expanding body of research and experience that attests to its merit in addressing these problems. Despite the fact that the United States spends more on healthcare than any other country, both in absolute numbers and on a per capita basis, the health status of Americans ranks relatively low when compared with that of people in other developed nations. Moreover, the general discrepancy between expenditures and health status indicators in the United States masks significant differentials among segments of the population, based on socio-economic, geographic, cultural, ethnic, and other factors. Hence, we continue to suffer from inequities in access to healthcare, inefficiencies in the delivery of care, escalating costs, and the prevalence of adverse lifestyles that exacerbate these problems.Much attention has been devoted to the utility of the electronic health records (EHRs) as a means to improving the healthcare system. Yet, despite its potential benefits, the EHR represents only a partial solution to the problems we face. A broader focus on telemedicine (also frequently referred to as telehealth or e-health) that incorporates EHRs is a more prudent and effective approach. We believe that an exclusive concern with developing system-wide EHRs, while laudable and potentially valuable in improving one sector in healthcare delivery, would ultimately increase the cost of care without contributing to necessary changes in the rest of the system.Telemedicine technology embodies the electronic acquisition, processing, dissemination, storage, retrieval, and exchange of information for the purpose of promoting health, preventing disease, treating the sick, managing chronic illness, rehabilitating the disabled, and protecting public health and safety. Telemedicine systems consist of collaborative health networks, facilities, and organizations dedicated to these objectives. Over the past several decades, telemedicine systems have demonstrated the capacity to do the following:Improve access to all levels (primary, secondary, and tertiary) of healthcare for a wide range of conditions-including, but not limited to, heart and cerebrovascular disease, endocrine disorders such as diabetes, cancer, psychiatric disorders, and trauma; as well as services such as radiology, pathology, and rehabilitation.Promote patient-centered care at lower cost and in local environments that also contributes to stabilizing local healthcare and economies.Enhance efficiency in clinical decision making, prescription ordering, and mentoring.Increase effectiveness of chronic disease management in both long-term care facilities and in the home.Promote individual adoption of healthy lifestyles and self-care.Telemedicine has costs and benefits. However, the benefits accruing to providers, clients, and society at large far exceed the cost. These benefits include: providing primary care physicians with ready access to specialist colleagues; extending the reach of specialist providers at tertiary care centers; integrating medical services across multiple delivery sites; obviating unnecessary patient travel to distant specialists; enabling rational triaging of patients; minimizing duplication of diagnostic tests and clinical services; stabilizing rural providers and local economies; and enhancing access to care for institutionalized populations while reducing cost and enhancing public safety.The tasks facing the nation in improving the health status of Americans through major reform of the health system are formidable. This reform must assure improved access to appropriate and quality healthcare while controlling costs. One necessary component of this reform is the provision of insurance coverage for people who are under- or uninsured. However, health insurance does not guarantee appropriate access to healthcare that is not distributed equitably. Hence, we acknowledge that telemedicine is not the panacea for healthcare reform. Rather, it is a cost-effective and clinically effective solution. A cornerstone of telemedicine development rests in the simultaneous requirement of parity in reimbursement between telemedicine and in-person care. The current context for reform presents an ideal opportunity for the full-fledged integration of telemedicine in the health system, with far-reaching benefits for this and future generations.