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    Can telemedicine boost our ailing healthcare system?



    Dr Levine is the Practice Director at the Colorado Center for Reproductive Medicine, New York, New York.



    Dr Goldschlag is an assistant professor of Clinical Obstetrics and Gynecology and Assistant Professor of Clinical Reproductive Medicine at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at the Weill Cornell Medical College at New York Presbyterian Hospital.



    Between 2008 and 2020 the number of Americans older than 65 years will have increased by 36%, while the physician supply will hardly keep up with a corresponding 7% increase, according to a report published in 2010 by the Association of American Medical Colleges (AAMC) Center for Workforce Studies.1

    That was an update to an AAMC report published in 2008, but the findings were no more reassuring from the new study conducted by IHS Inc. on behalf of the AAMC addressing trends and factors affecting the physician workforce. Using the latest modeling methods and available data, IHS projected a shortfall of between 46,100 and 90,400 physicians by 2025, most in primary care.2 All Americans are likely to be affected, but the shortfall may have the greatest effect on the approximately 20% of our population that lives in rural and underserved areas.

    As a medical community, how do we address this evolving health disparity? One solution that has begun to be met with great success is telehealth. The federal agency tasked with improving access to health care defines telehealth as “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.”3 Telehealth includes a broad array of remote services, such as clinical services, provider training, administrative meetings, and continuing medical education.

    Telemedicine defined

    According to the American Telemedicine Association (ATA), "Formally defined, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology."4 A 2012 systematic review of the telemedicine program at the University of Pittsburgh Medical Center (UPMC) found that sites using telemedicine resources had lower medical and pharmacy costs, delivered services more efficiently, and had lower rates of hospital admission and readmission.5

    Telemedicine also may help reduce costs associated with unneccesary hospitalizations of nursing home residents. In a controlled study, use of telemedicine instead of an on-call system for physician coverage in nursing homes was found to generate cost savings for Medicare that exceeded a facility’s investment in the telemedicine service.6


    Brian A. Levine, MD, MS, FACOG
    Dr. Levine is Practice Director at the Colorado Center for Reproductive Medicine, New York, New York.


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