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Given the explosion of direct to consumer telemedicine (TM), it is likely that medical advice will soon be available to anyone wherever they are and whenever it is needed.
According to the American Telemedicine Association, TM can be defined as “the remote delivery of health care services and clinical information using telecommunications technology.”1 Although the concept of distance health care is not new, it previously was limited by the technology that was available at the time. In its early stages, distance care could be delivered in real-time only by telephone or in a delayed fashion by mail. With the advent of remote-monitoring technologies, biologic parameters such as blood pressure, pulse, glucose, and others became possible. The care was not synchronous, however, in that the provider and patient were not connected at the same time. As technology improved, synchronous visits that could serve as virtual visits became possible. This is now considered to be the forefront of TM health care.2
A significant challenge facing people who live in rural communities is the uneven distribution and relative shortage of health care providers.3 In addition, rural communities tend to have residents with lower incomes and higher rates of certain chronic diseases. By reducing the geographical distance barrier, TM has the potential to aid in addressing this challenge.4 Although it is likely that TM will be most helpful for patients who live in large rural states, people who live in underserved urban areas may also benefit from the technology. TM is also beneficial to patients who live far from their providers or who want to see a specialist who does not live nearby. It also will likely help people who are unable to travel due to disability.
As the technology continues to evolve, remote care likely will continue to displace conventional in-person visits, leading to types of care that can only be imagined. This article reviews the current state of TM services with an eye toward future trends that are likely to displace current care options, hopefully leading to vastly improved forms of health care.
Types of Telemedicine
At the highest level, TM can be divided into asynchronous and synchronous interactions (Table 1). Asynchronous interactions occur when the provider and patient are not online at the same...