Telemedicine in remote areas

An interesting telemedicine story from Brazil told in Israel

Here's how providers at the Hospital Israelita Albert Einstein in Brazil take care of workers on an oil platform away from the continent. 

 

 

Photo: Roy Habani

 

Telemedicine as a technology is gaining ground all over the world. How it is being used on an oil platform in Brazil provides a fascinating look at how effective it can be both as a means to deliver care and in lowering costs.

The story was shared by Dr. Eduardo Cordioli, general telemedicine manager at the Hospital Israelita Albert Einstein in Sao Paolo, Brazil. Cordiolo was a speaker at the recently-concluded MedinIsrael digital health conference in Tel Aviv, which aimed to highlight how Israel has adopted digital health as a national strategy and where the technology is globally.

Hospital Israelita Albert Einstein is a teaching hospital, with a medical school and separate nursing school. The main hospital, which is a private hospital, has 650 beds but executives also manages two public Brazilian hospitals together with the city where they are located and the Brazilian ministry of health. They also have locations for clinics and ambulatory care. It employs 14,000 people.

Caring for oil platform workers far from the mainland is tricky and in virtually all instances prior to the launch of the telemedicine program required urgent, immediate evacuations from the platform via a helicopter to a hospital on the mainland with the necessary resources.

But in 2017, the hospital conducted 965 telemedicine visits between urgent care nurses on the oil platform and physicians at the hospital on the continent. Here’s the type of connected devices – shown in the presentation – that the telemedicine program relied on for diagnosis.

Photo: Roy Habani

Of those 965 appointments, a whopping 93.2 percent let to patient discharge. Only 6.8 percent of the visits therefore needed evacuations –  that’s a 50 percent reduction from when the telemedicine program was not in place, Dr. Cordioli said. And there appears to be an even better statistic. Of those 6.8 percent requiring evacuations, the majority — 71.4 percent —required non-urgent flights.

Previously, the evacuations were a 100 percent urgent evacuations as the urgent care nurses on the oil platform would not have been able to judge the acuity of the problem. Urgent helicopter evacuations are far more expensive than planned ones, Dr. Cordioli explained.

Later, in an interview Dr. Sidney Klajner, president of the Hospital Israelita Albert Einstein, said that through the telemedicine program, even myocardial infarctions or heart attacks, were able to be diagnosed.

Since the telemedicine program was launched in 2012, the number of video visits have seen an exponential increase. Just in the last three years, the number of appointments went from 7,000 in 2016 to 45,000 in 2017 to 80,000 video visits in 2018.

“We have a huge country and there is a lot of differences between the states. We have rich states like Sao Paolo, Sao Paolo city and the southeast of the country but we have very poor regions also with people who have no access to medicine to care and specialists for example,” Klajner said.

Telemedicine attempts to bridge this very gap. For instance in the northeast portion of Brazil, there is a shortage of specialists and so in ICUs, the telemedicine program is aimed to connect “generalists” with specialists like neurologists and cardiologists. These specialists are now responsible for a certain number of “virtual beds,” he explained.

Aside from this, the hospital has also created a proprietary dermatology app to help in diagnosing skin problems remotely.

“The team can suggest diagnosis or urgent biopsy based on the picture [through the app] and the patient history,” Klajner explained.

He noted that the focus on telemedicine is only part of the digital transformation that is underway at the hospital. Another big change was the removal of an innovation center from the hospital’s research institute about four or five years ago. The innovation center was created to rapidly innovate, prototype and validate ideas within the hospital ecosystem. This is both meant to encourage innovative thinking among hospital employees including physicians and encourage external collaboration.

For instance, a year and a half ago an incubator was created, he said. More than 1,000 Brazilian startups have been able to submit their ideas. The hospital has also acquired a health IT startup that has developed a next-generation sequencing software.

So, it’s not just telemedicine that the health system that serves nearly 1.5 million people is looking at for a digital transformation. But the telemedicine story on the oil platform is certainly compelling.

Medical virtualists

Is It Time for a New Medical Specialty?The Medical Virtualist

Michael Nochomovitz, MD¹; Rahul Sharma, MD, MBA²

   

¹New York Presbyterian, New York, New York    ²New York Presbyterian, Weill Cornell Medicine, New York, New York

JAMA. Published online November 27, 2017.     doi:10.1001/jama.2017.17094

Medicine has seen a proliferation of specialties over the last 50 years, as scientific discovery and care delivery advanced. Diagnoses and treatments have become more complex, so the need for formal training for specialty competence in cognitive and surgical disciplines has become clear. There are currently 860 000 physicians with active certifications through the American Board of Medical Specialties and 34 000 through the American Osteopathic Association.¹

Drivers of Specialty Expansion

Specialty development has been driven by advances in technology and expansion of knowledge in care delivery. Physician-led teams leverage technology and new knowledge into a structured approach for a medical discipline, which gains a momentum of its own with adoption. For instance, critical care was not a unique specialty until 30 years ago. The refinement in ventilator techniques, cardiac monitoring and intervention, anesthesia, and surgical advancements drove the development of the specialty and certification, with subsequent subspecialization (eg, neurological intensive care). The development of laparoscopic and robotic surgical equipment, with advanced imaging, spawned new specialty and subspecialty categories including colon and rectal surgery, general surgical oncology, interventional radiology, and electrophysiology.

In nonprocedural areas, unique certification was established for geriatrics and palliative care. Additional new specialties include hospitalists, laborists, and extensivists, to name a few. These clinical areas do not yet have formal training programs or certification but are specific disciplines with core competencies and measures of performance that might be likely recognized in the future.

Telemedicine and Medical Care

Telemedicine is the delivery of health care services remotely by the use of various telecommunications modalities. The expansion of web-based services, use of videoconferencing in daily communication, and social media coupled with the demand for convenience by consumers of health care are all factors driving exponential growth in telehealth.²

According to one estimate, the global telehealth market is projected to increase at an annual compounded rate of 30% between 2017 and 2022, achieving an estimated value of $12.1 billion.² Some recent market surveys show that more than 70% of consumers would consider a virtual health care service.³ A preponderance of higher income and privately insured consumers indicate a preference for telehealth, particularly when reassured of the quality of the care and the appropriate scope of the virtual visit.³ Telemedicine is being used to provide health care to some traditionally underserved and rural areas across the United States and increased shortages of primary care and specialty physicians are anticipated in those areas.⁴

A New Specialty

Digital advances within health care and patients acting more like consumers have resulted in more physicians and other clinicians delivering virtual care in almost every medical discipline. Second-opinion services, emergency department express care, virtual intensive care units (ICUs), telestroke with mobile stroke units, telepsychiatry, and remote services for postacute care are some examples.

In the traditional physician office, answering services and web-based portals focused on telephone and email communication. The advent of telehealth has resulted in incremental growth of video face-to-face communication with patients by mobile phone, tablet, or other computer devices.^2,3,5 In larger enterprises or commercial ventures, the scale is sufficient to “make or buy” centralized telehealth command centers to service functions across broad geographic areas including international.

Early telehealth focused on minor ailments such as coughs, colds, and rashes, but now telehealth is being used in broader applications, such as communicating imaging and laboratory results, changing medication, and most significantly managing more complex chronic disease.

The coordination of virtual care with home visits, remote monitoring, and simultaneous family engagement is changing the perception and reality of virtual health care. Commercialization is well under way with numerous start-ups and more established companies. These services are provided by the companies alone or in collaboration with physician groups.

The Medical Virtualist

We propose the concept of a new specialty representing the medical virtualist. This term could be used to describe physicians who will spend the majority or all of their time caring for patients using a virtual medium. A professional consensus will be needed on a set of core competencies to be further developed over time.

Physicians now spend variable amounts of time delivering care through a virtual medium without formal training. Training should include techniques in achieving good webside manner.⁵ Some components of a physical examination can be conducted virtually via patient or caregiver. Some commercial insurance carriers and institutional groups have developed training courses.⁵ These are neither associated with a medical specialty board or society consensus or oversight nor with an associated certification.

Contemporary care is multidisciplinary, including nurses, medical students, nurse practitioners, physician assistants, pharmacists, social workers, nutritionists, counselors, and educators. All require formal training in virtual encounters to ensure a similar quality outcome as is expected for in-person care.

It is possible that there could be a need for physicians across multiple disciplines to become full-time medical virtualists with subspecialty differentiation. Examples could be urgent care virtualists, intensive care virtualists, neurological virtualists, and psychiatric or behavioral virtualists. This shift would not preclude virtual visits from becoming a totally integrated component of all practices to varying extents.

Based on early experience in primary care, one estimate suggests that 30% to 50% of visits could possibly be eligible for a virtual encounter.⁴ This could be amplified when coupled with home care and remote monitoring devices. There are varying data on the influence of telehealth on total health care services utilization and that will be determined with greater adoption. In addition, as the number of emergency department visits continues to increase nationally, health care systems must develop innovative ways to maximize efficiency and maintain high-quality standards.⁶

However, complete replacement of the traditional clinical encounter will not occur. “Bricks and clicks” will prevail for patients’ convenience and value. Physicians will lead teams with both in-office and remote monitoring resources at their disposal to deliver care. This model could be enhanced in the future with digital assistants or avatars.

In the surgical specialties, remote surgery has been more focused on telementoring and guiding surgeons in remote locations. There have been examples of true virtual surgeons who have operated robotically on patients hundreds of miles away.⁷ This approach can be expected to develop further in the coming years.

Critical Success Factors

The success of technology-based services is not determined by hardware and software alone but by ease of use, perceived value, and workflow optimization.

Medical virtualists will need specific core competencies and curricula that are beginning to develop at some institutions. In addition to the medical training for a specific discipline, the curriculum for certification should include knowledge of legal and clinical limitations of virtual care, competencies in virtual examination using the patient or families, “virtual visit presence training,” inclusion of on-site clinical measurements, as well as continuing education.

It will be necessary for early adopters, thought leaders, medical specialty societies, and medical trade associations to work with the certifying organizations to formalize curriculum, training, and certification for medical virtualists. If advances in technology continue and if rigorous evidence demonstrates that this technology improves care and outcomes and reduces cost, medical virtualists could be involved in a substantial proportion of health care delivery for the next generation.

Article Information

Corresponding Author: Michael Nochomovitz, MD, Physician Services Division, New York Presbyterian, 525 E 68th St, PO Box 182, New York, NY 10021 (mnochomovitz@nyp.org).

Published Online: November 27, 2017. doi:10.1001/jama.2017.17094

Conflict of Interest Disclosures: Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Additional Contributions: We thank Risa Oliveto, Jonathon Monteiro, Shauna Coyne, and Laura Forese, MD, MPH, New York Presbyterian; Jane Torres, Weill Cornell Medicine; and Peter Fleishut, MD, New York Presbyterian-Weill Cornell Medicine, for providing input on the manuscript, none of whom were compensated for their help.

References

1.

American Osteopathic Academy of Orthopedics website. http://www.aoao.org/. Accessed August 23, 2017.

2.

Vaidya A. Global telehealth market to rapidly rise to $12.13B by 2022: 7 key trends. Becker’s Hospital Review. July 19, 2017. https://www.beckershospitalreview.com/telehealth/global-telehealth-market-to-rapidly-rise-to-12-13b-by-2022-7-key-trends.html. Accessed August 23, 2017.

3.

Dare  F. Voting for virtual health. https://www.accenture.com/t20170216T205948__w__/us-en/_acnmedia/PDF-43/Accenture-Health-Voting-for-Virtual-Health.pdf. Accessed August 23, 2017.

4.

Ripton  JT, Winkler  CS. How telemedicine is transforming treatment in rural communities. Becker’s Hospital Review. April 8, 2016. http://www.beckershospitalreview.com/healthcare-information-technology/how-telemedicine-is-transforming-treatment-in-rural-communities.html. Accessed August 23, 2017.

5.

There's a growing need to train physicians on how to handle virtual visits with patients. Modern Healthcare. August 27, 2016. http://www.modernhealthcare.com/article/20160827/MAGAZINE/308279981. Accessed September 11, 2017.

6.

Reddy  S. Can tech speed up emergency room care? Wall Street Journal; March 27, 2017. https://www.wsj.com/articles/can-tech-speed-up-emergency-room-care-1490629118. Accessed August 23, 2017.

7.

Eveleth  R. The surgeon who operates from 400km away. BBC. May 16, 2014. http://www.bbc.com/future/story/20140516-i-operate-on-people-400km-away. Accessed August 23, 2017.

Telenursing

What is telenursing?

 

Renato Marcos Endrizzi Sabbatini, 
Full professor of Biomedical Informatics 

Telenursing can be defined as “the use of telecommunications and information technology in the provision of nursing services whenever a large physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telehealth, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, telemonitoring, telemedicine etc.”. (Ref: Wikipedia).

It may be considered that telenursing is a branch of the more general Nursing Informatics, i.e., the application of Information and Communication Technologies (ICT) to nursing scopes and activities.

Telenursing is enjoying a fast growth in many countries, particularly in the USA, where the role of nurses in delivering primary care faces less regulatory hurdles than in other countries and is cheaper than physician-led care. The job boards of American Telemedicine Association and other specialized sites are full of job offers for attending telenurses, RN (registered nurses) coordinators for telemedicine programs, etc. Telenursing is already a hot area for professional development for nurses and there are certification programs in the USA. It may involve clinical care as well as administrative and operational roles.

The cost/benefit factor has been an important drive for the worldwide adoption of telenursing. In the United States, almost 46% of the on-site nursing visits could reasonably be replaced by telenursing. Compared to the traditional homevisits, agency costs could be cut in half. According to a 1999 study by authors Britton et al., “telenursing is cost effective in reducing the requirement for, or the length of, hospital stays; in increasing access to services to widely dispersed populations; and in expanding high-quality home care services (…) The result is a decrease in total health care costs and increased access to health care with more appropriate use of resources”.

Besides, telenursing has been important, relevant and meaningful when provided to dispersed, distant or isolated populations, to rural areas, during climatic catastrophes and disaster areas, in military situations, for imobilized patients, etc.

There are several application areas for telenursing:

• Triage and counseling of patients by medical call centers
• Telediagnostics (not only basic tele-ECG, but more advanced nursing diagnostics, as well)
• Nursing teleconsultation, both before and after admission to a hospital)
• Support to home care
• Monitoring in risk pregnancies, home-bound seniors, the physically disadvantaged, etc.
• Suport to nursing second opinion services
• Case management, personal health tutoring and follow-up of chronic and post-acute patients
• Emergency nursing, paramedic rescue
• Remote intensive care monitoring (e-ICU)
• Tele-rehabilitation
• Tele-education and training for nurses
• Tele-education for patients, particularly for informed consent
• Healthcare plans audits
• Support to nursing research

Telenursing uses most of the telemedicine ICTs, such as on-line electronic health records (EHR), PoR (Patient Owned Records, such as self-monitoring, Personal Health Records), text-, audio- and videoconferencing, support websites and portals, especialized home-based devices for home care, portable medical-grade devices for ECG, satO2/CO2, respirometry, remote patient monitoring, and so on.

References:

1. Telenursing. In: Nursing Matters Fact Sheet. International Council of Nurses (PDF).
2. Telenursing. In: ISFTeH: International Society for Telemedicine and e-Health.

Telehealth

Telemedicine and telehealth change the reality of health in Brazil

Whenever she needed to do an eye examination, seamstress Ana do Nascimento used to wake up before sunrise, take a bus that took two hours to get to downtown Goiânia and spend the entire morning in a public hospital, waiting for her turn to be seen by an ophthalmologist who could verify her degree of myopia. She arrived home in the afternoon, tired and not always satisfied. Today, the “examination day” is no more than 30 minutes. Ana only needs to go to the health center of the municipality of Morrinhos, where she lives, to be seen.

the network is enabling exchanges between health professionals and national research groups, the sharing of information…and tele-consultancies.

The new reality is due to the benefits of telehealth, which offers healthcare services and attention remotely, through Information and Communication Technologies (ICT) and to the work of professionals who, regardless of where they are, exchange information regarding the patient, through video or web conferences, aiming to analyze the case and reach the final diagnosis.

In Brazil, the change in the routine of many Brazilians, whether they are patients or doctors, is justified due to two public initiatives in the health area: the Brazilian National Telehealth Network Program (“Telessaúde Brasil Redes”) and the Telemedicine University Network (Rute). Launched in 2006, the Brazilian National Telehealth Network Program is a program by the Ministry of Health (MS), which aims to improve quality of service and primary care in the Unified Health System (SUS), through ICT tools, which enable the promotion of tele assistance and tele-education. The action is present throughout Brazil and allows the qualification of Family Health professionals and the exchange of information via internet between SUS doctors and experts, through the offer of tele-diagnosis and tele-consultancies on clinical cases, work process, health education, planning and monitoring of actions in primary health care.

Rute also emerged in 2006, as an initiative by the Ministry of Science, Technology and Innovation (MCTI), to deploy communication infrastructures at public universities and their university hospitals (UHs), health institutions and certified education and research hospitals in the country, benefitting the creation of Telemedicine and Telehealth cores.

Coordinated by RNP, the network strengthens and integrates the Brazilian National Telehealth Network Program by enabling exchanges between health professionals and national research groups, through the sharing of information, lectures, lifelong learning actions, formative second opinion and tele-consultancies. It also has 55 Special Interest Groups (SIGs) in various health specialties, which gather to discuss clinical cases and exchange experiences and knowledges. Currently, Rute is comprised by 118 units in full operation in the five regions of Brazil, and covers over 150 institutions.

Equipped with cutting edge equipment for real-time communication, the Telehealth and Telemedicine cores are connected to the high-performance infrastructure operated by RNP, the Ipê network. Currently, they serve approximately seven thousand teams from the Family Health Program, in over one thousand Brazilian municipalities.

The benefits of telehealth and telemedicine across Brazil are many

In Rio Grande do Sul, the videoconference resources were used to help the victims of the fire at the Kiss nightclub, in the city of Santa Maria, in January 2013. Virtual meetings were held between the Ministry of Health, the National SUS Force, the Brazilian hospitals, especially those from the South that assisted the wounded, and reference centers in training of lung burns, such as those in Iraq, Miami, Toronto and San Diego, to define strategies for the treatment of the patients.

“The Santa Maria health teams had our support in the psychological treatment of the victims of the fire and the relatives, since incidents such as this hit close to the emotional side”, Erno Harzheim, coordinator of the telehealth core of the Federal University of Rio Grande do Sul (UFRGS), remembers.

In Rio de Janeiro, in the Telemedicine core of the National Institute of Traumatology and Orthopedics (INTO), there is the partnership with the Brazilian Olympic Committee (COB) for the discussion, via videoconferences, of clinical cases of more complex lesions of athletes during the Olympics. In 2012, in London, the medical teams of Brazilian delegations received help from experts from the INTO orthopedic surgery centers.

“We gave support during the Olympic games”, coordinator Marisa Peter Silver says. “We will also participate in the organization and performance of large events in Brazil”, she reveals. In the 2016 Olympics, the focus of the work will also be the second medical opinion.

In Goiás, almost 500 ethnographies are examined monthly, detecting the main causes of blindness at an early stage. An important work in the ophthalmology area is performed through tele-diagnosis.

“The patients go to the health center, do the necessary sight exams and wait for the result. The captured images are sent to a central, so the specialized ophthalmologist doctor makes the diagnosis. After the report is done, he sends it to the health professional caring for the patients at the center. If it is a serious case, the recommendation shall be to visit an ophthalmologist. Otherwise, it shall only contain the indication for treatment”, explains Alexandre Taleb, coordinator of the telehealth and telemedicine core of the University of Goiás.

In Amazonas, the deployment of the National Telehealth Program and Rute’s telehealth and telemedicine cores narrowed the geographic access barriers and the lack of professionals for assisting with health in the state, overall in the countryside, in areas of riverside population and indigenous community. The telecommunication is done through radiofrequency antennas spread through the basic health units distributed across the Amazonian territory, which integrate local health professionals to the central core of the University of the State of Amazonas (UEA). The indigenous health work is highlighted among the telehealth actions in the Amazonian region.

“Our indigenous population may be the largest in Brazil. In addition to getting closer, we had to know the reality in which they live”, says Cleinaldo Costa, coordinator of the Amazonia telemedicine pole and current dean of UEA.

In Amazonas, there are two telehealth poles in Brazilian indigenous areas, one located at the district of Iauaretê, in the municipality of São Gabriel da Cachoeira, in the extreme northwest of the State, and another in Umirituba, in the municipality of Barreirinha, 372 km away from Manaus, or a 6h trip – 4h30 using a “voadeira”, small craft used by the riverside population, to reach Parintins, and 1h30 by plane from Parintins to Manaus. Currently, approximately five thousand indigenous people are attended by health professionals in Umirituba. At the indigenous areas, most tele-care is associated with skin diseases and ailments caused by alcoholism, such as liver cirrhosis, diabetes and high blood pressure.

“In addition to the indigenous communities, with the telehealth infrastructure, in five years, we had the opportunity to care for over 75 thousand people. It is a considerable number, because people would have to resort to SUS in Manaus,with a very high cost of travel and often by air”, Cleinaldo explains.

In Minas Gerais, telehealth care is provided to 710 municipalities (83% of the state), corresponding to almost one thousand service points, benefitting almost 1,900 Family Health teams. Approximately 60 thousand tele-consultancies were performed, and, in the area of tele-cardiology, the State beat the record of over 2 million electrocardiograms analyzed from a distance.

The Telehealth Center of the Clinical Hospital of the Federal University of Minas Gerais (UFMG) coordinates the Tele-assistance Network of Minas Gerais (RTMG), a partnership by six public universities from Minas Gerais that became an example of sustainable, large-sized telehealth service. Currently, approximately two thousand electrocardiograms are analyzed daily. In addition, the patient does not need to have any transportation, food and lodging expenses, if necessary. Beatriz Alckmin, coordinator of the telehealth core of the UFMG Clinical Hospital, stresses the benefits of the technology.

“On average, 80% of the tele-health consultations avoid the referral of patients, which generated savings for the public health system of approximately R$ 80 million in eight years of operation, proving the economic viability of the practice”.

Another highlight of the tele-cardiology area is the participation of the service in the Acute Myocardial Infarction (AMI) Care Network, in Belo Horizonte. The results reached allowed to develop the Minas Telecardio 2 project, which is deploying the AMI Care Network to the North of the State, with the installation of electrocardiograms in ambulances of the Mobile Urgent Care Service (SAMU) and in regional hospitals to improve the caring for patients with suspected AMI in remote, isolated areas.

In Pernambuco, the telehealth core of the Federal University of Pernambuco (UFPE) makes available tele-education, tele-assistance and tele-management services. According to coordinator Magdala Novaes, there is a great performance also in the area of research and development.

“It is one of the strongest areas, because we develop technologies and we evaluate their impact in improving the quality of health care for the population, while also contributing to training of specialized human resources in digital health”, she says. Another strong feature is the work performed in the area of blood policy. The core developed and deployed the Rhemo Network, of virtual videoconference collaboration for the hemotherapy and hematology services in the country, in partnership with the General Blood and Hemoderivatives Coordination of the Ministry of Health. Thirty one videoconference rooms were deployed at every coordinating blood centers of Brazil.

“This network’s goal is to contribute to increase the efficacy of management processes, exchange of experiences, support to research and formation of knowledge networks among the services of the Brazilian hemo-networks, and their integration with the other telehealth networks of the country, such as Rute and the Brazilian National Telehealth Network Program. Through videoconferences, clinical and managerial meetings, courses and seminars take place from north to south, enabling the improvement of diagnostic techniques and permanent professional development in every Coordinating Blood Center of the country”, Magdala explains.

According to the National coordinator of the Telehealth Brazil Networks, Tâmara Guedes, the program is gaining visibility. “It is becoming a focus of interest by the management from the evidences presented, becoming an important regulatory tool. The Telehealth acts in the reduction of referrals to specialties, reducing waiting lines for care and costs for management”.

These results were seen in focal studies performed by the cores of the State of Minas Gerais and by the State of Rio Grande do Sul, which show that tele-consultancy is able to avoid, in approximately 70% of the cases, the need for removal of patients, because these are resolved in the same Family Health units. A satisfaction research with the teams that use the service attested that 67% of the professionals believe telehealth to contribute largely to disrupt the sense of isolation and for their decision to remain in remote locations.

“The growth of Telehealth since its inception in 2006 is noticeable. From the amount of points deployed, the growth in the use of services to its complex cores network. The results achieved with the implementation of the program and Rute demonstrate a significant progress in the qualification of health professionals, especially those working in the municipalities of difficult access”, Tâmara concludes.

Telemedicine

‘Father of Telemedicine’ sees label disappearing

By Neil Versel

Just like digital/wireless/mobile health eventually will just be called “health,” telemedicine will soon just be another part of medicine.

So said Dr. Jay Sanders, widely known as the “Father of Telemedicine.” He’s been involved in the field since his residency at Massachusetts General Hospital in the late 1960s.

“We’re going to get rid of the term ‘telemedicine,'” Sanders said in a video interview with MedCity News. Instead, remote care is going to become routine, which makes sense because the home is a better place for examining patients because clinics are sterile environments, according to Sanders.