What's holding up the telemedicine explosion?

The future of telemedicine looks bright, but only if telecommunications service providers and health care providers can work together to make the best use of integrated technology, according to a market assessment from Siemens Telecom Networks.

Although analysts predicted the telemedicine market would be bigger than it is now, a better understanding of the needs of health care practitioners is behind new projections that the market will rise to $2 billion by 2001.

"The key is for service providers to use the new broadband infrastructure being deployed today to better meet the needs of health care in general," said Grant Henderson, director of product marketing for Starvision, a company that makes products for videoconferencing over broadband networks. Starvision is one of two companies that have partnered with Siemens' Telecom Networks division to offer its MainStreetXpress health care solution.

Telemedicine is a broad term for several facets of medical care. Collaborative videoconferences between sites, on-line access to patient records, medical libraries and databases, and continuing medical education all fall under the term, said Dan Floyd, senior product manager at Siemens.

"Telemedicine as a term has been used and abused so that now it brings to mind everything from sending a file by e-mail to tele-surgery," he said. "And it's still an emerging market."

What Siemens Telecom Networks offers in the MainStreetXpress family of products includes the 36150 asynchronous transfer mode access switch, which supports LAN interconnect and customer premises ATM DS-3/OC-3 access to the broadband network. A second switch, the 36170 ATM multiservices switch also supports frame relay, ATM and T-1 line circuit emulation connections. Along with Starvision, Newbridge Networks supplies enterprise networking equipment to complete the Siemens partnership and give the service provider a total telemedicine solution.

Most telemedicine programs today are either simple store-and-forward systems or ISDN videoconferencing systems adapted for use in a health care setting. Because of these kinds of arrangements, service providers are perceived to have little or no role in telemedicine today, the Siemens market assessment found. Such focus on the front end ignores the potential for a service provider to become an integral part of a telemedicine program.

For example, by creating a virtual private network with the Siemens solution, a cardiologist could bring students at a remote medical school up to date on new techniques through a teaching session held at his office.

"Because there is a Web scheduler, the connection would just be made at the scheduled time rather than having the cardiologist also become proficient at technology and initiate the call himself," said Henderson. "And he would have the use of full rotating video, CD-quality audio and an electronic white board he can write on. If you don't give the doctors something like a board that they are familiar with, they will resist the technology."

A telemedicine network can be used for many kinds of conferences, including administrative, telebusiness discussions and demonstrations, Floyd said.

"Telemedicine is an exciting and dynamic field that is evolving from simple solutions to tools developed specifically for health care," he said, pointing to telepathology and teleradiology as examples.

Recently, telemedicine got a push from the state legislature of California, which passed a Telemedicine Development Act dealing with several issues, including payment for doctors who give consultations via video. "That act is being looked at as a model by other states," Henderson said.

Now all that's needed is for service providers to develop an end-to-end solution that suits the needs of telemedicine program directors, health care provides, patient end users and vendors, the market assessment concluded.

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