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Patient care goes paperless as telemedicine moves mainstream.


A patient with lung cancer walks into a rural ambulatory oncology clinic reporting increasing dyspnea, cough, and weakness since receiving his treatment two weeks ago at an academic cancer center. The nurse triages the patient and contacts the oncologist on call. The oncologist at the ambulatory clinic is unfamiliar with the patient because treatment was rendered at a major cancer center 200 miles away.

The patient cannot recall his regimen, leading the local oncologist to a computer to retrieve significant data from the patient's electronic medical record card, which houses medical history, dates and dosages of treatment regimens, and any previous diagnostic results. Thanks to telemedicine, the evidence of the patient's history is at the oncologist's fingertips, and the patient is promptly admitted for management of pleural effusion.

According to the American Telemedicine Association ([ATA], 2007), telemedicine is "the use of medical information exchanged from one site to another via electronic communications to improve patients' health status." An associated term is telehealth, which encompasses a broader definition of remote health care that does not always involve clinical services. Videoconferencing, transmission of still images, ehealth that includes patient portals, remote monitoring of vital signs, continuing medical education, and nursing call centers all are considered part of telemedicine.

Telemedicine has the potential to impact the lives of patients with cancer. A pilot study was conducted to assess psychological treatment for rural people with cancer (N = 25) delivered entirely via videoconferencing (Shepherd et al., 2006). Preliminary results demonstrated that patients benefited in terms of anxiety and quality of life and that the intervention was feasible and acceptable.

Another pilot study looked at evaluating patient and physician acceptance of subspecialty oncologic teleconsultation for distant communities (Weinerman, Den-Duyf, Hughes, & Robertson, 2005). One group (n = 30) participated in the videoconferencing arm, and the other group (n = 30) was evaluated face to face. Patients and oncologists completed satisfaction questionnaires. No difference was observed in patient satisfaction whether patients were seen via videoconferencing or in person. Moreover, patients were very satisfied with teleconsultation, and it saved them several hours of travel.

Several examples of telemedicine include consultation services (diagnostic imaging, medical data), remote patient monitoring (electrocardiogram, blood glucose), medical and nursing education (seminars, Web conferencing), and access to consumer and health information via the Internet. ATA (2007) estimated that the total amount of federal grants and contracts for telemedicine in 2003 was approximately $270 million.

More information on telemedicine is available from National Telehealth Resource Centers (, which assist healthcare organizations, networks, and providers in the implementation of cost-effective telehealth programs to serve rural and medically underserved areas and populations.

American Telemedicine Association. (2007). ATA defining telemedicine. Retrieved October 8, 2007, from

Shepherd, L., Goldstein, D., Whitford, H., Thewes, B., Brummel, V., & Hicks, M. (2006). The utility of videoconferencing to provide innovative delivery of psychological treatment for rural cancer patients: Results of a pilot study. Journal of Pain and Symptom Management, 32, 453-461.

Weinerman, B., Den-Duyf, J., Hughes, A., & Robertson, S. (2005). Can sub-specialty cancer consultations be delivered to communities using modern technology? A pilot study. Telemedicine and e-Health, 11, 608-615.

Michele E. Gaguski, MSN, RN, AOCN[R], CHPN, APN-C

Contributing Editor Michele E. Gaguski, MSN, RN, AOCN[R], CHPN, APN-C, is an oncology clinical nurse specialist in oncology services at Ocean Medical Center in Brick, NJ.
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Title Annotation:A CLOSER LOOK
Author:Gaguski, Michele E.
Publication:ONS Connect
Geographic Code:1USA
Date:Dec 1, 2007
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