The amendment to the Medical Service Act that codifies telemedicine recently passed the National Assembly. Telemedicine, which operated temporarily during the COVID-19 period, has been incorporated into the formal system and is set to launch in earnest. North America has already used phone- and video-based remote care as part of routine medicine for decades. We visited the United States to see how it works on the ground. [Editor's note]
"If a student is injured during PE class, they can receive remote care from a doctor from the school nurse's office."
On the 25th (local time) of last month at Children's National Hospital. Karen Smith, chief medical director, said the hospital provides telemedicine in coordination with local schools. A sick student at school can receive a prescription from a Children's National Hospital doctor via camera in the nurse's office.
Parents usually panic when a child is hurt. Many rush from work to school and then take the child to the hospital. Telemedicine has reduced this hassle for parents and children. It is that convenient.
◇ Even if injured in PE, care is remote… observed like a "patient critical" control center
In the late 1950s, psychiatrists in the United States began caring for patients via video. In 1997, Medicare (public health insurance for those 65 and older) began covering telehealth, spurring the expansion of telemedicine across specialties. Now, doctors examine patients not only by phone but also by video.
At Children's National Hospital, a large hot-air balloon floated from the ceiling and about 10 people were waiting in the lobby. Compared with the pediatric care crunch at home, the atmosphere was calm.
Tejal Raichura, telehealth director, said, "Washington is the capital, so the infrastructure is good, but there are also areas far from hospitals where visits are difficult," and added, "Regardless of location, children can receive remote care at school." She also said, "Seventy-five percent of students receive remote care in the nurse's office and return to class."
The hospital not only connects with schools but also remotely monitors inpatients on the wards. That is because it has created a separate Telehealth Command Center within the hospital.
Opening the door, it looked like an air traffic control center. Dozens of screens showed ward footage, and graphs of patients' oxygen saturation levels moved constantly. Medical staff watch ward patients from here and alert the attending physician if signs of trouble are detected.
For example, if a patient's oxygen saturation falls from the 85% baseline down to 30%, they respond immediately. If low oxygen saturation persists, insufficient oxygen supply to the brain can cause problems such as cognitive decline. This is when they keep to the golden time and prevent deterioration.
Alejandro Jose Lopez Magallon, a specialist, said, "The ultimate goal of the Telehealth Command Center is to prevent patient emergencies," and added, "There are clinicians (at the patient's side) on the wards as well, so it's important to collaborate with them."
◇ Cutting ER wait times… "Within 10 miles, 藥 delivered the same day"
In the United States, patients also receive telemedicine in the emergency room. In the emergency room at MedStar Washington Hospital Center the previous day, there was a black tablet PC.
If the wait is long, patients can be seen quickly via a tablet PC by a doctor located elsewhere, such as at home. A nurse on site decides whether a patient uses telemedicine. Doctors in the United States can work from home.
Ethan Booker, chief of telehealth at MedStar Washington Hospital Center, said, "Last year alone, there were more than 520,000 telemedicine visits," and added, "Sixteen percent of primary care visits are remote."
Of course, patients can also receive care from home. Because it can be difficult for those 85 and older to visit the hospital, there is a program in which nurses visit homes. Nurses help with tablet PC consolidation and other setup. In addition, specialists in emergency medicine, orthopedics, and other fields provide remote consultations to other hospitals.
MedStar Washington Hospital Center has a pharmacy that operates from 9 a.m. to 6 p.m. on weekdays. When a doctor sends an e-prescription, the pharmacy ships the medication to the patient. In Korea, as the amendment to the Medical Service Act recently passed the National Assembly, residents of islands and remote areas and people with disabilities can now receive medication by delivery. Patients can also receive paper prescriptions at the hospital or go to a pharmacy to pick up their medication.
Katia Phillips, a pharmacy staffer, said, "When patients are discharged after surgery, they can choose how to receive their medication," and added, "We deliver to the location the patient wants, with same-day or next-day delivery within 10 miles (16 km), and 2–3 days for farther areas."
She said, "For medications that require refrigeration, we control the temperature and, for safety, obtain a signature when the patient receives the medication," and added, "We also provide bedside delivery for inpatients."