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Telemedicine is the use of medical information exchanged from one site to another via electronic communications for the purpose of improving a patient’s health. Closely associated with telemedicine is the term “telehealth,” which is often used to encompass a broader definition of remote health care that does not always involve clinical services. The following are all considered part of telemedicine and telehealth:21
- Transmission of still images.
- E-health including patient portals.
- Remote monitoring of vital signs.
- Continuing medical education.
- Nursing call centers.
The use of telemedicine and telehealth is becoming routine in many areas of medicine, from neurology to critical care pediatrics to dermatology. To date, the application of telemedicine in health care settings generally suggests an improvement in a patient’s care. One area in which telemedicine stands out as particularly effective is in its response to patient care in rural communities.22 Rural communities have been documented as having significant inequities in health care as compared with urban communities, particularly regarding a patient’s access to specialty care.23 Given the special needs of sexual assault patients and the limited access to trained providers in rural areas, greater access to telemedicine resources could prove especially useful for these victims.
Various telemedicine approaches have been used in the field of child maltreatment, specifically child sexual abuse, for some time.24 Telemedicine provides a menu of possible uses for the clinician caring for sexual assault patients.
- Second opinion on the sexual assault examination and its findings (live and post-exam).
- Peer review for clinicians.
- Quality assurance for both clinicians and patients.
- Education of colleagues.
- Education of patients.
The cost of implementing a telemedicine program in a health care system varies dramatically. It depends on what the system wants to do, what resources are already available, and what resources must be outsourced. Fees can range from nominal to millions of dollars. Research suggests that implementing telemedicine approaches for specific patient populations can be cost effective,25 or not.26 A literature review of 33 economic evaluations in which both cost and outcome were measured showed highly diverse study contexts and methods, with a final recommendation for further research using standard evaluation techniques.27
In addition to cost, the prospect of telemedicine may bring resistance from clinicians.28 Education regarding how to use telemedicine appropriately and competency training, particularly when use is expected to be infrequent, are key to success.
The use of telemedicine specifically for sexual assault victims will need further research and discussion to determine
- Funding opportunities.
- Criminal justice implications.
- Clinicians’ educational needs.
In fact, telemedicine could assist with educating clinicians and responding to the shortage of Sexual Assault Forensic Examiners in rural and tribal areas. Even when trainers have been brought in, clinicians frequently have no opportunity to obtain the necessary post-didactic clinical hours because of the area’s limited number of patients. Telemedicine could dramatically alter this and allow for ongoing training as well as technical assistance for the examiner working in underserved communities.