By Dr. Stephen Schimpff, author of The Future of Medicine - Mega Trends in Healthcare 

E-medicine will have a wide, growing and very important place in the delivery of health care in the years to come. By e-medicine I refer to simple approaches like email all the way to the very complex telesurgery done remotely across continents with a robot.

There are many hurdles, not the least of which are funding and reimbursement. For example, most physicians do not like to use email with their patients because the time invested is not reimbursed by insurance. Too bad because email can save visits to the doctor, speed up diagnosis and therapy and reduce the overall cost of care while improving quality. The same goes for wireless devices such as a digital scale used by the patient with heart failure. Every morning his weight is transmitted to the doctor's office. An algorithm notifies the staff if the weight is rising, perhaps suggesting the need for a medication modification. This can prevent an office visit or even a trip to the emergency room or admission to the hospital. Similar wireless technologies can be used for observing blood sugar among diabetics; but again, no reimbursement so these technologies are not yet finding their maximum value.

An approach that is gaining acceptance is the virtual ICU. Here the intensivist is present some of the time but virtually all of the time. One physician can monitor many ICU beds in multiple hospitals from a central location. He can "see" the patient via camera, inspect the monitor outputs, read the laboratory results and do a virtual exam with the electronic stethoscope. The result is better care since most ICUs today do not have intensivists in house 24/7, with fewer complications and shorter lengths of stay along with reduced costs.

E-prescriptions mean that the doctor can send the message directly to the patient's preferred pharmacy so that the drug is available by the time the patient gets there. It cuts down on handwriting errors and allows for feedback between physician and pharmacist over issues like generic versus branded medication, possibilities of side effects or drug-drug interactions and the cost of this drug versus another approach.

E-notifications are a reverse communication approach. It is a way for the physician to contact the patient with pertinent information. Perhaps it is a reminder to follow exactly the drug regimen prescribed. Or it is information on managing for a specific condition, such as diabetes foot care. This can be an excellent technique for good continuing contact between doctor and patient, especially when the care plan is complex.

Once some of the reimbursement issues get resolved, e-medicine will rapidly proliferate. Until then, it will be used by the leading edge of medical practioneers or those in settings such as the military where reimbursement is not relevant. 

Dr. Stephen C. Schimpff is the author of The Future of Medicine - Mega Trends in Healthcare, which explains the science behind what's happening on the medical frontier in layman's terms - and shows readers how to make the most of it now. You can also read Dr. Schimpff's running commentary on health care reform and the delivery of medical care over at his blog, Medical Mega Trends.