By 1999, however, that number jumped to more than 75,000, according to the Association of Telehealth Service Providers. And those figures don't include tele-radiology and home health care applications, which remain untracked. But still, there are obstacles. Sites that do have ISDN lines are not immune to computer glitches, power failures or connection problems. And hospitals need to have skilled technical support to operate their telecommunications equipment.
Equipment is expensive.
And providers also must pay fees for every minute the telephone lines are in use during a consult. Many specialists have also had difficulty getting reimbursed by insurers for their time spent giving a telemedicine consultation. Currently, the Visiting Nurses Association in Sonora, which checks in on 40 of its home-bound patients via the Internet, isn't paid a penny for its cyberspace monitoring. And some have questioned whether the impersonal technology used in telemedicine negatively alters the relationship between physicians and their patients. Health care providers aren't used to providing medicine through a computer terminal.