Abstract
The largest obstacle to telemedicine deployment is the lack of well controlled studies validating the safety and efficacy of this type of physician-patient encounter. These studies will eventually lead to clinical acceptance and the codes for reimbursement. The second largest obstacle for telemedicine is validating the change from live, three-dimensional viewing to a two-dimensional image on a monitor. In otolaryngology, video protocols need to be standardized for flexible nasopharyngolaryngoscopy and laryngostroboscopy. Because these are already commonly viewed on a two-dimensional monitor in the live setting, reimbursement could follow for these portions of the examination in a store-and-forward format. Viewing images of the tympanic membrane will be more challenging because the resolution of binocular microscopy will be difficult to duplicate. However, if telemedicine images can safely determine the difference between a normal and abnormal tympanic membrane, patients with an abnormal image can be triaged for a live visit.
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