TelehealthTeam Members:Sukhjinder KaurMelissa JohnsonOluyemisi IbekwehCiji Jones8 June 2013
Introduction• Telehealth is the use of telecommunications technologies to deliverhealth-related services and information that support patient care,administrative activities, and health education. Telehealth is beingtouted as a means to improve access to care, while reducing costs oftransportation and increasing /convenience to patients in obtainingcare. Access to care is an issue in regions where physician-to-patientratios are inadequate, or where there are not enough medicalspecialists available to meet the population’s needs. As such, it hasbecome a key component of multifaceted strategies to improvehealth service delivery in medically underserved areas in both ruraland urban settings. When patients are better able to access medicalcare, they can have acute conditions treated locally, receivetreatment for medical problems before they become critical, andreceive care to better manage chronic conditions. Telehealth isexpansion of telemedicine with preventive, promotive and curativemedication widely used by members of health care community. TheAmerican Nurses Association (1996) prefers the term telehealth asinclusive and accurate description of services provided.
Definitions Of Telehealth• "The use of communications and information technology todeliver health services and exchange health information whendistance separates the participants." (Elford, 1998)• “Telehealth is understood to mean the integration oftelecommunication systems into the practice of protectingand promoting health while telemedicine is the incorporationof these systems into curative medicine.” (WHO 1997)
History of Telehealth in U.S.• Telehealth began with the use of telephone consults.• During last five decades, U.S. government played a major rolein development and promotion of Telehealth through variousagencies.• The most aggressive development of Telehealth in the U.S. hasbeen by NASA and the military.• Telehealth is commonly used to treat prisoners, avoiding thecosts and danger of transporting prisoners.• The U.S. may lead in the development of Telehealth, butAustralia, Canada, Norway, and Sweden are among the currentworld leaders in the use of Telehealth.
Four Areas of TelehealthTeleConsultations TeleEducationHomeTelehealth TeleTriage(poole,2007)
Benefits of Telehealth• Benefits - PatientImproved access to medical specialistsQuicker , more accurate diagnosis and treatment --->improved patient outcomes• Benefits – Central Health Care ProviderDecreased need to travel - "see patients, not the road"Improved screening of patients• Benefits - Health Care PayerDecreased overall health care costs (per patient)Human resources are used more efficiently, "Do morewith less"Improved patient outcomes
The Need for Telehealth• Clinical shortage• Misdistribution of providers• Rural/urban underserved• Aging population• Travel, time, cost and hardship• Delayed treatments• Language barriers• Clinical education programs• Administrative meetings
Challenges to using Telehealth• Regulatory barriers• Costs for equipment, network services, and training time• Fear of healthcare system changes• Lack of acceptance by healthcare professionals• Lack of acceptance by user• Lack of reimbursement of consultative services
The Different TechnologiesUsed for Telehealth• Telephones• videophones• personal computers (PCs)• videoconferencing systems• store and forward systems (S&F)• specialized telemedicine workstations.
Basic Desktop VideoconferencingComponents for Healthcare Application• Pc• Pc adapter cards• Camera• Microphones• Video overlay cards• External speakers on existing PCs with broadbandswitches
Modes of Telehealth• Store and forward telehealth. All clinical data (vital signs, audio, video,digital images ) are captured on client computer or mobile device storedand transmitted securely to another location where they are thenstudied by clinicians who make correlations and prescribe treatmentbased on their findings. This mode is used in areas where an immediateresponse is not critical to patient care, e.g. dermatology, some radiologyand pathology.• Real time telehealth. “Here, a telecommunications link allows forinstantaneous interaction” between all involved in real-time.Videoconferencing being one of the most common form of this method.This mode is frequently used in cardiology, dentistry, mental health,home health, neurology, radiology nursing and rehabilitation.• Remote patient monitoring. In this mode, “the patient has a centralsystem that feeds information from sensors and monitoring equipment ,e.g. blood pressure monitors, glucometers, scales, to an externalmonitoring center” which can be done in either real-time, or store andforward. This mode is frequently used in home health for diseaseprocess management like Renal failure requiring home dialysis, COPD,CHF, and Diabetes.
Peripheral Devices• Otoscope: This device allows images from the ear, nose andthroat to be captured and transmitted to a distant site forreview.• Electronic stethoscope: This device allows heart, lung andbowel sounds to be captured and transmitted to a distant sitefor review.• General exam camera: This device can be used for multiplepurposes such as capturing gross pictures of the ear, throatand skin.
Tele-health in Action• With tele-health, providers are able to have face to faceassessment time with patients.• They are able to use the different peripheral devices to hearheart sounds, listen to lung sounds, and assess other areaswithout actually being with the patient.
Impact on Nursing• Nurses can find themselves in a variety of tele-health related jobs.• Tele-health nurses take on more of a leadership role.• Nurses employed from home or other settings screen calls, offeringexpert healthcare advise and make necessary referrals.• Nurses who work in telehealth must have excellent communicationskills, often the nurse becomes a life line to the patients.• Good assessment skills and nursing judgment are essential for nurses intelehealth related jobs.• More and More telehealth clinics are opening across the United States.• Tele-health clinic are often run by nurses, with remote access todoctors.• Another area of telehealth that utilizes nurses is home monitoring,often the equipment is set up and reviewed with the client bynurses. Nurses can monitor data and relay vital information todoctors.
Strategies to EnsureSuccessful Teleconferences• Select a videoconferencing system to fit your needs, such as a desktop or mobilesystem or customized room.• Locate videoconferencing facilities near where they will be used, yet in a quiet,low-traffic area.• Schedule sessions in advance to avoid time conflicts. Start on time.• Establish a working knowledge of interactive conferencing features.• Provide an agenda to keep the conference on track.• Introduce all participants.• Set time limits.• Send materials needed in advance to maintain focus and involve participants.• Summarize major points at the conclusion.• Start by asking all participants if they have a good audio and video feed.• Participate in a conference call as if it were a face-to-face meeting. Enunciateclearly.• Minimize background noise or use the mute future.• Promote interactivity through questions and answers.• Have technical support available to resolve any problems that might arise
Future of Telehealth• In the future there maybe penaltiesfor not utilizing telehealthtreatment, verses inpatienttreatment.• More consumer demand will pushto bring telehealth main stream.• Government funding will increase.• The development of moretelehealth clinics, will allowindividuals in rural areas access tospecialist• Medical specialist predict thattelehealth will become a standardof care.• The definition of telehealth willbroaden in order to include moreaspects of care.
References:• AHRQ (Agency for Healthcare Research and Quality). Retrieved from www.healthit.ahrq.org• Digital telehealth incorporated by Dr. Rod Elford. Retrieved from www.telhealth.ca• Elford, Dr. R (2004). Digital telehealth incorporated. Retrieved fromhttp://www.telehealth.ca/intrototelehealth.html• Hebda,T.& Czar,P. (2009) Handbook of Informatics for Nurses & Healthcare Professionals.(5th Edition). Prentice Hall.• How Concordia Visiting Nurses Telehealth Technology Works. May 25, 2012. YouTube video.Retrieved from http://www.youtube.com/watch?v=9vDV9zsvHOE• Infinity Rehab (January 25, 2012). Infinity rehab advances patient care with Tele-health.Retrieved fromhttp://www.infinityrehab.com/blog/2012/01/25/infinity-rehab-advances-patient-care-with-telehealth/• Poole, L (2007) An Overview of history and current status of telehealth in Canada. Retrievedfrom www.inet-international.com• Telehealth. Retrieved from Wikipedia.Org http://en.wikipedia.org/wiki/Telehealth• University of Kentucky (July 4, 2011). Kentucky P20 innovation lab. Retrieved fromhttp://p20.education.uky.edu/labs/telehealth-lab/