2. DEFINITION
The use of technology (telecommunication
and electronic devices) to coordinate health
services and information between
healthcare providers and patients
Services include health promotion, disease
prevention, diagnosis, consultation,
education and therapy
Overcomes social, economic and
geographical barriers to healthcare
Electronic, visual and audio capabilities
3. BACKGROUND
Initial uses were telephone calls between healthcare providers, patients
and hospitals
With the advancements of technology the practice grew
NASA and the U.S. military have been the most aggressive in the
advancement of the technology
Prison systems use to prevent the cost and dangers of transporting
prisoners
Telepsychology is a huge benefit to rural areas that are unable to attain
round-the-clock psychiatric care for patients
The Telecommunications Act of 1996
The American Recovery and Reinvestment Act of 2009
Allows vendors of cable and telephone services to compete in each others’
markets
Requires carriers to offer same rates and services to urban and rural
providers so that it is affordable in all areas
Funding for research, operations and grants in telemedicine, telehealth and
informatics
Australia, Canada, Norway and Sweden are the current leaders in the
use of telehealth, and have already achieved great strides in this area
4. DRIVING FORCES
SAFETY, ACCESSIBILITY, COST EFFECTIVENESS
Improved access to providers that allows earlier
treatment
Care and treatment in the patient’s own home and
community
More expert advice is available
Convenient follow-up care
Improved record keeping of vital signs, blood sugar
readings, wound images
Healthcare provider time saving, allowing more
time for patient care and less time traveling
5. ONLINE DATABASES AND TOOLS
Patients
-Education
-Drug information
-Record Keeping
-Home health
-Disease management
-Support Groups
-Referrals
Healthcare providers
-Standards of Care
-Evidence-based Practice
guidelines
-Computerized diagnoses
-Drug information
-Retrieval of literature
-Bulletin Boards, discussion
groups
-Continuing Education
7. EXAMPLES OF TELEHEALTH USES CONTINUED
An I-phone app that allows reading and reporting of O2 Sat readings
8. EXAMPLE OF TELERADIOLOGY
Example from Onepacs.com
X-rays, Cat Scans, MRI’s taken at local hospital, images are
transmitted to a radiologist on duty 24 hours a day. The radiologist
types in the results, then e-mails or faxes back to the local hospital.
9. TELENURSING
Telephone and faxes have been in use for
decades between nurses and other healthcare
providers
Home visits via telephone and internet visits
allow for more seen patients daily vs. traveling
to homes in person
Follow up calls from ER visits/Hospital
admissions
Dial-A-Nurse, nurse helplines
10. BENEFITS OF TELEHEALTH
Continuity of care
Centralized health records
Patients living away from major population centers or in economically disadvantaged areas can access care more
readily
May lower costs for healthcare
Access to care & access to specialists is improved
Removes geographic barriers to care
Offerings readily available
Higher quality of care
Experts are readily available
Education of healthcare consumers & professionals
Cooperation is fostered among interdisciplinary members of the healthcare team
Improved decision making
The patient is an active participant in videoconferences
Collaboration among healthcare providers
Patients remain in the same healthcare system
Incorporation of the health consumer as an active member of the health team
Patients can stay in the community & use their regular healthcare providers
Eliminates travel costs
Patients are seen earlier when they are not ill
Treatment may take place in local hospitals, which are less costly
Improved quality of health records
The record contains digitalized records of diagnostic tests, biometric measures, photographs, and communication
Hebda & Czar, 2013, p. 510
12. APPLICATIONS OF TELEHEALTH
Ambulatory care settings
Cardiology
EMTs & nurses at the site of a disaster can consult with physicians about the health needs of victims
Education
Patients may report blood glucose readings by using the touch-tone telephone
Mobile unit post-disaster care
Primary physicians may ask specialists to see a patient without the patient waiting for an appointment with the
specialist and traveling to a distant site
Diabetes management
Research may be conducted on large databases for educational, diagnostic, cost/benefit analysis, and evidencebased practice
Dermatology
Patients may be seen at home or in outpatient settings by a counselor at another site
Data mining
ECG strips can be transmitted for interpretation by experts at a regional referral center, and pacemakers can be reset
from a remote location
Counselling
Patients are connected with automated systems to monitor medication adverse events & medication non-adherence
Clinicians have real-tine information on a patient’s experience with medications
Healthcare professionals in geographically remote areas can attend seminars to update their knowledge without
extensive travel, expense, or time away from home
Emergency care
Community hospitals can share information with trauma centers so that the centers can better care for patients &
prepare them for transport
Hebda & Czar, 2013, p. 510
13. APPLICATIONS OF TELEHEALTH
Fetal monitoring
Geriatrics
Palliative and end-of-life services via technology can increase access to services in remote
areas or supplement traditional care
Military
Once equipment is in the patient’s home, nurses & physicians may evaluate the patient in home
without leaving their offices
Hospice
Patients receive automated reminders & education feedback regarding hypertension treatment
guidelines
Home care
Videoconference equipment in the home permits home monitoring of medication administration
for a patient who has memory deficits but who is otherwise able to stay at home
Hypertension management
Some high-risk antepartum patients can be monitored from home with greater comfort &
decreased expense
Physicians at remote sites can evaluate injured soldiers in the field via the medic’s equipment
Pharmacy
Data can be accessed at a centralized location
Hebda & Czar, 2013, p. 510
14. APPLICATIONS OF TELEHEALTH
Pathology
Psychiatry
Social workers can augment services with telehealth home visits
Virtual intensive care units
School nurses, particularly in remote areas, can quickly consult with other professionals about
problems observed
Social work
Radiologists can take calls from home and receive images from the hospital
School clinics
Specialists at major medical centers can evaluate patients in outlying emergency departments,
hospitals, and clinics via teleconferences
Radiology
The transmission of slide and tissue samples to other sites make it easier to obtain a second
opinion on biopsy findings
Remote monitoring capabilities and teleconferencing allowing experts at medical centers to monitor
patients in distant, rural hospitals, particularly when weather conditions or other factors do not allow
transport
Extended emergency services
Remote monitoring and teleconferencing support allow emergency care physicians to view and
monitor ambulance patients, supervise EMTs, initiate treatments early and redirect patients to the
most appropriate facilities, such as burn centers or trauma units, without being seen first in the
emergency department
Hebda & Czar, 2013, p. 510
15. BARRIERS TO TELEHEALTH
Regulatory barriers
Lack of reimbursement for consultative services
Personnel may fear job loss as more patients can be treated at home & hospital units close
Lack of acceptance by healthcare professionals
Equipment capable of transmitting and receiving diagnostic grade images is still expensive,
although costs are declining
Fear of healthcare system changes
Most third party payers do not provide reimbursement unless the patient is seen in person
Costs for equipment, network services, and training time
State laws are either unclear or may forbid practice across state lines
This may stem from liability concerns & discomfort over not seeing a patient face-to-face
Lack of acceptance by users
This may stem from discomfort with technology, the relationship with the provider, & concerns
over security of information & confidentiality
Hebda & Czar, 2013, p. 516
16. WHAT WILL WE SEE IN THE FUTURE?
New ways to access healthcare
New ways to communicate with and monitor
patients
Improved reimbursements from insurance to
insure the survivability of the programs
Improved licensure availability and privacy
Many international and national organizations
(FCC, National Institute for Nursing Research,
etc…) are putting more money and resources into
this area for growth and expansion of these areas
17. REFERENCES
Agency for Healthcare Research and Quality. (n.d.).
http://psnet.ahrq.gov/primer.aspx?primerID=9
Great Plains Telehealth Resource and Assistance Center. (2012, May 30).
Telemedicine consultation example [Video file]. Retrieved from
https://www.youtube.com/watch?v=y5IB1BZGlnA
Hebda, T., & Czar, P. (2013). Handbook of Informatics for Nurses and Healthcare
Professionals (5th ed.). Upper Saddle River, NJ: Pearson Education, Inc.
Masimo Corporation. (2013, March 8). iSpO2 Pulse Oximeter from Masimo [Video
file]. Retrieved from http://www.youtube.com/v/pE-gm0s5J3E
National Center for Biotechnology website. (2007).
http://www.ncbi.nlm.nih.gov/pubmed/17672809
Streitfeld, J. (2012, June 04). Why Telehealth Services Can Remedy Healthcare
Deficiencies. Retrieved November 26, 2012, from
Excalibur Blog:
http://www.excaliburmed.com/teleradiology- telehealth-blog/bid/142123/
