The document discusses telehealth as the delivery of health-related services via telecommunications, emphasizing its growth and applications, particularly for the elderly and those in rural areas. It details the evolution of telehealth technology, regulatory challenges, and the pros and cons from a nursing perspective. The conclusion highlights that while telehealth can improve health equity and be cost-effective for certain services, it also raises concerns regarding malpractice liability and the need for comprehensive economic analyses.

1. Tele health the cutting edge of healthcare
Darlene Cunningham
Rachel Driscoll
Amber Swanger
Vida Milligan-Shangoo
Alondrea Hill
Tara Stewart
Jacksonville University

2. Abstract
Tele health is defined as the delivery of health-related services and information via telecommunications
technology for clinical and non-clinical purposes and encompasses telelmedicine (Healthcare Intelligent
Network, 2015).
There are many healthcare organizations that are currently using tele health. Tele health targets the elderly
population, those living in remote, poor, and rural areas. This power point will discuss the origination of tele
health, the different types, laws and regulations, pros and cons as well as the liabilities with tele health as it
relates to malpractice. There are many organizations that are turning to Tele health to lower costs and improve
efficiencies while expanding patients’ access to services – particularly in rural areas (Healthcare Intelligent
Network, 2015). Furthermore, telecommunication technology delivers clinical diagnosis, services and patient
consultations.

3. What is Tele
health?
Tele health uses communication and information technology to provide excellence in health care delivery to
the nation’s veterans. The term means using technology to provide clinical care and patient education when the
patient providers are in separate locations.
Tele health began more than 50 years ago, in 1960, TLC began installing and financing hotel and hospital
television systems throughout the US and had emerged as one of the leading companies serving the hospitality
and healthcare industries by the late 1970s. In 1984, TLC created the Tele Health Services division to focus
exclusively on healthcare television systems. Tele Health Services’ product line included one of the first
computer-based interactive systems, the Tele Computer (N.A., 2015).
Since its inception, Tele Health has been an innovator in custom-engineering televisions and other
technologies to meet the ever-changing needs of hospitals. Tele Health partnered with DIRECTV in 1997 to
expand hospital channel line-ups and reduce costs. That same year, Tele Health became the exclusive US
distributor of the Philips healthcare televisions (N.A., 2015).
Tele health and the Origination

4. Tele health and the Origination
In 2006, Tele Health acquired Hospital Communication Systems, and in 2008 Tele Health Services acquired Instant
Health Line, the second-largest hospital educational television company in the United States. In 2010, Tele Health
Services partnered with Samsung Electronic America, Inc. to design and market Samsung’s ground-breaking healthcare
TVs to hospitals (N.A., 2015).
In 2012, Tele Health Services launched and installed its iTigr interactive system. The iTigr system expands upon
Tigr’s “pull” system, meaning information is “pulled” by the user, to being a “push” system, meaning that information can
be “pushed” specifically to a patient. The iTigr system provides advanced care plan, management tools with workflow and
integration capabilities for hospitals. Tele Health's full suite of patient systems, the scalability of the Tigr and iTigr
platforms, and its long-standing leadership position in the industry allows Tele Health to assure hospitals the best value
and operability in system and secure effectiveness and efficiency (N.A., 2015).

5. The Regulations Governing Tele health
Telemedicine and Tele health have some legal and privacy issues such as reimbursement
and licensure. Two of the major barriers to the growth and practice of health are
inconsistency with reimbursement when it comes to integration of tele health. The
insufficient payment affects payment, resources and policies (Hebda & Czar, 2013). Some
rules about tele health are:
Physician must see their patients face to face at least once before commencing with any
online healthcare for this builds a good rapport with the patient and a pleasant atmosphere.
Physician’s who have done this makes the patients feel more at ease under his/her care.
State regulatory barriers state laws are either unclear or may forbid practice across stated
lines unless there is an exception provision within it licensure laws. Accreditation and
regulation requirements according to the JACHO practitioners are required to be
credentialed and have privilege at the site where the client is located (Hebda & Czar, 2013).

6. Who is the targeted population ?
Rural Areas
Elderly
People served at rural low income clinics

7. Tele health targets the elderly population, those living in remote, poor, and rural
areas.
Levels of tele health:
• Level 1 – using emails or faxes to transfer medical data over telephone lines;
• Level 2 – transmitting still images or “store and forward” information such as
electrocardiogram strips, pathology slides and/or x-rays;
• Level 3 – transmitting synchronous, interactive, audio-visual communications.
This requires satellite, telephone and microwave or internet technology; (N.A.,
2015).
Tele health interventions are based on patients or professionals obtaining an opinion
on treatment or care from someone who is more experienced or an expert in a
particular field. Accordingly, tele health interventions could be classified on the
basis of the type of interaction and information transmitted between patients and
professionals (N.A., 2015).
Target Populations and Levels and types of Tele health

8. Impact of Tele health on Healthcare
Pediatrician visits from the
comfort of your home.
Tele health impacts healthcare by increasing the communication between patient and the healthcare
provider via phone, email, video transmission and conferencing and remote monitoring systems. The
health providers are able to receive and access patient information, such as labs, EKG and view x-rays,
anywhere on smart phones, iPads, and laptops (Hebda & Czar, 2013). Additionally, the “web-base disease
management programs encourage clients to assume greater responsibility for their own care.” (Hebda &
Czar, 2013).
• Reducing inappropriate visits to high cost setting, such has ER.
• Reduce cost of managing chronic patient population.
• Reduce unnecessary care requested by patients.
Remote monitoring of patients, such as elderly patients in their home, notifying a caregiver or
healthcare provider if activities of patient change or of a fall. It impacts health care by transcending
geographical boundaries by using GPS to direct rescue/ambulance to the nearest trauma, heart or stroke
facility for patient treatment (Hebda & Czar, 2013).

9. Impact of Tele health on Patients
Further impacts as it relates to patients is that it reduces cost, less travel time, and less wait time
because appointments are made online. Less travel time is due to the population ability to be seen at the
local health clinics by using tele health (Hebda & Czar, 2013).
.

10. Pros and Cons from a Nurses’ Prospective
Pros
 Patients can be treated at home without traveling to a clinic.
 Nurses can monitor process/deterioration and discuss treatment via telephone and liaise
with other team members.
 Cuts down clinic list.
 Saves time and effort and is therefore cost effective (Field, 2006).
Cons
 Quality of picture;
 Not knowing the exact location of the wound;
 Unable to assess the cause, for example, mattress, toilet
seat, shower chair, transfers;
 Unable to assess home environment;
 No networking (Field, 1996).

11. Tele health Malpractice and Liability
For tele health “face-to-face” encounters involving direct care of patients, most medical malpractice
insurance covers only “face to face” encounters within the State in which the doctors practice and is
licensed. Doctors who provide tele health services to patients outside of the State in which they are
licensed can be exposed to uninsured claims, if State law requires the physician to be licensed in the
State where the test results are delivered (Tele health, 2015).
Some carriers assert that they are only require to make claims against providers when the provider is
performing medical services in the state where the carrier agreed to cover the provider. Some states
protect providers of tele health services by forcing insurers to cover claims against the providers even if
the claim arises from out of state patients. Other states either exempt the insurer from providing the
coverage or fail to address the issue at all. Obligations of malpractice insurance carrier must be
examined on a state-by state basis. Insurance underwriters are also offering separate policies for
clinicians who provide interpretive tele health services, such as tele radiology (Tele health, 2015).

12. Conclusion
When reviewing the 36 economic analyses of delivering health services by synchronous video
communication, it was learned that this form of tele health offers valuable health care, and it suggested key factors
that are associated with the setting and specific models of health service deliveries. It was discovered that the
patients health equity improved tremendously compared to conventional care, with two minor exceptions that did
not compromise the care of the patients (Wade, Karnon, Elshaug, & Hiller, 2010). Therefore the decision as to
whether or not to introduce a tele health service can be made using cost-effectiveness criteria and consideration of
the model of care. It is concluded that synchronous video delivery is cost-effective for home care, and for on-call
hospital specialists, and it can be cost-effective for regional and rural health care, depending upon the particular
circumstances of the service (Waller, Karnon, Elashaug, & Hiller, 2010).

13. However, it is not cost-effective, from the health services perspective, for local delivery of
service between hospital specialists and primary care, particularly due to additional health care
staffing. Across settings, equipment and connectivity costs have been major factors in setting up
tele health services, but even as these costs reduce, this will not necessarily make tele health more
cost-effective, unless the other factors such as health workforce and facility space are also
addressed. Improvement in the quality of economic analyses is also needed to provide data for
more accurate modeling of the effects of widespread introduction of tele health into the health care
system (Wade, Karnon, Elashaug, & Hiller, 2010).
Conclusion

14. Hebda, T., & Czar, P. (2013). Handbook of Informatics (5th ed). Boston, MA: Pearson.
N.A. (2015). Tele health. Last reviewed 2/11/2015. From website: http://www.telehealth.com/our-history.
Wade, V.A., Karnon, J., Elshaug, A.G., Hiller, J.E. (2010). A systematic review of economic analyses of telehealth
services using real-time video communication. BMC Health Services Research 10.233
, doi:10.1186/1472-6963-10-233.
References