Telemedicine_Telehealth

17 September 2012 There is a growing cost of medical care and gaps in medical coverage which has created pressure on providers and public policymakers to deliver cost-effective and quality care for all Americans. Some believe the answers lies with telemedicine/telehealth due to the increasing power of information technology and broadband. Telemedicine includes a variety of application and services using two-way video, e-mail, wireless phones and other forms of telecommunication technology. This service was started forty years ago with hospitals extending care to patients in remote areas; this use has spread rapidly and is now becoming integrated into the operations of hospitals specialty department, home health agencies, private physician office and consumers home (American Telemedicine Association, n.d.). Telemedicine and telehealth are considered interchangeable terms, incorporating a wide definition of remote healthcare patient consultation through videoconferencing, transmitting of still images, e-health, remote monitoring of vital signs, continuing medical education, consumer-focused wireless application and nursing call center are part of telemedicine and telehealth (American Telemedicine Association, n.d.). Telehealth refers to a broader definition of remote health care that does not always involve clinical services. Telehealth is in partnership with the term health information technology (HIT); which is commonly refer to electronic medical records and other related information systems and other non-clinical services such as medical education, administration and research. Telemedicine refers to the actual delivery of health services using technology (American Telemedicine Association, n.d.) . Telemedicine incorporate many specialties of medicine including radiology, pathology, oncology, opthalmology, cardiology, neurology, dermatology and psychology/psychiatry (Weil, 2009, p. 58-60) Telemedicine may be as simple as two healthcare professionals discussing a case over the telephone or as complex as using satellite technology and videoconferencing equipment to conduct a real-time consultation between medical specialist in two different countries (American Telemedicine Association, n.d.). Telemedicine technologies can cut cost of transport from nursing homes to emergency department by fourteen percent (Vo, 2008). Physicians visit would fall because right now nursing facilities must arrange trips to physicians offices. Telehealth would not only reduce costs but would also reduce the risk involved in transporting frail patients. It will also allow nursing staff to consult with a patients, physician, another primary care physician or a specialist. A series of reports from the United Kingdom has shown that fewer test and procedures are ordered through a teleconsult than at an in-person visit because of early involvement of the specialist and their ability to order target testing for there patients condition (Vo, 2008). In addition, specialist have access to test results ordered by the primary care provider that is normally unavailable at the time of face-to-face consultation (Vo, 2008). In rural areas patients are often transferred from one emergency department to another because the first cannot provide specialty care, for example, potential stroke victim needing to be asset by neurologist for anticoagulation therapy. A telehealth link could eliminate the need to transfer. Telehealth technology can greatly reduce costly patient transports and the patient can receive specialty care and providers can receive specialized guidance (Vo, 2008). Telehealth can lead to a reduction in admission from emergency department, reduction in need for referrals from emergency department to outside specialist, reduced wait time for outpatient consultation, reduction of patient travel time and expenses, provide provider education access, reduction in hospital admissions and improve quality care (Vo, 2008). Telemedicine/telehealth is used in the prison system. Although correctional facilities have onsite healthcare professionals, however, they may be unable to manage emergent health care matters because of lack of expertise in evaluation or management of the inmate symptoms. Telehealth can manage an inmate health care at the correctional facility. Avoiding a transport, eliminating the cost of vehicles and correctional officers to accompany patients and the cost of security (Vo, 2008). Several technologies are used in telemedicine; telephone services to high-speed lines to the internet. Medical information transmitted can be in any form including voice, data, still images and video. The linking of computers and other devices into networks form the foundation of telemedicine. Telemedicine may be based on store – and- forward technology, which involves sharing information in a time and place independent way over the internet. The information is store, digitized and then sent. The information may include digital images and clinical information (Weil, 2009, p. 58-60). Images can be created by digital camera and sent over the internet. Because this technology is cheaper and do not require sophisticated equipment or broadband line, it is being used to introduce telemedicine at low cost to developing countries (Weil, 2009, p. 58-60). Interactive videoconferencing or teleconferencing allows doctors to consult with each other and with patients in real – time, at a distance. It may require only a video phone and a connection to the internet. The more sophisticated systems involve microphones, scanners, cameras, medical instruments and dedicated telephone lines (Weil, 2009, p. 58-60). Telehome care involves the monitoring of vital signs from a distance via telecommunication equipment and the replacement of home nursing visits with videoconferencing. Telehome care involves links between the patient's home and a hospital or central office that collects the data (Weil, 2009, p.65) -add more information- Many states medical broads make it difficult for health care professionals to participate in telehealth programs because they require a prior physician-patient relationship before virtual consultation or prior medical exam before allowing virtual appointment (Not mentioned, 2012). Lack of reimbursement remains a serious problem by the health care financing administration. Most private insurers routinely pay for telecare. The elimination of reimbursement constraints has not made it noticeably easier to advance adoption of these project (King, n.d.). Physicians are resistant to change and averse to new technology. Another barrier is it deviate from existing routine. It has to be integrated into the routine of clinicians and their office staffs (King, n.d). Another possible consequence of using tele-consultation or videoconferencing is a breakdown in the patient and healthcare professional relationship. Communication breakdown could result from poor interpersonal skills as well poor mastery of telemedicine technology. Depersonalization due to physical and mental factors, new and different processes of consultation, inability to perform the whole consultation due to technical difficulties and patients reduced confidence in healthcare professional are all potential negative aspects of using telemedicine (Sarhan, 2009). Other barriers are: lack of confidentiality due to increased access to patient records, potential medical malpractice liability due to uncertainties concerning the legal status of telemedicine within and between states, lack of regulation for practicing telemedicine and lack of professional regulation activities and implementing healthcare policies (Sarhan, 2009) Patient confidentiality is a key issue that hinders adoptions of telemedicine/telehealth and restrict it to specialist applications. These concerns are being addressed by improved data security standards and encryption techniques. Virtual private networks (VPNs) have be extremely successful in providing managed security networks. Patient smart cards is another tool to secure patient data. Other steps that need to be addressed to improve access to telemedicine are: system needs to be developed that defines payment and reimbursement for telemedicine, telemedicine infrastructure should be brought to rural areas of the United States, patient education and awareness-building should be developed to help the public understand telemedicine and its availability, current tools and resources can help facilitate telemedicine better coordination and integration, physicians should encourage to help raise awareness of telemedicine as a variable care option, steps should be taken to ensure that software and network communication systems support telemedicine evolve and health professionals licensing and regulatory boards should increase their efforts to address license portability (Federation of State Medical Boards , 2011). These steps need to be taken to improve safety in telemedicine: the telemedicine support team should demonstrate competency in the use of telemedicine technology, a system of authentication must be in place to protect medical transactions and ensure appropriate medical treatment, standards and guidelines for practice in telemedicine should be better defines and more consistent, updated definitions should be created for traditional concepts and clear and fair guidelines ability accountability (Federation of State Medical Boards , 2011). In order to improve quality in telemedicne these steps need to be taken: medical education in the use of telemedicine technology should be expand at undergraduate and graduate levels, enhancement to credentials verification mechanisms are needed to ensure patient protection in telemedicine interaction and clinical guideline, standards of care and standards of measurement should be developed for telemedicine to ensure consistency and continues quality improvement (Federation of State Medical Boards , 2011). The practice of telemedicne/telehealth has challenges and opportunities for growth. The benefit of telemedicine/telehealth range from reaching individuals in rural and distant countries to cutting healthcare cost. The telemedicine/telehealth is still in its infant stage but most medical professionals agree that the use of advanced technology and telemedicine software is going to make telemedicine useful in the future. References: [ONLINE] Available at: http://www.americantelemed.org/files/public/abouttelemedicine/what_is_telemedicine.pdf. American Telemedicine Association (n.d). What Is Telemedicine & Telehealth'. [Last Accessed 11 September 2012]. Burke, L. & Weill, B. (2009). Information technology for the health professions. Upper Saddle River: Pearson Federation of State Medical Boards (10 March 2011). Balancing access, safety and quality in a new era of telemedicine. [ONLINE] Available at: http://www.fsmb.org/pdf/pub-symposium-telemed.pdf. [Last Accessed 16 September 2012]. King, Barry (n.d). Telehealth as an Everyday Tool. [ONLINE] Available at: http://collab.nlm.nih.gov/tutorialspublicationsandmaterials/telesymposiumcd/1-1.pdf. [Last Accessed 13 September 2012]. 'Not mention (7 May 2012). Employers, Insurers Embracing Telehealth, but Barriers Remain. [ONLINE] Available at: http://www.ihealthbeat.org/articles/2012/5/7/employers-insurers-embracing-telehealth-but-barriers-remain.asp. [Last Accessed 13 September 2012]. Sarhan, F. , (2009). Telemedicine in healthcare 1: exploring its uses, benefits and disadvantages. Nursing Times;. 105 (), pp.42 Vo, Alexander H., (2008). Better Health Care and Cost Savings for the 21st Century. 1st ed. Texas: University of Texas Medical Branch.