Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.
Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.
Telehealth is an expansion of telemedicine, and unlike telemedicine which more narrowly focuses on the curative aspect, it encompasses preventative, promotive and curative aspects.
One of the most significant increases in telehealth usage is the home monitoring of conditions by patients.
Telemedicine uses Information and Communication Technologies to overcome geographical barriers, and increase access to health care services. This is particularly beneficial for rural and underserved communities in developing countries – groups that traditionally suffer from lack of access to health care.
Uses of telehealth
Transmission of medical images for diagnosis (Store and forward telehealth)
Distance education including continuing medical education, grand rounds, and patient education
Groups or individuals exchanging health services or education live via videoconference (Real-time telehealth)
Administrative uses including meetings among telehealth networks, supervision, and presentations
Transmission of medical data for diagnosis or disease management (Remote patient monitoring)
Research on telehealth
Advice on prevention of diseases and promotion of good health by patient monitoring and followup
Online information and health data management
Health advice by telephone in emergent cases (Teletriage)
Healthcare system integration
Asset identification, listing, and patient to asset matching, and movement
Overall healthcare system management
Patient movement and remote admission
Modes of telehealth:
There are 3 modes of Telehealth:
Store and forward telehelath
Remote patient monitoring
1. Store-and-forward telehealth:
In store-and-forward telehealth, digital images, video, audio, observations of daily living and clinical data are captured and stored on the client computer or mobile device, then at a convenient time they are transmitted securely to a clinic at another location where they are studied by relevant specialists. The opinion of the specialist is then transmitted back.
2. Real-time telehealth:
In real-time telehealth, a telecommunications link allows instantaneous interaction. Videoconferencing equipment is one of the most common forms of real-time telemedicine. Peripheral devices can also be attached to computers or the video-conferencing equipment which can aid in an interactive examination.
3. Remote patient monitoring:
In remote monitoring, the patient has a central system that feeds information from sensors and monitoring equipment, e.g. blood pressure monitors and blood glucose meters, to an external monitoring center. This could be done in either real time or the data could be stored and then forwarded. Examples of remote monitoring include Home-based nocturnal dialysis, Cardiac and multi-parameter monitoring of remote ICUs, Disease management including COPD, Chronic Heart Failure, Diabetes, Coagulation, Arthritis, Depression, Obesity, etc…
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Pros of telemedicine:
1. Convenience: Through video, Web chat, or phone, workers can follow-up on a prescription or diagnosis with a physician they’ve been seeing for years if that physician indeed provides telehealth services or with a new doctor in their network. The goal of telehealth is to create an experience that closely mirrors a traditional doctor visit.
2. Less time in the waiting room: Telemedicine eliminates waiting time in ER. It takes a couple of minutes to register and put your health history in and then patients are ready to get the healthcare they need.
3. Cost-efficiency: An increasing number of doctors are charging less for a telemedicine consultation than they would for an in-person visit. Telemedicine can also reduce travel expenses. This is especially true for those living in rural communities. Rural families who would normally travel hours out of their way to access key health services can do it from the comfort of their couch.
4. Expedited transmission of MRIs or X-rays for a second opinion: E-mailing an MRI or X-ray to a specialist for a second opinion is another benefit of telemedicine. It can improve communication between patients and their medical practitioners.
5. Privacy assurance: Telemedicine complies with HIPAA laws, which aim to prevent private or secure medical documents from being leaked.
Cones of telemedicine:
1. Electronic glitches: Technology is only as reliable as the electrical current that keeps it running. Inclement weather and other annoyances can cause a power outage or disrupt an internet connection, complicating online consultation with a doctor. Workers should keep that in mind prior to scheduling online visits.
2. Physician resistance: The bulk of resistance comes from doctors struggling to comfortably use the new technology. At the same time, when they think about how they might begin to use this to better manage patients with chronic illnesses or be able to expand access to rural areas in particular.
3. Inadequate assessment. While having the ability to interface with your primary care physician or dentist is a major plus, certain non-verbal cues might still slip through the cracks. There are no limits on how you can use telemedicine, but of course one of the cons is you cannot personally touch or feel the patient.
Benefits and uses:
Improved Access – Telemedicine has been used to bring healthcare services to patients in distant locations. Not only does telemedicine improve access to patients but it also allows physicians and health facilities to expand their reach, beyond their own offices
Cost Efficiencies – Reducing or containing the cost of healthcare is one of the most important reasons for funding and adopting telehealth technologies. Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays.
Improved Quality – Quality of healthcare services delivered via telemedicine are as good those given in traditional in-person consultations. In some specialties, particularly in mental health and ICU care, telemedicine delivers a superior product, with greater outcomes and patient satisfaction.
Patient Demand – Consumers want telemedicine. The greatest impact of telemedicine is on the patient, their family and their community. Using telemedicine technologies reduces travel time and related stresses for the patient
U.S. licensing and regulatory issues:
Restrictive licensure laws in the United States require a practitioner to obtain a full license to deliver telemedicine care across state lines. Typically, states with restrictive licensure laws also have several exceptions (varying from state to state) that may release an out-of-state practitioner from the additional burden of obtaining such a license. A number of States require practitioners who seek compensation to frequently deliver interstate care to acquire a full license.
Regulations concerning the practice of telemedicine vary from state to state. Physicians who will be prescribing over the Internet to patients should mandate strict controls on their practice to insure that they stay compliant with the various State Medical Board Regulations concerning Internet Prescribing.
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