Telehealth and Patient Engagement: With telehealth technologies, patients are taking more control of their well-being. Educational videos, health management apps for mobile devices, and online health learning and support communities empower patients to manage chronic conditions, lose weight, increase physical activity levels, and gain emotional support. Diabetes patients are benefiting from carbohydrate tracking apps and are using glucose monitoring devices to document and report their blood sugar measurements. Other patients are interacting with their providers and scheduling appointments through secure online communication portals. Additionally, they are accessing health education content via smartphones and computers to add to their self-care toolboxes. They are also using wearables and monitoring systems to gain knowledge about their sleep patterns, vital signs, and activity levels.
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Dr. Parker has practiced medicine since 1994 and provided virtual care since 2013. He received his medical degree from the Medical College of Wisconsin and went on to complete a family practice residency at St. Joseph's Hospital and St. Mary's Family Practice. In addition to his work in telemedicine, he is an Assistant Clinical Professor at the St. Louis University School of Medicine. Dr. Parker and his family have a strong commitment to organic, sustainable, and humane food preparation, raising and growing much of their own food. In his spare time, he is a trail runner, half-marathoner and amateur photographer.
When a healthcare service decides to provide telehealth to its patients, there are steps to consider, besides just whether the above resources are available. A needs assessment is the best way to start, which includes assessing the access the community currently has to the proposed specialists and care, whether the organisation currently has underutilized equipment which will make them useful to the area they are trying to service, and the hardships they are trying to improve by providing the access to their intended community (i.e. Travel time, costs, time off work). A service then needs to consider potential collaborators. Other services may exist in the area with similar goals who could be joined to provide a more holistic service, and/or they may already have telehealth resources available. The more services involved, the easier to spread the cost of IT, training, workflow changes and improve buy-in from clients. Services need to have the patience to wait for the accrued benefits of providing their telehealth service and cannot necessarily expect community-wide changes reflected straight away.
It has not only expanded and improved access to healthcare services, but also increased patient engagement and enabled more efficient care models. The Department of Veterans Affairs (VA) is one of the largest providers of telehealth services. Last year, more than 700,000 veterans accessed VA telehealth services, which include everything from mental healthcare to surgical specialist consultations. But it’s not just veterans who are benefiting.
Point-to-point connections link small remote health centers to one, large, central health facility via high speed internet. This type of telemedicine connection lets smaller or understaffed clinics outsource medical care to specialists at other locations within the same health system. Point-to-point connections are especially common for telepsychiatry, teleradiology, and urgent care services.
But getting doctors to jump on board is easier said than done, and takes time. Many are afraid of liability, as it's possible to miss something during a remote visit. And for years, it wasn't clear whether they would get paid as much as an in-person visit. Reimbursement questions are still getting resolved across different states, but most of the commercial and government plans are on board with the idea of telemedicine -- at least in specific circumstances.
Once a medical history and symptoms are detailed, the patient is either then immediately connected to a clinician via video conferencing technology or gets an interactive call back from a physician or nurse. The provider that the patient speaks to may not be the patient's primary care physician, but instead a contracted clinician at a telemedicine network.
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In developed countries, health promotion efforts using telehealth have been met with some success. The Australian hands-free breastfeeding Google Glass application reported promising results in 2014. This application made in collaboration with the Australian Breastfeeding Association and a tech startup called Small World Social, helped new mothers learn how to breastfeed. Breastfeeding is beneficial to infant health and maternal health and is recommended by the World Health Organisation and health organisations all over the world. Widespread breastfeeding can prevent 820,000 infant deaths globally but the practice is often stopped prematurely or intents to do are disrupted due to lack of social support, know-how or other factors. This application gave mother's hands-free information on breastfeeding, instructions on how to breastfeed and also had an option to call a lactation consultant over Google Hangout. When the trial ended, all participants were reported to be confident in breastfeeding.
However, whether or not the standard of health care quality is increasing is quite debatable, with literature refuting such claims. Research is increasingly reporting that clinicians find the process difficult and complex to deal with. Furthermore, there are concerns around informed consent, legality issues as well as legislative issues. Although health care may become affordable with the help of technology, whether or not this care will be "good" is the issue.
HIT is the generation and transmission of digital health data, often through an electronic health record. Generally, HIT is used for administrative functions (keeping track of patient's health history, sharing information between providers, etc.) while telemedicine is the delivery of an actual clinical service. HIT can facilitate telemedicine but it is not a requirement for delivering remote health care.
“Telemedicine is not a separate medical specialty,” the organization continues. “Products and services related to telemedicine are often part of a larger investment by healthcare institutions in either information technology or the delivery of clinical care. Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services. ATA has historically considered telemedicine and telehealth to be interchangeable terms, encompassing a wide definition of remote healthcare. Patient consultations via video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, consumer-focused wireless applications and nursing call centers, among other applications, are all considered part of telemedicine and telehealth.”
The term telehealth includes a broad range of technologies and services to provide patient care and improve the healthcare delivery system as a whole. Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services. According to the World Health Organization, telehealth includes, “Surveillance, health promotion and public health functions.”
Telehealth, the use of electronic communication to remotely provide health care information and services, is gaining more and more attention as providers, patients, and payers all seek more effective and cost-efficient ways to deliver care. Physical therapy is no exception, and while those services have developed mostly in rural areas to accommodate the long distances between patients and providers, telehealth in physical therapy is being considered in other geographic and clinical settings.
Telemedicine involves the use of electronic communications and software to provide clinical services to patients without an in-person visit. Telemedicine technology is frequently used for follow-up visits, management of chronic conditions, medication management, specialist consultation and a host of other clinical services that can be provided remotely via secure video and audio connections.
^ Parikh, Mili; Grosch, Maria C; Graham, Lara L; Hynan, Linda S; Weiner, Myron; Shore, James H; Cullum, C. Munro (2013). "Consumer Acceptability of Brief Videoconference-based Neuropsychological Assessment in Older Individuals with and without Cognitive Impairment". The Clinical Neuropsychologist. 27 (5): 808–17. doi:10.1080/13854046.2013.791723. PMC 3692573. PMID 23607729.
Billions of investment dollars have been poured into apps and websites that offer this virtual consultations with physicians, ranging from Doctor on Demand to American Well. The theory behind them is that millennials would opt for a digital alternative to an in-person physician's visit, if the option were available. And patients in remote, rural areas who are miles away from the nearest doctor would have few alternatives.
In the future, experts say, internet-connected sensors—such as blood pressure monitors—could be paired with e-visits to help people manage chronic conditions from home. So far, such devices aren't widely used. But the list of conditions that patients and doctors can manage remotely is “ever expanding,” says Eric Topol, M.D., director of the Scripps Translational Science Institute.