Telepsychiatry, another aspect of telemedicine, also utilizes videoconferencing for patients residing in underserved areas to access psychiatric services. It offers wide range of services to the patients and providers, such as consultation between the psychiatrists, educational clinical programs, diagnosis and assessment, medication therapy management, and routine follow-up meetings. Most telepsychiatry is undertaken in real time (synchronous) although in recent years research at UC Davis has developed and validated the process of asynchronous telepsychiatry. Recent reviews of the literature by Hilty et al. in 2013, and by Yellowlees et al. in 2015 confirmed that telepsychiatry is as effective as in-person psychiatric consultations for diagnostic assessment, is at least as good for the treatment of disorders such as depression and post traumatic stress disorder, and may be better than in-person treatment in some groups of patients, notably children, veterans and individuals with agoraphobia.
“I woke up Sunday morning with a dry cough and terrible headache,” Ben said. “Realizing I didn’t feel up to going to a clinic, I logged on to Medical City and selected the virtual option. Using the interface was straightforward. I answered several easy questions about my current condition and minutes later I received an email that my info was being examined. I was instructed to set up an account. A second email contained my prescription and expected recovery time. I sent the prescription to the pharmacy next to my house and good to go. In no time, I had the medication and was on my way to feeling better.”
As telehealth continues to replace traditional health care, it is going to inherit some of its challenges. These include increased cost of care due to multiple vendors, complex care pathways, and government policies. However, the question that remains to be answered is will this advanced technology that we call telehealth, be able to redefine the quality, equity and affordability of healthcare throughout the world.
Used when both health providers are not available or not required at the same time. The provider’s voice or text dictation on the patient’s history, current affliction including pictures and/or video, radiology images, etc., are attached for diagnosis. This record is either emailed or placed on a server for the specialist’s access. The specialist then follows up with his diagnosis and treatment plan.
An example of these limitations include the current American reimbursement infrastructure, where Medicare will reimburse for telehealth services only when a patient is living in an area where specialists are in shortage, or in particular rural counties. The area is defined by whether it is a medical facility as opposed to a patient's' home. The site that the practitioner is in, however, is unrestricted. Medicare will only reimburse live video (synchronous) type services, not store-and-forward, mhealth or remote patient monitoring (if it does not involve live-video). Some insurers currently will reimburse telehealth, but not all yet. So providers and patients must go to the extra effort of finding the correct insurers before continuing. Again in America, states generally tend to require that clinicians are licensed to practice in the surgery' state, therefore they can only provide their service if licensed in an area that they do not live in themselves.
While widespread research on the effects of telemedicine is still relatively young, many studies do show positive results. When the Veterans Health Administration implemented telemedicine for past heart attack patients, they sawhospital readmissions due to heart failure drop by 51%. Another study on the Geisinger Health Plan showed that telemedicine reduced 30-day hospital readmissions by as much as 44%. And while telemedicine skeptics often claim virtual visits tend to be lower quality than in-person visits, a recent study of 8,000 patients who used telemedicine recorded no difference in care outcomes between in-person and virtual care.
Telemedicine in the trauma operating room: trauma surgeons are able to observe and consult on cases from a remote location using video conferencing. This capability allows the attending to view the residents in real time. The remote surgeon has the capability to control the camera (pan, tilt and zoom) to get the best angle of the procedure while at the same time providing expertise in order to provide the best possible care to the patient.
^ Arora, Sanjeev; Thornton, Karla; Murata, Glen; Deming, Paulina; Kalishman, Summers; Dion, Denise; Parish, Brooke; Burke, Thomas; Pak, Wesley; Dunkelberg, Jeffrey; Kistin, Martin; Brown, John; Jenkusky, Steven; Komaromy, Miriam; Qualls, Clifford (2011). "Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers". New England Journal of Medicine. 364 (23): 2199–207. doi:10.1056/NEJMoa1009370. PMC 3820419. PMID 21631316.
Telemedicine/Telehealth: Basically, these two terms are used to describe the use of technology and telecommunications to exchange medical information from one place to another with an aim of improving the patient’s health status. Telemedicine is sometimes involved in direct patient clinical services which include diagnosis and treatment of patients.
The telemedicine foundation is quickly being built. But what do patients think about telemedicine? Are they ready to try it? Recent studies show that a majority of patients are interested in using telehealth services, especially once they see how it works and the potential benefits for them. NTT Data found 74% of surveyed US patients were open to using telemedicine services, and were comfortable communicating with their doctors via technology. 67% said telemedicine at least somewhat increases their satisfaction with medical care.
There are currently 29 states with telemedicine parity laws, which require private payers to reimburse in the same way they would for an in-person visit. As additional states adopt parity laws, private payers may institute more guidelines and restrictions for telemedicine services. Although it’s a step in the right direction, there is still uncertainty regarding reimbursement rates, billing procedures, and more.
Telehealth allows multiple, different disciplines to merge and deliver a much more uniform level of care using the efficiency and accessibility of everyday technology. As telehealth proliferates mainstream healthcare and challenges notions of traditional healthcare delivery, different populations are starting to experience better quality, access and personalised care in their lives.
Traditional use of telehealth services has been for specialist treatment. However, there has been a paradigm shift and telehealth is no longer considered a specialist service. This development has ensured that many access barriers are eliminated, as medical professionals are able to use wireless communication technologies to deliver health care. This is evident in rural communities. For individuals living in rural communities, specialist care can be some distance away, particularly in the next major city. Telehealth eliminates this barrier, as health professionals are able to conduct a medical consultation through the use of wireless communication technologies. However, this process is dependent on both parties having Internet access.
In 1967 one of the first telemedicine clinics was founded by Kenneth Bird at Massachusetts General Hospital. The clinic addressed the fundamental problem of delivering occupational and emergency health services to employees and travellers at Boston's Logan International Airport, located three congested miles from the hospital. Over 1,000 patients are documented as having received remote treatment from doctors at MGH using the clinic's two-way audiovisual microwave circuit. The timing of Bird's clinic more or less coincided with NASA's foray into telemedicine through the use of physiologic monitors for astronauts. Other pioneering programs in telemedicine were designed to deliver healthcare services to people in rural settings. The first interactive telemedicine system, operating over standard telephone lines, designed to remotely diagnose and treat patients requiring cardiac resuscitation (defibrillation) was developed and launched by an American company, MedPhone Corporation, in 1989. A year later under the leadership of its President/CEO S Eric Wachtel, MedPhone introduced a mobile cellular version, the MDPhone. Twelve hospitals in the U.S. served as receiving and treatment centers.
Teleradiology – Teleradiology is actually one of the earliest fields of telemedicine, beginning in the 1960s. Teleradiology solutions were developed to expand access to diagnosticians of x-rays. Smaller hospitals around the U.S. may not always have a radiologist on staff, or may not have access to one around the clock. That means patients coming into the ER, especially during off-hours, will have to wait for diagnosis. Teleradiology solutions now offer providers at one location to send a patient’s x-rays and records securely to a qualified radiologist at another location, and get a quick consult on the patient’s condition.
Funding Opportunities: Telehealth can be an important tool for improving access to quality health care, especially for underserved and economically or medically vulnerable populations. Applicants who propose a telehealth component to their work plan are encouraged to reach out to one of the 12 HRSA-supported Regional Telehealth Resource Centers , which provide technical assistance to organizations and individuals who are actively providing or interested in providing telehealth services to rural and/or underserved communities.
Most telerehabilitation is highly visual. As of 2014, the most commonly used mediums are webcams, videoconferencing, phone lines, videophones and webpages containing rich Internet applications. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. It is most widely used for neuropsychological rehabilitation; fitting of rehabilitation equipment such as wheelchairs, braces or artificial limbs; and in speech-language pathology. Rich internet applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) were first introduced in 2001. This endeavor has expanded as a teletherapy application for cognitive skills enhancement programs for school children. Tele-audiology (hearing assessments) is a growing application. Currently, telerehabilitation in the practice of occupational therapy and physical therapy is limited, perhaps because these two disciplines are more "hands on".
There are many new medical tech terms being used today that the average patient may not be familiar with. For example, a common misunderstanding is that the terms telemedicine, telecare, and telehealth are interchangeable. The truth is that each of these terms refers to a different way of administering health care via existing technologies or a different area of medical technology. To clarify the subtle differences between these three terms, we have provided a detailed definition of each.
Not all state and federal agencies define telehealth in exactly the same terms, but most are fairly consistent with the federal Health Resources and Services Administration, which defines telehealth this way, “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.”
It has been around for decades, but in recent years private insurers, employers, and government programs have expanded their coverage. By 2016 at least half of U.S. healthcare institutions and hospitals were using some form of telehealth. And last September the Senate passed a bill that will expand Medicare coverage for telehealth services, if it’s signed into law.