Telepharmacy is the delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist. It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities.
The benefits posed by telehealth challenge the normative means of healthcare delivery set in both legislation and practice. Therefore, the growing prominence of telehealth is starting to underscore the need for updated regulations, guidelines and legislation which reflect the current and future trends of healthcare practices. Telehealth enables timely and flexible care to patients wherever they may be; although this is a benefit, it also poses threats to privacy, safety, medical licensing and reimbursement. When a clinician and patient are in different locations, it is difficult to determine which laws apply to the context. Once healthcare crosses borders different state bodies are involved in order to regulate and maintain the level of care that is warranted to the patient or telehealth consumer. As it stands, telehealth is complex with many grey areas when put into practice especially as it crosses borders. This effectively limits the potential benefits of telehealth.
A landmark 2010 report by the World Health Organization found that telemedicine – literally meaning “healing from a distance” — can be traced back to the mid-1800s, was first featured in published accounts early on in the 20th Century, and adopted its modern form in the late 1960s and early 1970s, primarily through the military and space industries. Owing to the fact that much of the technology encompassed in today’s telemedicine platform wasn’t around back then, and noting a 2007 study that found 104 different peer-reviewed definitions for the word, the WHO settled on its own broad-based definition:
Synchronous, real-time or Clinical Video Telehealth requires the presence of both parties at the same time and a communication link between them that allows a real-time interaction to take place. Video-conferencing equipment is one of the most common forms of technologies used in synchronous telehealth. There are also peripheral devices that can be attached to computers or the video-conferencing equipment which can aid in an interactive examination.
“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.”
Real-time communication is probably what jumps to mind when you think of telehealth technology. It happens with the patient is at one location and the provider is at another and they connect using a video-enabled device and a telephone or computer audio. Sometimes the patient might be at a healthcare facility with a provider and they establish communications with a specialist at a remote location, other times the patient might not be at a medical office at all. She might join the encounter from work or the office, for example. Many state laws require insurers to reimburse for these types of video visits. Most don’t have a similar stipulation for telephone calls that don’t involve video.
Sometimes called asynchronous telemedicine, store-and-forward solutions enable healthcare providers to forward and share patient medical data (lab results, images, videos, records) with a provider at a different location. These platforms offer a kind of sophisticated, secure, email platform – a way to share private patient data online in a secure way.
Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning. Teleophthalmology may help reduce disparities by providing remote, low-cost screening tests such as diabetic retinopathy screening to low-income and uninsured patients. In Mizoram, India, a hilly area with poor roads, between 2011 till 2015, Tele-ophthalmology has provided care to over 10000 patients. These patients were examined by ophthalmic assistants locally but surgery was done on appointment after viewing the patient images online by Eye Surgeons in the hospital 6–12 hours away. Instead of an average 5 trips for say, a cataract procedure, only one was required for surgery alone as even post op care like stitch removal and glasses was done locally. There were huge cost savings in travel etc.
Telehealth requires a strong, reliable broadband connection. The broadband signal transmission infrastructure includes wires, cables, microwaves and optic fibre, which must be maintained for the provision of telehealth services. The better the connection (bandwidth quality), the more data can be sent and received. Historically this has priced providers or patients out of the service, but as the infrastructure improves and becomes more accessible, telehealth usage can grow.
Children under 3 with a fever need to be seen immediately by a doctor in an office based setting. Children under 12 with ear pain can be treated if the pain is due to a virus (e.g. Colds), allergies, or an external infection. If there is a high likelihood it is a bacterial inner infection that needs antibiotics, they should be seen immediately by a doctor in an office based setting.