This report will show how telehealth has an impact on patients but before future discussion I would like to define telehealth.
“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, and includes both the use of interactive, specialized equipment, for such purposes as health promotion, disease prevention, diagnosis, consultation, and/or therapy, and no interactive (or passive) communications, over means such as the Internet, e-mail, or fax lines, for communication of broad-based nutrition information that does not involve personalized nutrition recommendations or interventions” (Busey & Micheal, 2008).
There are two more definitions I would like to add as following.
“Use of telecommunications to provide health information and services that is, a health related activity carried out at distance” (Conrick , 2006).
“Telehealth refers to the use of telecommunication technology to remove time and distance barriers in the delivery of healthcare services” (Artinian, 2007).
Telehealth enables remote patient management. From many findings, study shows that patients with heart failure problem who get experience in weight increase or blood pressure would likely involve in negative medical outcomes including expensive hospitalization in later stage. But if the patient’s symptoms can be monitored on daily basis then disease can be diagnosed in early stages which can prevent expensive visit to hospital and patient’s life can be saved. Telehealth works as following.
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The evaluation of any information systems especially health information systems are recognized as a complex and challenging activity. There is no agreement on a ‘best way’ to evaluate, on what and how to evaluate, who to involve, and within what paradigm to proceed (Klecun-Dabrowska & Cornford, 2001).
There are unique challenges for evaluators in telehealth services because they are not all the same and can be measured in separate and different terms. Technologies those are used in telehealth are not mature yet and some of them are still in prototyping stage. These telehealth services are developed by expert and passionate people who are working in the field of medical and other technologies which are related to telecommunication like recording, video conferencing.
Telehealth has also enabled efficient distribution of information not only with the patients but also between health care providers who are divided either geographically or within the states. The Utilization this type of technology has been shown to be very cost effective and has proved in favorable health outcomes for chronically ill patients. (Fleming, 2007)
Telehealth increases access to health care especially in remote areas where normal access of health care is difficult. It can act as a bridge between the patient and health provider to increase the delivery of care. One of the biggest strength of telehealth is its capability to be an extension of basic health care by enhancing access between the patient and their providers.
“With the help of telehealth we can have access to ultra specialized services without transferring the patient. The idea is not transferring patients if we can offer the service here. It doesn’t make sense to transfer a patient only for a diagnosis when it can be done remotely” (Gagnon, Duplantie, Fortin & Landry, 2006).
“Telehealth is believed to produce significant savings for remote hospitals and for the health care system. For instance, teleconference can be used to attend administrative meetings, leading to substantial savings on travel costs. However, the redistribution of savings between organizations and levels of care is an important and complex issue” (Gagnon et al, 2006).
Telehealth can help to systematize on call duties on a regional level specialists like x-ray specialist. Therefore, as an alternative, sharing the responsibility for on call duties between specialists of a hospital, telehealth can allow a large number of specialist persons from different health care centers to cover whole region.
According to Artinian (2007) “Telehealth helps patients gain more flexibility in scheduling healthcare visits, provides easier and more convenient access to healthcare, and allows patients to have fewer time-consuming clinic visits. It also allows patients to receive care in a location that does not require the burden of transportation, and in an environment that is less threatening than a clinic or emergency department.”
There are many barriers in telehealth field. Some states do not allow its physicians to practice outside of the state without getting license from those states first. Reimbursement is also a big factor in this field as many insurers will not reimburse.
According to Gustke et al (2000, as stated by Brown (2005)) fear of malpractice suites is another consideration for physicians, as is acceptance of the technology and lack of hands on interaction with patients, although most patient satisfaction studies to date find patients on the whole satisfied with long distance care.
Lack of telecommunications technology is also a big problem in this field. As normal phone line can not supply high bandwidth and there are many rural areas where they do not have high speed cabling and can not get high bandwidth telecommunication for telehealth.
Getting federal funds from the state is also a problem for telehealth projects. Telecommunication companies and technology manufacturers are competing with each other to produce low price tools and bandwidth needed.
Need of telehealth
Telehealth was developed because
Telehealth has the potential to change healthcare delivery but faces many challenges in adoption. Despite the benefit of telehealth, the lack of reimbursement for telehealth is a major challenge in widespread adoption of telehealth. (Bushell, 2007 as stated by Change, 2007).
“With no financial incentive for healthcare providers to implement the technology, providers are likely to view telehealth as an increase in workload without a subsequent increase in pay” (Bushell, 2007).
The ethical issues unique to telehealth relate to the possible impact on the curing relationship which go outside the expected challenges of privacy and confidentially.
The loss of touch, the potential for depersonalization, the potential for exploitation, the possible inequity when distributing the benefits of telehealth services, and the potential burden that this form of new technology may impose on sick and dying patients are some of the ethical concerns that should be considered.
Future research and educational initiatives should explore areas of ethical concern that pertain to the innovative and burgeoning field of telehealth, and the potential for good and harm that may result. Potential themes include the following:
â€¢ Improving health care access in underserved populations
â€¢ Professional expectations in meeting a new, higher standard of car
â€¢ Telemedicine as a potential new form of access discrimination
â€¢ Technology as added burden for patients with chronic and terminal illness
â€¢ When virtual visits “replace” actual visits
â€¢ The impact of “loosing touch” on trust and the healing relationship
â€¢ The risk of exploitation when using new and expensive technology
â€¢ Depersonalization in the use of store and forward technology
â€¢ Privacy and confidentiality issues
The use of telehealth has raised many legal issues as well like licensing, liability and reimbursement. Data security is also a big concern in telehealth. As personal data is being transferred from patient to health provider, there is possibility of loss of data or could criminal access that should be considered and prevented. (Wootton, Patil, Scott and Ho, 2009)
Bandwidth is also an issue, especially when high quality images need to transfer from patient to health care provider and getting the technical support needed to make sure telehealth networks are up and running around the clock is a major challenge for rural programs or those in small hospitals and practices. (Brian, 2009)
The health sector faces two opposing demands: firstly, it should provide extended and reasonable access to high quality health care services; secondly, it should also decrease or at least control the rising costs of health care. Telehealth assures and offers the promise of giving people equal access to high quality medical health care at reasonable and affordable cost.
Information and communication technology has developed very rapidly in the last few years. There has been rapid growth of the telecommunication market and very fast circulation of the internet. Many hospitals have developed information systems which help to share information between different health care providers, and now health sharing networks are being developed in many countries to share health information.
Population which is increasing very rapidly with insufficient health resources has produced demands to develop telehealth and the rapid development of information and communication technology has provided the opportunities to do so. (Wootton, Patil, Scott and Ho, 2009)
“A telehealth consortium led by the University of California, Office of the President and the UC Davis Health System was formed to create a statewide broadband system. AT&T was selected to build a secure medical-grade telecommunications system as part of the California Telehealth Network (CTN). AT&T with a three year $27 million contract will provide the Network Services to support the telehealth initiative” (Bloch, 2010).
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“According to Dr. Cathryn L. Nation, University of California Associate Vice President for Health Sciences and Services, the new network is also designed to address healthcare disparities in the state since millions of Californians live in rural and other medically underserved areas in the state where disparities in care exist. CTN will improve their access to quality healthcare services” (Bloch, 2010).
“Plans call for the network to be a peer-to-peer system enabling each member to have reliable, high quality connections with public and nonprofit healthcare providers located in both rural and urban locations. The network will also provide opportunities for continuing education and distance learning for health professionals, along with access to clinical research, and the possibility of access to commercially hosted EHR systems” (Bloch, 2010).
Telehealth provides benefits to individual patients, their family members, health care providers, community organizations, governments and health care facilities.
Telehealth expands health related skills across geographic barriers using information and communication technologies (“Benefits of telehealth”, 2007).
It improves access to health care providers for remote and rural practitioners. It also provides great access to continuing medical education. It increases access to specialty services for rural patients. Using telehealth, patients can stay in their homes or community rather than travelling to hospitals. Telehealth can be used to decrease number of cancelled appointments due to weather and travel conditions.
Telehealth reduces time for investigation, diagnosis and treatment through quicker consultations and patients can get real time second opinions (“Benefits of telehealth”, 2007). It can reduce the cost of healthcare and increase efficiency through reduced patient and provider travel, better management of chronic diseases and fewer as well shorter hospital stays.
Remote monitoring and home telehealth have been demonstrated to improve disease management and reduce re-hospitalization and emergency department visits (“Benefits of telehealth”, 2007).
“In a study that evaluated cost savings among patients using telehealth services in rural Arkansas, investigators found that without the telehealth services, 94% of patients would travel greater than 70 miles for medical care, 84% would miss 1 day of work, and 74% would spend $75 to $150 for additional family expenses. With telehealth, 92% of patients saved $32 in fuel costs, 84% saved $100 in wages, and 74% saved $75 to $150 in family expenses” (Artinian, 2007).
There are many barriers in telehealth delivery. Implementation of telehealth infrastructure can be costly, time consuming and complicated initially. There is lack of information and communication technology usage among healthcare professionals in some areas.
Telehealth is a complex matter. Organizational factor is another barrier to telehealth. A change is required for doctors and how hospitals operates which could be avoided by some provided by some professionals. There could be lack of staff with appropriate skills for telehealth. A lack of financial support is a major barrier in the research and development of telehealth.
“Many potential projects, especially in rural areas and in the developing world have been hampered by the lack of an adequate telecommunication infrastructure. Other barriers in telehealth are the legal and ethical issues. These include licensing, privacy and confidentially” (Conrick, 2006).
Reimbursement or the lack of it is also a barrier for possible telehealth practitioners and there are some ethical and legal issues about telehealth that need to be resolved.
The main objective of telehealth today is to develop next generation telehealth tools and technologies to improve delivery of health care services in underserved areas using information and communication technologies. It also helps to decrease the cost of health care services and increase access to medical related services to the public.
“Key drivers for these tools and technologies are the need and interest to collaborate among telehealth stakeholders, including patients, patient communities, research funders, researchers, healthcare services providers, professional societies, industry, healthcare management/economists, and healthcare policy makers” (Ackerman, Filart, Burgess, Lee & Poropatich, 2010).
Future of telehealth
Telehealth is the future of home care. By its nature, telehealth relies on technology and technology is changing very rapidly these days. If we look at the history, new technologies emerged and then used by people to send information across long distances. The high access of mobile devices and different networks on global level means that mobile technologies can be used very efficiently in healthcare field in order to compensate the lack of resources problem.
“With the proliferation of mobile technologies, mobile health (mHealth) will play a vital role in the rapidly growing electronic health (eHealth) area.” (Vatsalan, Arunatileka, Chapman, Senaviratne, Sudahar, Wijetileka & Wickramasinghe, 2010).
Due to the large number of mobile technologies adoption, telehealth can play a very important role in the rapidly growing electronic health care area and in future lots of the people will be using mobile devices to monitor their health any time. The future of telehealth will give advantages greatly from this technology innovation, especially in undeserved areas and old homes.
“Recent trends are beginning to push the demand for and the development of new technologies specific to the individual needs of telehealth applications” (Brennan, Holtz, Chumbler, Kobb & Rabinowitz, 2008)
It is 2014 and Mrs Smith has ongoing trouble with her high blood pressure. One morning she wakes with a headache and worries that the reservoir of her implanted drug delivery system may be running down. Her bedside ambient health orb (see www.ambientdevices.com) is a reassuring green, but she turns to her video wall and asks “Cyberdoc, how are my recent blood pressure levels?” The simulated voice responds “Your records show that the drug reservoir needs a refill in three weeks time. Your telemetered blood pressure readings have been under control for the past month and today’s figures are normal. Your implanted blood sugar sensor shows normal readings too. Do you have some symptoms that you want to discuss?” Meanwhile Mrs Smith’s wall graphs her recent blood pressure readings, and a list of the most common 20 symptoms affecting people of her age group in the locality. She responds, “No, don’t worry. Remind me to book my repeat prescription (for a refill) in two weeks, please.” (Wyatt & Sullivan, 2005)
Telehealth has signification potential to address a variety of healthcare problems especially in undeserved areas.
Has significant potential to address a range of healthcare problems
Need to resolve ethical issues
Need protection of health information and privacy rights
Need for higher speed and higher capacity telecommunications
Government, professional groups in healthcare, and telecommunications industry need to work together to develop some standards
Next-generation telehealth tools and technologies which use internet and its robust computational resources hold big promise for improving healthcare for the persons who are living in undeserved areas
Next-generation telehealth tools and technologies that utilize the Internet and its robust computational resources hold great promise for improving healthcare for medically underserved populations, increasing access to specialty services at lower cost, enhancing health literacy, and expanding the healthcare workforce through “virtual” education and training. Realizing these benefits will require extensive and ongoing collaboration and coordination among stakeholders across the research and healthcare ecosystem. Communication, training, cultural sensitivity, and end-user customization are critical to success. Extending the “traditional” point-to-point telemedicine model to include newer cell phone and Internet-based telecommunications tools that are increasingly widespread and affordable, even in rural and remote locations, will be key to putting the “person” in “personalized medicine” and making research advances available to everyone. Furthermore, we must appreciate system complexity to realize the benefits of telehealth as it evolves toward increasing functionality, integration, interoperability, outreach, and quality of service.
The balance of benefits and risks of eHealth for individual
patients and clinicians over the next two to three years is
unclear. Healthcare organisations and policy makers need to
consider the issues that will arise. In the long term, eHealth
offers many opportunities for prevention, choice, home based
care, and chronic disease management, and it will widen access
to health care for most patients.We all need to join the
discussion and decide what we want for the future before
others, who could be guided by commercial motives rather than
quality and equity, do so.
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