TELEMEDICINE

1. TELEMEDICINE Medical Therapeutics

2. Medical Therapeutics Standard • 16) Summarize information found in news media, professional journals, and trade magazines to examine how Telehealth has impacted the healthcare system and explain its benefits and challenges.

4. I. Telemedicine: • The use of telecommunication and information technologies in order to provide clinical health at a distance • The exchange of medical information from one site to another via electronic communications to improve patient’s health status

5. I. Telemedicine: • It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities • These technologies permit convenient and timely communications between patients and medical staff along with transmission of medical imaging (x-rays, MRI, CAT scans, ultrasound, etc images) and health informatics data from one site to another

6. II. Common Uses for Telemedicine: • Videoconferencing between patients and healthcare staff • Communications and advice during critical care and emergency situations • Transmission of still images • E-health including patient portals • Remote monitoring of vital signs • Continuing medical information • Nursing call centers

7. Types of Telemedicine:1. “Store-and-Forward”: • AKA Asynchronous • Involves acquiring medical data (i.e. imaging, biosignals, etc…) and then transmitting this data to a physician or medical specialist at a convenient time for assessment offline • It does not require the presence of both parties at the same time

8. 1. “Store-and-Forward”: • Dermatology, radiology, and pathology are common specialties that use “store-and-forward” telemedicine • A thorough medical record, preferably in electronic form, should be a component of this transfer • This process requires the clinician to rely on a history report and audio/visual information in lieu of a physical examination

9. 2. Remote Monitoring: • AKA Self-Monitoring or Testing • Enables medical professionals to monitor a patient remotely using various medical devices • Primarily used for managing chronic diseases or specific conditions (i.e. heart disease, diabetes mellitus, or asthma) • These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction, and may be cost-effective

10. 3. Interactive Services: • AKA “Real-Time” • Provide real-time interactions between patient and provider • Includes phone conversations, on-line communications, and home visits

11. 3. Interactive Services: • Many activities, such as history review, physical examination, psychiatric evaluations, and ophthalmology assessments, can be performed comparably to those done in traditional face-to-face visits • Also, these services may be less costly than in-person clinical visits

12. Pros ________________ ________________ ________________ Cons __________________ __________________ __________________ Compare types of telemedicine:

13. IV. Benefits of Telemedicine: • Beneficial to persons living in isolated communities and rural or remote regions: • Gives these persons the opportunity to receive care from virtually all medical domains • Physicians/specialist can provide an accurate and complete examination without the patient traveling long distances • Allows healthcare professionals in multiple locations the ability to view, discuss, and assess patient issues as if they were in the same room

14. 2. Teaching Tool: • Experienced medical staff can observe, demonstrate, and instruct medical staff in another location a more effective or faster examination technique • Provides continuing medical education credits for health professionals • Special medical education seminars can be offered to targeted groups in remote locations (public groups or medical groups)

15. 3. Reduces healthcare costs by: • Increasing patient care of chronic diseases • Better management of chronic diseases • Shared health professional staffing • Reduced travel time

16. Fewer and shorter hospital stays: • Patients who were routinely monitored in a hospital can now be monitored in the home • The patient can have a variety of monitoring devices in the home to collect data (i.e. glucometer, blood pressure cuff, heart monitor, etc..) • The results of these devices can be transmitted via telephone or computer to the healthcare provider • This reduces cost of care to the patient and hospital

17. 5. Both subjective and objective information can be collected: • Healthcare staff can collect the same forms of data without the travel, that a routine office visit provides • Verbal communication can take place via phone or a tele-monitoring on-screen device

18. 5. Both subjective and objective information can be collected: • Objective information can be collected and transmitted through a variety of devices • The provider can then make decisions about the patient’s treatment based on a combination of subjective and objective information similar to an on-site appointment

19. Telemedicine Services:1. Telenursing: • The use of telecommunications and information technology in order to provide nursing services • This can occur between patient and nurse, nurse-to-nurse, or nurse-to-other healthcare provider

20. Telenursing is achieving significant growth rates in many countries due to several factors: • A preoccupation in reducing the cost of healthcare • An increase in the number of aging and chronically ill population • The increase in healthcare coverage to distant, rural, small, or sparsely populated regions

21. Benefits of telenursing: • May help solve increasing shortages of nurses • Reduce distances and save travel time • Keep patients out of the hospital

22. 2. Telepharmacy: • A growing trend for providing pharmaceutical care to patients at remote locations where they may not have physical contact with a pharmacist

23. Drug therapy monitoring Patient counseling Prior authorization Refill authorization Monitoring compliance Patient education Staff training Managerial services Telepharmacy encompasses:

24. Example: • Community Health Association of Spokane, WA (CHAS) • Program utilized videotelephony for dispensing medications and patient counseling at six urban and rural clinics

25. CHAS Process: • The prescription is sent from one of the remote clinics to the base pharmacy • The base pharmacist verifies the prescription and enters the order • A label is generated and the label queue is transmitted back to the ADDS (medication dispensing cabinet) at the remote location

26. CHAS Process: • The authorized person can access the medication from the ADDS followed by medication barcode scanning and the printing and scanning of labels • The remote site personnel are connected to the base pharmacist via videoconferencing for medication verification and patient counseling

27. 3. Telerehabilitation: • The delivery of rehabilitation services over telecommunication networks and the internet

28. Two categories of telerehabilitation: • Clinical Assessment—identifying the patient’s functional abilities in his/her environment • Clinical Therapy—actions to rehabilitate a patient in a remote environment

29. Several fields of telerehabilitation: • Neuropsychology • Speech-language Pathology • Audiology • Occupational Therapy • Physical Therapy

30. Telerehabilitation: • Can deliver therapy to people who cannot travel to a clinic because the patient has a disability or because of travel time • Ground-breaking research in telehaptics (sense of touch) and virtual reality may broaden the scope of telerehabilitation in the future

31. 4. Telecardiology: • Includes the transmission of electrocardiograph (ECG) readings via the telephone or wirelessly • This system is also used to monitor patients with pacemakers in remote areas • Also electronic stethoscopes can be used as recording devices for diagnosis, treatment, or evaluation

32. 5. Telepsychiatry: • Utilizes videoconferencing for patients residing in underserved areas to access psychiatric services

33. Services to patients and providers include: • Consultation between psychiatrists or psychiatrist and patient • Educational clinical programs • Diagnosis and assessment • Medication therapy management • Routine follow-up meetings

34. 6. Teleradiology: • The ability to send radiographic images from one location to another

35. For this process to be implemented three essential components are required: • An image sending station—an image is scanned and then sent to the receiving station • A transmission network—i.e. high speed broadband internet • A receiving-image review station—the computer must have a high quality display screen that has been tested and cleared for clinical/healthcare purposes

36. Teleradiology: • The most popular use for telemedicine and accounts for at least 50% of all telemedicine

37. For teleradiology to be implemented 3 essential components are required: • An image sending station—an image is scanned and then sent to the receiving station • An transmission network—ie. High-speed broadband secure Internet • A receiving-image review station—this computer must have a high quality display screen that has been tested and cleared for clinical/healthcare purposes

38. Radiology: • Teleradiology is the most popular use for telemedicine and accounts for at least 50% of all telemedicine usage

39. 7. Telepathology: • Uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purpose of diagnosis, education, and research • It requires that a pathologist select the video images for analysis to develop a diagnosis

40. 8. Teledermatology: • Telecommunications technologies are used to exchange medical information concerning skin conditions and tumors of the skin over a distance using audio, visual, and data communications • One of the most common applications of telemedicine and e-health • Applications include diagnosis, consultation, treatment, and continuing education

41. Telesurgery—AKA remote surgery: • Allows a physician to perform surgery on a patient even though they are not physically in the same location • Combines elements of robotics, cutting edge communication technology, and elements of management information systems • Promises the expertise of specialized surgeons to be available to patients worldwide without the need for patients to travel beyond their local hospital

42. VI. Technologies Enabling Telemedicine: • Videotelephony • Health Information Technologies (HIT)

43. 1. Videotelephony: • Includes the technologies for the reception and transmission of audio-visual signals by users at different locations, for communication between people in real-time • Currently it is particularly useful to the deaf and speech-impaired who can use them with sign-language

44. 2. Health Information Technology: • Provides the umbrella framework to describe the comprehensive management of health information across computerized systems and its secure exchange between consumers, providers, government, and insurers • It is increasingly viewed as the most promising tool for improving the overall quality, safety, and efficiency of the health delivery system

45. Broad and consistent utilization of HIT will: • Improve health care quality • Prevent medical errors • Reduce health care costs • Increase administrative efficiencies • Decrease paperwork • Expand access to affordable care

46. Interoperable HIT will improve individual patient care, but it will also bring many public health benefits including: • Early detection of infectious disease outbreaks around the country • Improved tracking of chronic disease management • Evaluation of health care based on value, enabled by the collection of de-identified price and quality information that can be compared

47. US Licensing and Regulatory Issues: • Restrictive licensure laws in the US 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 (vary 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

48. Even if a practitioner never practices medicine face-to-face with a patient in another state, he/she must meet a variety of other individual state requirements including: • Paying substantial licensure fees • Passing additional oral/written examinations • Traveling for interviews and examinations

49. Licensures and Regulations: • Physicians who will be prescribing over the Internet should mandate strict controls on their practice to insure they stay compliant with the various State Medical Board Regulations concerning Internet prescribing