Telehealth: Lowering the quality of care

Arisha Assaf, Kerry de Mello, Juan Gonzalez Pineda, Olivia Rominiyi, Tori Vanderheyden, and Samantha Weygandt

Group #1

Professor Rekha Gupta

What is Telehealth Care?

Telehealth is the delivery of health-related services and information via telecommunications technologies. This technology encompasses telephone calls, fax machines, electronic health records, mobile

applications, websites, robotic surgical machines, and online pharmacy systems.

Reasons for Research

America is considered to be a leader in health care technology, but on average American’s spend 8% more on health care than other devolved nations.

Despite the presence of technology and money spent annually American’s still have some of the highest rates for heart disease, obesity, diabetes, cancer, and pregnancy complications.

Identifying the Problem

When examining the reasons for poor health in American there seems to be a common denominator- the presence of technology in place of actual medical treatment.

This lead our research group to form the following thesis: Telehealth care is an emerging practice that is using technology in place of “traditional

medicine”, the presence of telehealth is causing a standard of lower quality health care.

Tackling the Topic

Our research group examined each of these fundamental health areas to show how telehealth is lowering the quality of health care:

I. History of Healthcare (Olivia Rominiyi)

II. Ethical Concerns (Samantha Weygandt)

III. Technology Concerns for Patients (Kerry de Mello)

IV. Physician Responsibility (Juan Gonzalez Pineda)

V. Government Interventions (Arisha Assaf)

VI. Rebuttal (Tori Vanderheyden)

Olivia Rominiyi

Olivia Rominiyi is a senior at Old Dominion University majoring in biological sciences and music performance. She hopes to pursue

careers in obstetrics and music therapy. She currently volunteers at Sentara Leigh Hospital in their Healing Notes program as one of their volunteer performers, performing various arias and art songs for the

benefit and enjoyment of patients. In addition to her studies and volunteer work, Olivia is also professional musician. She often works

with the ODU concert Choir, Virginia Opera, Tidewater Opera Initiative, the I. Sherman Greene Chorale, and the Cantabile Project of Hampton Roads. In her spare time, Olivia enjoys reading, shopping, travelling, performing, and stimulating conversations. Her portion of this paper covers the background and history of telehealth. This topic interests her because she plans to work in healthcare and telehealth is rapidly

becoming a standard way of administering healthcare.

 

Background on TelehealthOlivia Rominiyi

Telehealth is the delivery of health related services and information via telecommunication technologies.

Telehealth is an expansion of telemedicine which encompasses preventative, promotive, and curative aspects

Telehealth has direct and indirect effects all over the globe

History of HealthcareOlivia Rominiyi

I. The background and history of Telehealthcare

A. Healthcare is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in human beings.

1. Healthcare is delivered by practitioners in allied health, dentistry, midwifery-obstetrics, medicine, nursing, optometry, pharmacy, psychology, and other car providers.

2. It refers to the work done in providing primary care, secondary care, and tertiary care, as well as public health

History of HealthcareOlivia Rominiyi

II. Telehealth is the delivery of health related services and information via telecommunication technologies.

A. The term telemedicine was coined in the 1970s by the American Thomas Bird and, literally translated, means “healing at a distance” (from Latin “medicus” and Greek “tele”).

1. The actual origins of telehealth date back to the 20th century.

2. Willem Einthoven, a Dutch physiologist, developed the first electrocardiograph in his laboratory in Leiden. This is considered the first use of health at a distance.

B.. Telehealth is an expansion of telemedicine which encompasses preventative, promotive, and curative aspects

C. This type of health administration can be done using several different commonly used technological devices.

1. Computers, laptops, webcams are some of the most commonly used devices.

a. Two complementary methods of transmitting data, images and sound can be differentiated

1. The live technique, where the health professional has direct video contact with the patient.

2. The store and forward technique, where information is acquired in one location and reviewed in another at a later stage.

D. Telehealth has direct and indirect effects all over the globe.

A. It affects the world medically.

B. It affects different areas of the globe financially.

 

Research StrategyOlivia Rominiyi

My research started with a simple Google search of our topic.

I also had to research the technologies that help to improve telehealth and make it possible.

I search various combinations of terms and phrases such as “telehealth,” “telehealthcare technologies,” “telemedicine,” “telehealth in the 20th/21st century,” and “telehealth in recent years.”

I also utilized the ODU library database which gave me several of the same results.

Methodology Olivia Rominiyi

With an increase in telehealth use to expand healthcare access and curb costs, there is an interest in knowing the return on investment percentages generated by healthcare organizations' application of telehealth and telemedicine. The Healthcare Intelligence

Network's second annual Telehealth and Telemedicine e-survey conducted in September 2010 captured the nuts and bolts of telehealth services offered by 111

healthcare organizations, including the ROI reported by organizations with telehealth services

Statistical ChartOlivia Rominiyi

As seen in the chart (which has been remade in exact likeness due to being unable to copy and paste it), the majority of healthcare organizations find it to be too soon to calculate or give a rough estimate of their ROI, mainly because it is still a relatively new course of action in the medical field.

BibliographyOlivia Rominiyi

Boulanger, B., Kearney, P., Ochoa, J., Tsuei, B. & Sands, F. . (2001). Telemedicine: a solution to the followup of rural trauma patients. Journal of the American College of Surgeons, 192(4), 447-452. doi: http://dx.doi.org/10.1016/S1072-7515(01)00796-7

Brown, N. (2005). Telemedicne Coming of Age. from http://tie.telemed.org/articles/article.asp?path=consumer&article=tmcoming_nb_tie96.xml

Darkins, A. C., M. . (2000). Telemedicine and Telehealth: Principles, Policies, Performance, and Pitfalls. New York, NY: Springer.

Higgs, R. (2009). What is Telemedicine? , from http://www.icucare.com/PageFiles/Tele-medicine

Puskin, D., Johnston, B. & Speedie, S. . (2006). Telemedicine, Telehealth, and Health Information Technology. from http://www.americantelemed.org/docs/default-source/policy/telemedicine-telehealth-and-health-information-technology.pdf?sfvrsn=8

Reeves, R. K., M. (2014). Telehealth: Driving Adoption of Virtual Visits. from https://www.mevisit.com/mevisit/resources/MPLC_Telehealth_FINAL.pdf

Strehle, E. S., N. . (2006). One hundred years of telemedicine: does this new technology have a place in paediatrics? Archives of Disease in Childhood, 91(12), 956-959. doi: 10.1136/adc.2006.099622

Samantha Weygandt

Samantha is a junior, biochemistry major with a minor in environmental health at Old Dominion University. She is hoping to peruse a career as a

doctor or as an environmental health officer. Samantha is an undergraduate research assistant in the pathology department at Eastern Virginia Medical School. She also volunteered as a Child Life Assistant at The Children’s Hospital of the King’s Daughters. Samantha has been a nationally certified and Virginia State Licensed Pharmacy Technician for

four years. She is recently married and in her spare time she likes to play with her two dogs, do yoga, go to the beach, and cook. Her section of this paper covers the ethical concerns of telehealth care and how it impacts

patients’ quality of care. She is interested in this topic because it relates to the medical field and the concern of quality treatment control and both of

these topics relate to her future career choices

Ethical Concerns of TelehealthSamantha Weygandt

The telehealth care field is an emerging practice of the medical field that is not pardoned from ethical concerns.

Ethical issues in this case are defined by if the physician does what is right (ethical) or what is wrong (unethical).

This section will examine the key ethical concerns with telehealth that prevent patients from receiving the highest quality health care possible.

Areas of ConcernSamantha Weygandt

The highest areas of ethical concern are: Patient privacy involving electronic health records (EHRs)

This includes breach in records that make patients vulnerable to identity theft and insurance fraud

Physicians’ ability to adapt to new technology

This includes image quality control that effects time needed and quality of health care administered

Physicians’ access to approved, current treatment protocols

This includes unreliable sources of treatment protocols available to physicians via the internet

Patient integrity involving telepharmacy

This includes patients lying through telehealth applications that allow access to dangerous prescription medications.

Research StrategySamantha Weygandt

The first research strategy I used was to use search engines such as google and key terms to find sources. This strategy returned many unreliable sources that I could not use for my research.

The second research strategy I used was the one I used to tackle my topic. This strategy involved using search engines, google scholar, and data bases to return reliable

sources.

Key terms, subject headings, and advanced search options were used.

Examples of key terms used:

Telehealth technology negative impact

Telehealth lower quality health care

Telehealth ethical concerns

What is an Acceptable Source?Samantha Weygandt

An acceptable source is a source that is written by an author that is considered to be an expert or a qualified individual within the scope of the work.

An acceptable source will also contain: Non-biased stances

Current information on the topic

References that are clearly indicated and can be found for cross referencing

Quantitative and qualitative data relevant to the topic

Reasons to Reject a SourceSamantha Weygandt

When implementing a proper research strategy, one will encounter many results that are not acceptable sources for information.

Sources that are rejected normally have these qualities:

Lack of information relative to the topic

Out of date material

Authors that are biased and write based on personal opinion

Lack of references or references with proper credentials

Sources that were rejected:

Fasano, P. (2013). Transforming Health Care: The Financial Impact of Technology, Electronic Tools and Data Mining. New York, NY: Wiley.

Wang, J. (2013). Body Area Communications: Channel Modeling, Communication Systems, and EMC. Singapore: J. Wiley & Sons

Wootton, R., Tait, A., & Croft, A. (2010). Environmental aspects of health care in the Grampian NHS regions and the place of telehealth. J Telemed Telecare 16(4), 215-220. doi: 10.1258/jtt.2010.00415

Research MethodologySamantha Weygandt

The sources that were used for this topic contained statistical data, literature review, and personal interviews as methodology for their work. Statistical data: This included data containing patients’ concern for privacy, identity and

insurance fraud rates in America, image quality of medical testing, and prescription abuse in the telepharmacy field.

Literature review: The authors of the sources that were used reviewed literature published on the ethical concerns of telehealth. The literature that was reviewed were scholarly, peer-reviewed articles published in renowned medical journals that contained protocols, statistical data, and personal interviews.

Personal interviews: The interviews conducted by the authors were done to show how telehealth effects all aspects of the medical field. Manuscript from physicians, patients, nurses, and other health care professionals related to telehealth were used.

Analyzing Statistical FiguresSamantha Weygandt

The following chart shows the statistical make up of the top drugs that are prescribed unnecessarily and sold illegally using telehealth care applications in Tennessee.

The majority of the drugs, 85%, are CIII & CIV classed which have high and moderate risk for dependency and abuse

o The majority is made up of Analgesics: Hydrocodone, Tramadol, Buprenorphine; Benzodiazepines: Alprazolam, Diazepam, Lorazepam, and Clonazepam; and gamma-Aminobutyric Acid-ergic Agonists: Zolpidem.

o The other 15% are schedule CII drugs which have the highest risk among legal drugs for abuse and dependency.

o These include morphine products and oxycodone products.

o These prescriptions are manipulated from physicians by patients using telehealth technologies to avoid detection of drug seeking behavior, to be able to pick up a valid prescription from a local office.

ConclusionsSamantha Weygandt

Patient privacy: Patients are not comfortable with their

physician’s ability to keep their personal information safe. The possible breach of security can cause patients to discontinue treatment or to be dishonest; which will lower their quality of health.

Adapting to Technology:

Physician’s that use low quality equipment and the variance of technology between offices cause inaccurate images and cause patients to unnecessarily repeat procedures.

Access to Information: Physicians that do not have access to reliable

information through telehealth risk the chances of misdiagnosing or providing inappropriate treatment. These issues risk for serious issues in the patient’s health and malpractice risks for the provider.

Patient Integrity: The dishonesty of patients to obtain

prescription medications raises extreme concern for the physician and the public. If patients obtain prescriptions for criminal purposes it puts the public at risk a higher amount of drug dependent citizens and for higher death rates from overdose.

Overall ConclusionsSamantha Weygandt

Based on the qualitative and quantitative data recovered, one can determine that ethical issues present in telehealth care cause the quality of health care administered to patients to be low.

If patients are receiving lower quality health care then America is at risk for more chronic health problems, earlier mortality age, prescription drug abuse, and other concerning matters.

Providers should examine if telehealth technology is really a useful tool in providing quality treatment, or if it is done out of convenience.

BibliographySamantha Weygandt

All of these sources are acceptable sources that fit into the criteria stated earlier in the presentation

Ethical Issue. (2014). Web Finance, Inc. .

Darkins, A. C., M. . (2000). Telemedicine and Telehealth: Principles, Policies, Performance, and Pitfalls (Vol. New York,

NY): Springer.

Fleming, D., Edison, K., &Pak, H. (2009). Telehealth Ethics. Telemedicine Journal and e-Health, 15(8), 797-803. doi: 10.1089/tmj.2009.0035

Khoja, S., Durrani, H., Nayani, P., & Fahim, A. (2012). Scope of Policy Issues in eHealth: Results From a Structured Literature Review. Journal of Medical Internet Research, 14(1), e34. doi: 10.2196/jmir.1633

Lawrence, O., Gostin, J., Turek-Brezina, J., Powers, M., Kozloff, R., Faden, R. & Steinauer, D. . (1993). Privacy

and Security of Personal Information in a New Health Care System. The Journal of the American Medical Association, 270(20), 2487- 2493. doi: 10.1001/jama.1993.03510200093038

McCann, E. (2014). Four-year EHR breach raises eybrows. Healthcare IT News. Retrieved from http://www.healthcareitnews.com/news/four-year-ehr- breach-raises-eyebrows

Murphy, K. (2013). What's preventing telehealth use by mental health providers? EHRintellegence.com. from http://ehrintelligence.com/2013/06/06/what%E2%80%99s -preventing-telehealth-use-by-mental-health-providers/

Sarhan, F. (2009). Telemedicine in healthcare2: the legal and ethical aspects of using new technology. NursingTimes.net. from http://www.nursingtimes.net/nursingpractice/specialisms/management/telemedicine-in-healthcare-2-the-legal-and-ethical-aspects-of-using-new- technology/5008068.article

Varney, D. (2014). PRESCRIPTION FOR SUCCESS: Statewide Strategies to Prevent and Treat the Prescription Drug Abuse Epidemic in Tennessee. Retrieved from

http://tn.gov/mental/prescriptionforsuccess /

Kerry de Mello

Kerry de Mello is a senior English Education major at Old Dominion University. This is her last class before she

finishes her undergraduate degree! She is an alumna of Delta Zeta Sorority, where she held the positions of

Secretary and President. She also received New Member of the Year and Sister of the Year. She is currently

interning in Human Resources at XO Communications and is loving it. In her free time, she loves to travel and

spend time with her family and 4 dogs. Kerry is responsible for the patient accountability aspect because

she is interested in that side of medicine and how it effects the recipients of it.

Patient AccountabilityKerry de Mello

Telehealth is a field that can lead to patient misuse, in more ways than one.

Groups of today’s population are unable to use technology in the way that it is supposed to be used.

This section will examine how patients should or should not have the ability to cut out face to face time with their doctors.

Research StrategyKerry de Mello

When I started my research, I began with regular Google – this is normally what I use and has always given me a good starting point.

As I went further, I found that going through the library databases provided more quality information.

Google Scholar was able to give me full articles that provided a lot of information on various aspects of the subject.

Acceptable SourcesKerry de Mello

I chose sources that were notable, like Mayo Clinic, which is a large national institution.

I also chose sources that gave full conclusions and showed a variety in patients studied.

Research MethodologyKerry de Mello

The sources that I used contained the following methodology: Literature Reviews

Statistical Data

Patient Satisfaction Polls

Government Documents

Rejected SourcesKerry de Mello

I chose to reject sources that were not current because the field of technology has changed so much and is changing still today.

I also rejected sources that did not have credible looking websites or have other educational articles listed as sources.

Technology TakeoverKerry de Mello

This graph shows that technology is making its way into the medical field. Now doctors and patients need to decide whether it should be or not.

My SideKerry de Mello

I believe that telehealth is something that is really important to people all over the country, of varying ages and mindsets—after doing research, I understand why my group is against telehealth, since there are so many drawbacks. From my standpoint, I think that there are a lot of benefits that can help doctor’s offices keep up with larger hospital systems, go green without the waste of paperwork (online systems), and maintain a better database of information since it would all be online.

BibliographyKerry de Mello

Currel, R. U., C., Wanwright, P. & Lewis, R. . (2000). Telemedicine versus face to face patient care: effects on practice and health care outcomes. from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002098/abstract

HIN. (2010). Top Coordinators of Care Transitions. from http://hin.com/healthcareperformancebenchmarks/category/healthcare-trends/

Koch, S. (2005). Home telehealth—Current state and future trends. from http://www.ijmijournal.com/article/S1386-5056(05)00188-7/abstract

Staff, M. C. (2014). Telehealth: When technology meets healthcare. from http://www.mayoclinic.org/healthy-living/consumer-health/in-depth/telehealth/art-20044878

Juan Gonzalez Pineda

Juan Alberto Gonzalez Pineda is a student at ODU who is majoring in Biology. He is currently taking summer

courses and plans to eventually go to medical to become a physician. He is belongs to the greatest branch of the

military in the world, the United States Navy. He serves as hospital corpsman, third class at Naval Medical Center Portsmouth. His goal is to attend the military’s medical

school in Maryland. He is drawn to this project because it is in the vein of his future and is a very interesting topic. He is responsible for the topic concerning a physician’s

responsibility when using telehealth technology.

A Physician’s ResponsibilityJuan Gonzalez Pineda

Physicians are not easily convinced to embrace new technologies.

The physician is not a one man show, they have a support system which is vital to their success and sanity.

The key to success is found by acquiring the correct type of technology for the best interests of the patient and provider, as well as understanding the reality of what a physician was meant to do.

What is a Physician Responsible for?Juan Gonzalez Pineda

Implementing technology for quality, not to be for compensated!

Too many times a physician is accepting a program for money or incentives.

Staying in their scope of practice

• Doctors should not be burdened by technology, it should assist them and allow them to stay in their scope of practice- diagnosing and treating patients.

Choosing technology based on reliable information, not information from people receiving commission.

• There are many great technological advances to medical professionals, but the correct ones must be chosen to be beneficial to the physician and patient.

Research StrategyJuan Gonzalez Pineda

For my first search I used google and it provided some decent article, but nothing substantial.

Too many unreliable sources.

The second research strategy was using ODU library system which provided some good journals for my second assignment.

I also used Scholar, Google, and Ebscohost

Keywords:

physician responsibility

eHealth responsibility

physician telehealth

What is an Acceptable Source?Juan Gonzalez Pineda

An acceptable source is authored by someone who is considered a subject matter expert.

An acceptable source will also contain: Non-biased stances

Current information on the topic

References that are clearly indicated and can be found for cross referencing

Quantitative and qualitative data relevant to the topic

Reasons to Reject a SourceJuan Gonzalez Pineda

I rejected many sources because of these qualities:

Biased toward one point, negative or positive.

Out of date material

Scope is too broad or too narrow.

Too much personal information and not enough data.

One sided

Rejected: Klaz I., Wohl Y., Nathansohn N., Yerushalmi

N., Sharvit S., Kochba I. & Brenner S. (2005). Teledermatology: quality assessment by user satisfaction and clinical efficiency. Israel Medical Association 7(8), 487-490. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/1616 771

Bravo, S., Valero, M., Pau, I., Duarte, J., Carrillo, M. & Blandino, J. (2012). A Tele-

Health Communication System Underserved Children in Rural Areas of Nicaragua. Special Bilingual Issue: Research on ICT4D from Latin America 8(4). Retrieved from: http://itidjournal.org/itid/article/view/965

Research Methodology Juan Gonzalez Pineda

The sources that were used for this topic contained statistical data, literature review, and personal knowledge as methodology for the work. The statistics covered physicians who were polled for the figure used in the document.

The authors of the articles covered were by subject matter experts and were representing very high profile organizations.

Statistical DataJuan Gonzalez Pineda

The chart to the left shows how many physicians had purchased Electronic Health Record Systems in 2012. 32 % don’t plan to in the next year. This source also demonstrates on how some physicians and groups

can get incentives for participating in programs such as this. The majority of the participants were under

50 and were part of a large group.

ConclusionsJuan Gonzalez Pineda

Compensation: Physicians should be looking for technology that will help the patient the most, not looking for compensation to use an inferior technological solution.

A doctor should be a doctor, not a secretary, a technician, or anything in between. They went to school to be a physician and they should allow their support system to assist them with any technology burdens.

The right technology is out there. Physicians need to make sure they are informed from reliable sources before purchasing expensive equipment.

BibliographyJuan Gonzalez Pineda

Aetna. (2014). Health care professionals: RelayHealth FAQs. Retreived from http://www.aetna.com/faqs-health-insurance/health-care-professionals-relayhealth-faqs.html

Jamoom, E., Beatty, P., Bercovitz, A., Woodwell, D., Palso, K. & Rechsteiner, E. . (2012). Physician Adoption of Electronic Health Record Systems: United States, 2011.

Hyattsville, MD: Centers for Disease Control and Prevention Retrieved from http://www.cdc.gov/nchs/data/databriefs/db98.htm.

Sein-Echaluce, M. (2014). How 3D Systems’ Medical Modeling Is Changing the Operating Room for the Better. Retrieved from http://3dprint.com/10195/3d-printing-operating- room/

Arisha Assaf

Arisha Assaf is a senior at Old Dominion University majoring in Human Service. She has a passion in caring for others, especially children. Arisha is a member of the Sigma Alpha Lambda Honor

Society. She also enjoys spending time with her family and cleaning. Her passion and dream is to finish nursing school and become a

Pediatric Nurse, while traveling around the word caring for those in need. Her interest in this group comes from her passion and love for others, as well as her interest in continuing her education within the nursing field. Arisha’s section of this paper covers the governmental

interventions of telehealth and its effects towards patient care.

Government InterventionArisha Assaf

The advance of technology within the medical field has changed the spectrum of the delivery and services.

The reticence demonstrated by these organizations has created a proliferation of legal issues to arise. As a result, the quality of care among the telehealth industry has decreased.

This section will examine the effects of the governments’ interventions within telehealth and how it effects its patients

Key IssuesArisha Assaf

o The issues concerning privacy and confidentially related to HIPAA

• Prohibitions of neglecting to comply with HIPAA laws

• Limitations of HIPAA coverage

o The hindrance of the reimbursement laws within telehealth

• Laws presiding, thus hindering users and physicians from obtains excellent service

o The licensure prohibitions of clinicians

• Jurisdiction of states

• Licensure requirements

o The limitation of software usage

• Cost and setup of software

• Connectivity issues

Research StrategyArisha Assaf

I began my research by gathering information from google by using keywords and phrases. As a result, I obtained a variety of sources and website to read from. Due to the high range of websites, I then decided to use the advance search method, which limited down the number of website to chose from. Later, I used journal article relative to my topic and search through reference page for other journals relative to the article.

After obtaining my selected sources by using relative terms and keywords, I then constructed a tentative outline which displayed questions or each subhead to remind me what to research. My overall research strategy incorporated journal articles, books, and websites.

Rejected SourcesArisha Assaf

Reasons for Rejection:

• Out of date

• unreliable references,

• not relevant to topic

McNeese-Smith, D. K. (1997). The influenceof manager behavior on nurses' jobsatisfaction, productivity, and

commitment. Journal of NursingAdministration,27(9), 47-55.

Wootton, R. (2012). Twenty years oftelemedicine in chronic diseasemanagement an evidencesynthesis. Journalof TelemedicineandTelecare,18(4), 211-220.

Research MethodologyArisha Assaf

• The sources used were derived from scholarly, peer reviewed articles, and website that contain studies conducted by doctors and research analyst.

• These sources also contains data from presiding institutions dedicated in detecting the effects of telehealth.

Statistical DataArisha Assaf

• The chart to the left shows the correlation of cost among the set up on the software kiosks.

• This software can cost up to 300,000 without insurance, however, the cost of rental, telephone lines, and technical support is not included.

• A telephone line can cost between $30 per month to $360 per year

BibliographyArisha Assaf

   

 

Dreyzehner, J. (2014). What is HIPPA. from http://health.state.tn.us/hipaa/

Fong, B. (2010). Telemedicine technologies electronic resourse: Information technologies in medicine and telehealth. Chickster, West Sussex, U.K.: John Wiley & Sons.

Gellis, Z. K., B., McGinty, J., Bardellie, E., Davitt, J. & Have, T. . (2011). Outcomes of Telehealth Invervention for Homebound Older Adults With Heart or Chronic

Respiratory Failure: A Randomized Controal Trial. The Gerontologist, 52(4), 541-522. doi: 10.1093/geront/gnr134

Hughes, M. B., M., Larson, D. & Weems, J. . (2010). Telehealth Reimbursment. from www.ruralhealthweb.org

Central, P. (2014). from http://www.apapracticecentral.org/update/2014/0424/skype-hipaa.aspx.

Dossel, D., Travers, H. & Hunter E. . (2007). The use of touch-screen technology for health-related

information in indigenous communities: Some economic issues. Prometheus, 25(4), 373-393. doi: 10.1080/08109020701689227

Downey, R. (2014). Medical Board Disciplinary Actions May Argue Against National Telehealth License. from

http://www.globalmed.com/telehealthanswers/medical-board-disciplinaryactions-argue-national-telehealth-license/

Tori Vanderheyden

Tori is a full time student at ODU, majoring in Biology and will graduate in the Fall of 2014. She is an alum of Zeta Tau

Alpha on campus and has held three executive position including First Vice President. In the spring she will

complete her certificate program where she will earn her certification in molecular pathology/biology and work in the field of Pathology. In her free time she likes to do yoga and play with her new puppy! Her interest in this group topic

follows with her interest in the healthcare field specifically her use of technology in pathology.

o The rising cost of health care has been a positive influence in the development of Telehealth Technologies.

o Telehealth Technologies would significantly decrease the cost of care by decreasing the amount of time spent with a doctor (Noel, 2004).

o Convenience of Telehealth on the consumer

o Disabled individuals find it very hard to commute to an appointment and find the technology very effective in maintaining their health from home (Turner, 2014).

o Working individuals have little time to spare and want to spend that time with their families instead making them a huge factor in the push for the new technologies (Charles, 2008).

o Government Involvement in the advancement of Telehealth and Telemedicine Technologies

o Government agencies have created federal mandates requiring healthcare facilities participate in electronic health records (Brusco, 2012).

o Policy makers are in the process of creating federal law and policies in support of telehealth technologies with the aid of Government agencies such as the FDA (Brusco, 2012).

Rebuttal Tori Vanderheyden

• I began the search using Google to get a general idea of the subject and find a more narrow target to research

• As I used the databases powered by ODU, I was able to find many peer-reviewed articles that gave many different view of why Telehealth is beneficial to the consumer.

• Google scholar also aided me in my search however the articles I found were not as credible as the database search article.

Research StrategyTori Vanderheyden

• I will continue to use the ODU databases to find pertinent articles related to the overall effectiveness and acceptance of Telehealth

• I plan to prove these statements by the following points

• Government Involvement in the advancement of Telehealth and Telemedicine Technologies

• The rising cost of health care has been a positive influence in the development of Telehealth Technologies

• Convenience of Telehealth on the consumer

Research strategyTori Vanderheyden

• Turner, L. (2013). Patient Mortality in Medical Tourism: Examining News Media Reports of Deaths Following Travel for Cosmetic Surgery or for Bariatric Surgery. Oxford University Press. doi:10.1093/acprof:oso/9780199917907.003.0001

• I rejected this book because it did not support the view that telehealth is beneficial to the consumer.

• PAGE, D. (2014). Telemed system speeds stroke care. H&HN: Hospitals & Health Networks, 88(4), 16.

• This article was very interesting however it was not written by an expert in the field and was featured in a periodical. It was more of an opinion piece rather than factual evidence.

• Peck, A. D. (2013). 5 tech trends that will affect the way you practice medicine in 2013. Medical Economics, 90(5), 48-42.

• Although this article had interesting information about new technologies in the telehealth world, it did not expand on the impact it would have on consumers or policy adaptations.

• Sood, S., Mbarika, Victor., Jugoo, Shakina., Dookhy, Reena., Doarn, Charles R., Prakash, Nupur., Merrell, Ronald C. (Novemeber 2007). What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings. . Telemedicine & e-Health, 13(5), 573-590. doi: 10.1089/tmj.2006.0073

• I rejected this article because it was simply an explanation of telehealth with no new information.

Rejected articles Tori Vanderheyden

Research MethodologyTori Vanderheyden

The resources I used for my topic included sources that used quantitative and qualitative data such as: Literature Reviews

Government Documents

Research Articles

Including data

Populations

Controlled Variables

Satisfaction Polls

Healthcare Protocols

Statistical DataTori Vanderheyden

*[This table is from the article “Home Tele-health Reduces Healthcare Costs. It exemplifies the total cost of care for an individual with Congestive Heart Failure.

The 1st row of total cost is the cost before health insurance is applied. The 2nd row of total cost is the cost after insurance is applied which the patient is required to pay out of pocket. The first and third

columns are number configured by patients who are using tele-health technologies. The second and fourth

columns are those patients who are not using the technology. The study showed a significant decrease in

the total amount of care cost between the pre-study groups which in turn exemplified the cost to patient

was a significantly less amount of money spent on care when using tele-health applications. The post study costs are much closer in price than the pre-study.]

Cost of health care for Congestive heart failure patients

BibliographyTori Vanderheyden

Brusco, J. (2012). Mobile health application regulations and compliance review. AORN Journal, 95(3), 391- 394. doi: 10.1016/j.aorn.2011.12.010

Charles, R., Peter, Y., Deborah, A., Denny, L., Sally D., Glenn, H. & Joseph, K. (2008). Societal Drivers in the Applications of Telehealth. Telemedicine & e- Health, 14(9), 998-1002.

Control, C. f. D. (2013). Rising health care costs are unsustainable. from http://www.cdc.gov/workplacehealthpromotion/businesscase/reasons/rising.html

Hanalon-Dearman, A., Edwards, C., Schwab, D., Millar, M. & Longstaffe, S. . (2014). 'Giving Voice': Evaluation of an Integrated Telehealth Community Care Model by Parents/Guardians of Children Diagnosed with Fetal Alcohol Spectrum Disorder in Manitoba. Telemedicne & e-Health, 20(5), 478-484. doi: 10.1089/tmj.2013.0161

Noel, H., Vogel, D., Erdos, J., Cornwall, D. & Levin, F. (2004). Home telehealth reduces health care costs. Telemedicne Journal and E-health, 10(2), 170-183. doi: 10.1089/tmj.2004.10.170

Turner, A., Sloan, A., Kivlahan, D. & Haselkom, J. . (2014). Telephone Counseling and Home Telehealth

Monitoring to Improve Medication Adherence: Results of a Pilot Trial Among Individuals With Multiple Sclerosis. Rehabilitation Psychology, 59(2), 136-146. doi: 10.1037/a0036322

ConclusionGroup #1

While it may seem that telehealth has benefits such as cost effective spending for patients, convenience, and government assistance it still has many discrepancies that do not qualify it as a comparable application in the medical field. The complications with telehealth support the argument that technology in health care not only effects patients and physicians, but all of America. Many issues have been presented in this paper that support the statement that the emerging practice of telehealth is using technology in place of “traditional medicine”, which is causing a standard of lower quality health care

Conclusion Group #1

o Ethical concerns highlight negligent systems causing concern for identiy theft and insurance fraud, patients using technology for ulterior motives, and physicians using technology without researching its capability.

o Patient concerns highlight how certain groups such as the elderly and disabled are unable to conform to technology and how dishonesty of patients through lower their quality of health.

o Physician responsibility concerns show that doctors are using telehealth to line their pockets, all while burdening themselves with extra work. This extra work takes away time from in office visits which effects patient health.

o Government intervention limits rural and disabled patients from receiving care and also limits doctors reimbursement rates, causing many Americans to go without.

ConclusionGroup 1

Americans spend more on health care than any other developed country and many relate this to the “technology used”. This technology has given America the highest rate of heart disease, diabetes, and obesity. It seems that the technology in place has given many patients and physicians a “placebo effect”, meaning they think they are doing something about their health by using technology, but really they are receiving nothing. Telehealth technology is damaging America’s health care system, physicians, and patients; which leads one to assume that “if it’s not broken don’t fix it”.

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