1. Jennifer Burk Christy ClineTELEHEALTH COMMUNICATIONS

2. DEFINITION The use of technology (telecommunication and electronic devices) to coordinate health services and information between healthcare providers and patients Services include health promotion, disease prevention, diagnosis, consultation, education and therapy Overcomes social, economic and geographical barriers to healthcare Electronic, visual and audio capabilities 3. BACKGROUND Initial uses were telephone calls between healthcare providers, patients and hospitals With the advancements of technology the practice grew NASA and the U.S. military have been the most aggressive in the advancement of the technology Prison systems use to prevent the cost and dangers of transporting prisoners Telepsychology is a huge benefit to rural areas that are unable to attain round-the-clock psychiatric care for patients The Telecommunications Act of 1996 The American Recovery and Reinvestment Act of 2009 Allows vendors of cable and telephone services to compete in each others markets Requires carriers to offer same rates and services to urban and rural providers so that it is affordable in all areasFunding for research, operations and grants in telemedicine, telehealth and informaticsAustralia, Canada, Norway and Sweden are the current leaders in the use of telehealth, and have already achieved great strides in this area 4. DRIVING FORCES SAFETY, ACCESSIBILITY, COST EFFECTIVENESS Improved access to providers that allows earlier treatment Care and treatment in the patients own home and community More expert advice is available Convenient follow-up care Improved record keeping of vital signs, blood sugar readings, wound images Healthcare provider time saving, allowing more time for patient care and less time traveling 5. ONLINE DATABASES AND TOOLS Patients -Education -Drug information -Record Keeping -Home health -Disease management -Support Groups -ReferralsHealthcare providers -Standards of Care -Evidence-based Practice guidelines -Computerized diagnoses -Drug information -Retrieval of literature -Bulletin Boards, discussion groups -Continuing Education 6. EXAMPLES OF TELEHEALTH USES A consult/exam done by telecommunications 7. EXAMPLES OF TELEHEALTH USES CONTINUED An I-phone app that allows reading and reporting of O2 Sat readings 8. EXAMPLE OF TELERADIOLOGY Example from Onepacs.com X-rays, Cat Scans, MRIs taken at local hospital, images are transmitted to a radiologist on duty 24 hours a day. The radiologist types in the results, then e-mails or faxes back to the local hospital. 9. TELENURSING Telephone and faxes have been in use for decades between nurses and other healthcare providers Home visits via telephone and internet visits allow for more seen patients daily vs. traveling to homes in person Follow up calls from ER visits/Hospital admissions Dial-A-Nurse, nurse helplines 10. BENEFITS OF TELEHEALTH Continuity of care Centralized health records Patients living away from major population centers or in economically disadvantaged areas can access care more readilyMay lower costs for healthcare Access to care & access to specialists is improvedRemoves geographic barriers to care Offerings readily availableHigher quality of care Experts are readily availableEducation of healthcare consumers & professionals Cooperation is fostered among interdisciplinary members of the healthcare teamImproved decision making The patient is an active participant in videoconferencesCollaboration among healthcare providers Patients remain in the same healthcare systemIncorporation of the health consumer as an active member of the health team Patients can stay in the community & use their regular healthcare providersEliminates travel costs Patients are seen earlier when they are not ill Treatment may take place in local hospitals, which are less costlyImproved quality of health records The record contains digitalized records of diagnostic tests, biometric measures, photographs, and communicationHebda & Czar, 2013, p. 510 11. BENEFITS OF TELEHEALTHStreitfeld, 2012 12. APPLICATIONS OF TELEHEALTH Ambulatory care settings Cardiology EMTs & nurses at the site of a disaster can consult with physicians about the health needs of victimsEducation Patients may report blood glucose readings by using the touch-tone telephoneMobile unit post-disaster care Primary physicians may ask specialists to see a patient without the patient waiting for an appointment with the specialist and traveling to a distant siteDiabetes management Research may be conducted on large databases for educational, diagnostic, cost/benefit analysis, and evidencebased practiceDermatology Patients may be seen at home or in outpatient settings by a counselor at another siteData mining ECG strips can be transmitted for interpretation by experts at a regional referral center, and pacemakers can be reset from a remote locationCounselling Patients are connected with automated systems to monitor medication adverse events & medication non-adherence Clinicians have real-tine information on a patients experience with medicationsHealthcare professionals in geographically remote areas can attend seminars to update their knowledge without extensive travel, expense, or time away from homeEmergency care Community hospitals can share information with trauma centers so that the centers can better care for patients & prepare them for transportHebda & Czar, 2013, p. 510 13. APPLICATIONS OF TELEHEALTH Fetal monitoring Geriatrics Palliative and end-of-life services via technology can increase access to services in remote areas or supplement traditional careMilitary Once equipment is in the patients home, nurses & physicians may evaluate the patient in home without leaving their officesHospice Patients receive automated reminders & education feedback regarding hypertension treatment guidelinesHome care Videoconference equipment in the home permits home monitoring of medication administration for a patient who has memory deficits but who is otherwise able to stay at homeHypertension management Some high-risk antepartum patients can be monitored from home with greater comfort & decreased expensePhysicians at remote sites can evaluate injured soldiers in the field via the medics equipmentPharmacy Data can be accessed at a centralized locationHebda & Czar, 2013, p. 510 14. APPLICATIONS OF TELEHEALTH Pathology Psychiatry Social workers can augment services with telehealth home visitsVirtual intensive care units School nurses, particularly in remote areas, can quickly consult with other professionals about problems observedSocial work Radiologists can take calls from home and receive images from the hospitalSchool clinics Specialists at major medical centers can evaluate patients in outlying emergency departments, hospitals, and clinics via teleconferencesRadiology The transmission of slide and tissue samples to other sites make it easier to obtain a second opinion on biopsy findingsRemote monitoring capabilities and teleconferencing allowing experts at medical centers to monitor patients in distant, rural hospitals, particularly when weather conditions or other factors do not allow transportExtended emergency services Remote monitoring and teleconferencing support allow emergency care physicians to view and monitor ambulance patients, supervise EMTs, initiate treatments early and redirect patients to the most appropriate facilities, such as burn centers or trauma units, without being seen first in the emergency departmentHebda & Czar, 2013, p. 510 15. BARRIERS TO TELEHEALTH Regulatory barriers Lack of reimbursement for consultative services Personnel may fear job loss as more patients can be treated at home & hospital units closeLack of acceptance by healthcare professionals Equipment capable of transmitting and receiving diagnostic grade images is still expensive, although costs are decliningFear of healthcare system changes Most third party payers do not provide reimbursement unless the patient is seen in personCosts for equipment, network services, and training time State laws are either unclear or may forbid practice across state linesThis may stem from liability concerns & discomfort over not seeing a patient face-to-faceLack of acceptance by users This may stem from discomfort with technology, the relationship with the provider, & concerns over security of information & confidentialityHebda & Czar, 2013, p. 516 16. WHAT WILL WE SEE IN THE FUTURE? New ways to access healthcare New ways to communicate with and monitor patients Improved reimbursements from insurance to insure the survivability of the programs Improved licensure availability and privacy Many international and national organizations (FCC, National Institute for Nursing Research, etc) are putting more money and resources into this area for growth and expansion of these areas 17. REFERENCES Agency for Healthcare Research and Quality. (n.d.). http://psnet.ahrq.gov/primer.aspx?primerID=9 Great Plains Telehealth Resource and Assistance Center. (2012, May 30). Telemedicine consultation example [Video file]. Retrieved from https://www.youtube.com/watch?v=y5IB1BZGlnA Hebda, T., & Czar, P. (2013). Handbook of Informatics for Nurses and Healthcare Professionals (5th ed.). Upper Saddle River, NJ: Pearson Education, Inc. Masimo Corporation. (2013, March 8). iSpO2 Pulse Oximeter from Masimo [Video file]. Retrieved from http://www.youtube.com/v/pE-gm0s5J3E National Center for Biotechnology website. (2007). http://www.ncbi.nlm.nih.gov/pubmed/17672809 Streitfeld, J. (2012, June 04). Why Telehealth Services Can Remedy Healthcare Deficiencies. Retrieved November 26, 2012, from Excalibur Blog: http://www.excaliburmed.com/teleradiology- telehealth-blog/bid/142123/