Telemedicine

Overview

Telemedicine is described as a medical practitioner using technology (computers, video, phone, message) to diagnose and treat patients at a remote place.

Telemedicine is a critical and rapidly expanding component of healthcare delivery in the United States. In the United States, there are now roughly 200 telemedicine networks with 3,500 service locations. In 2011, the Veterans Health Administration used telemedicine to provide over 300,000 remote consultations. More than half of all hospitals in the United States now employ some sort of telemedicine.

Telemedicine uses telecommunications technology to allow health care providers to examine, diagnose, and treat patients from a distance. In the previous decade, the method has seen a dramatic transformation, and it is now an increasingly significant component of the American healthcare system.

Telemedicine has specialized applications such as teletriage, telesurgery and telediagnostics, telecollaboration, and more. Teletriage is a sort of teleconsultation that is used in military circumstances and involves a military physician receiving online health advice from a remote medical specialist. Local and remote physicians share the same virtual area with the patient in telesurgery and telediagnostics, allowing the distant physician to see and examine the patient. 

Telecollaboration is defined as the interactive sharing of audiovisual information or real-time conferencing between two or more participants. Telephone conversations, voice conferencing, video conferencing, pictoral information transmission, and data or document conferencing are all examples of telecollaboration.

Is Telemedicine safe?

Yes. Telemedicine has been proved to be as safe and effective as in-person care when applied under the correct settings and for the right patients. Of course, not every ailment lends itself to video visits for treatment, so doctors must exercise caution when utilizing this channel for healthcare delivery.

Cost, Privacy & Interoperability issues

While authorities throughout the world think that widespread adoption of electronic health records (EHR) might reduce health-care costs, significant up-front implementation expenditures impose significant strain on public and private budgets. This was especially true in the early 2000s, when global economic slump stretched health-care resources and demand for EHR deployment skyrocketed. CMS anticipated that the EHR Incentive Program in the United States will cost $14.6 billion from 2014 to 2019. This estimate does not include any government or participating provider expenditures.

The rising usage of EHRs raises a slew of privacy and security concerns. Identity theft, fraud, or the public distribution of an individual's health information, as well as the exposure of sensitive information about health care providers, might all come from an EHR breach. Governments have attempted to address these concerns by enacting patient privacy, security, and access laws, such as the United States' Health Insurance Portability and Accountability Act (HIPAA) of 1996 and Sweden's Patient Data Act of 2008.

Because the benefits of EHR deployment are dependent on interoperability, the inability of EHR systems to interact and communicate across care settings and providers can significantly impede EHR success. For example, if a hospital's EHR system cannot communicate with the EHR system used in a nearby primary care practice, it will be ineffective in reducing duplicative testing or preventing medication errors. Interoperability is a challenge that is notably visible in Sweden, where providers deployed incompatible EHR systems at the regional level and were compelled to alter their systems. The European Union was attempting to achieve interoperability among all of its member countries.

Does Medicare or Medicaid Pay For Telemedicine?

For Medicare patients, national telehealth policy imposes several limits on patient location, telemedicine services, and institutions where patients can get these services. The Medicare Chronic Care Management Program, on the other hand, is a nationwide strategy that places no constraints on practicing telemedicine.

Medicaid funding differs per state, resulting in a hodgepodge of regulations and payment restrictions.

Applications

There are limited restrictions on how telemedicine can be used. Here are a few instances of how it is currently utilized.

• Visits for follow-up:

Using health software for routine follow-up visits not only makes physicians and patients more efficient, but it also enhances the chance of follow-up, minimizing missed appointments and increasing patient outcomes.

• Chronic illness management from a distance:

The rising prevalence of chronic illness such as Diabetes and Hypertension pose a significant challenge to our health-care system. It is an excellent candidate for the usage of telemedicine software since it allows people to keep control over their health in a more convenient and cost-effective manner.

• Post-hospitalization care from a distance:

One telemedicine program for congestive heart failure patients reduced 30-day hospital readmissions by 73% and six-month readmissions by 50%.

• Support for preventative care:

Weight loss and smoking cessation are essential for lowering the risk of heart disease and a variety of other illnesses. Telemedicine may be a great tool for connecting clinicians with patients and ensuring that they receive the assistance they require to be successful.

• Telehealth in the schoolroom:

When a kid becomes unwell at school, he or she may go to the school nurse or be picked up by their parents and brought to an urgent care clinic. Some forward-thinking school districts have partnered with doctors to provide school-based remote visits. The provider can assess the severity of the situation and provide parents guidance or reassurance.

• Support for assisted living facilities:

Telemedicine software has previously been shown to be effective in keeping residents of assisted living facilities out of the hospital. Problems frequently develop at night or on weekends, making hospitalization the sole choice, even for minor issues. On-call doctors can use telemedicine to perform a remote visit to assess whether hospitalization is required.

Telemedicine vs Telehealth

Although the phrases telemedicine and telehealth are sometimes used interchangeably, they are not identical.

The word telehealth refers to a wide variety of technology and services used to offer patient care and enhance the overall healthcare delivery system. Telehealth differs from telemedicine in that it encompasses a larger range of remote healthcare services than telemedicine. In addition to clinical services, telehealth can refer to remote non-clinical services such as provider training, administrative meetings, and continuing medical education. The World Health Organization defines telehealth as "surveillance, health promotion, and public health tasks."

Telemedicine is the use of electronic communications and software to deliver healthcare services to patients who are unable to visit a doctor in person. Telemedicine technology is commonly used for follow-up visits, chronic disease management, medication management, specialist consultation, and a variety of other clinical services that may be performed remotely via secure video and audio links.

Benefits & Barriers

There are advantages and disadvantages to using e-health for both providers and consumers. Beneficial effects include the adoption of computerized medication-ordering systems by clinicians, which can lower the likelihood of adverse drug events through decision support systems. Similarly, automated digital reminders can boost orders for suggested preventive measures like yearly physicals, mammograms, and prostate exams. In more severe cases, emergency medical staff and first responders have used e-health for consultation during natural catastrophes and wartime battlefield circumstances.

Primary care providers in rural and remote areas have used this technology to provide consultations for patients via direct linkage to urban-based specialists. E-health has also been employed as a basic and continuing education remote education technique. International collaboration projects have profited from e-health improvements by making information more accessible to health care providers and consumers.

Consumer benefits from e-health advancements include, for example, the ability to obtain medications online for direct delivery to the house. Hospitals and other acute care facilities have Web sites that explain their expertise and patient offerings. E-health has also assisted community-dwelling people with disabilities by allowing provider-patient contact through text, voice, or video conferencing to assess home-based progress.

A lack of financial incentives and reimbursement to support its use within and across organizations are two barriers to the use of e-health by health care providers. Furthermore, the initial implementation of new e-health technologies frequently delays existing procedures (due to the learning curve required to incorporate new tools and devices) until the more efficient system is established. Other impediments to e-health technology include costs associated with hardware and software purchases, maintenance, and upgrades, as well as a lack of standards governing the format and content of e-health information, particularly private patient health-related information, which has legal and economic implications for providers in terms of liability and malpractice insurance.

The so-called digital gap is one of the most significant hurdles to mainstream consumer usage of e-health. The digital gap is characterized by disparities in access to digital technology, notably the Internet. People on one side of the split often have access to such technologies and the expertise required to utilize them, whereas people on the other side of the divide typically do not. Although access to electronic communications is growing in both developed and developing nations, the gains are not universal, and gaps in availability and skill level continue.

Cost, literacy level, cultural appropriateness, and compliance with criteria for persons with impairments (e.g., Americans with Disabilities Act of 1990) are all important impediments to e-health use. Other concerns include those about the preservation of privacy, confidentiality, and informed consent, as well as those concerning the usability of e-health technology.

Delivery of Specialist Care

Telemedicine can facilitate specialty care delivered by primary care physicians according to a controlled study of the treatment of hepatitis C.

1. Telecardiology:

ECGs, or electrocardiographs, can be sent via phone or wifi. Willem Einthoven, the ECG's inventor, conducted studies with ECG transmission through telephone lines. This was due to the hospital's refusal to allow him to transport patients from the hospital to his laboratory for testing of his innovative equipment. Einthoven devised a method to send data from the hospital straight to his lab in 1906.

This method allowed wireless transmission of ECG from a moving ICU van or a patient's residence to the department of Medicine's central station in the ICU. Wireless transmission used frequency modulation, which decreased noise. Transmission was also accomplished over telephone lines.

The ECG output was linked to the telephone input through a modulator, which turned the ECG to high-frequency sound. A demodulator at the other end reconverted the sound into ECG with good gain accuracy. The ECG was converted to sound waves with frequencies ranging from 500 Hz to 2500 Hz, with a baseline frequency of 1500 Hz.

This technique was also utilized to monitor pacemaker patients in remote places. The ICU's central control unit was able to accurately interpret arrhythmia. This strategy aided in the delivery of medical aid to outlying places.

2. Telepsychiatry

Another element of telemedicine is telepsychiatry, which uses videoconferencing to provide psychiatric care to patients who live in underserved regions. It provides a wide range of services to patients and providers, including psychiatric consultation, educational clinical programs, diagnosis and evaluation, pharmaceutical therapy management, and so on.

The following are some of the model programs and initiatives being implemented for telepsychiatry in rural regions across the world:

• University of Colorado Health Sciences Center (UCHSC) supports two programs for American Indian and Alaskan Native populations

1. The Center for Native American Telehealth and Tele-education (CNATT) and
2. Telemental Health Treatment for American Indian Veterans with Posttraumatic Stress Disorder (PTSD)

• Military Psychiatry, Walter Reed Army Medical Center.

Links for several sites related to telemedicine, telepsychiatry policy, guidelines, and networking are available at the website for the American Psychiatric Association.

3. Teleradiology:

Teleradiology involves the transfer of radiographic images (x-rays, CT, MR, PET/CT, SPECT/CT, MG, US...) from one place to another. Three basic components are necessary for this procedure to be implemented: an image sending station, a transmission network, and a receiving-image review station. The most common solution is two computers linked over the Internet. 

The receiving computer must have a high-quality display screen that has been tested and certified for clinical use. Occasionally, the receiving computer will contain a printer, allowing photos to be printed for convenience. The image transmitting station is where the teleradiology procedure begins.

This initial stage necessitates the use of a radiographic picture as well as a modem or other type of connection. The image is scanned and then transmitted to the recipient computer over a network connection.

Today's high-speed broadband Internet permits the adoption of new teleradiology technologies: the image reviewer may now connect to faraway servers to watch an exam. As a result, they do not require special workstations to view the photos; a basic Personal Computer (PC) and Digital Subscriber Line (DSL) connection is sufficient to access to the keosys central server. There is no need for any special program on the PC, and the photographs may be accessed from anywhere in the globe. Teleradiology is the most common use of telemedicine, accounting for at least half of all telemedicine usage.

4. Telepharmacy:

Telepharmacy is the delivery of pharmaceutical care to patients in regions where they may not have direct touch with a pharmacist via telecommunications. It is an example of the broader phenomena of telemedicine as it is applied in the field of pharmacy. Telepharmacy services include medication treatment monitoring, patient counseling, prior authorization and refill authorization for prescription pharmaceuticals, and formulary compliance monitoring through teleconference or videoconferencing. Telepharmacy may also be defined as the remote delivery of drugs using automated packaging and labeling devices. Telepharmacy services are available in retail pharmacies as well as hospitals, nursing homes, and other medical care facilities.

The phrase can also apply to the usage of videoconferencing in pharmacy for various applications such as remote education, training, and administration of pharmacists and pharmacy staff.

Conclusion

Telemedicine is a branch of medicine in which telecommunications and medicine combine to enable for the provision of health care from a distance. Telemedicine is a subset of e-health because it employs a wide range of digital and interactive technology to improve patient health, typically through clinical intervention.

Telemedicine has the potential to improve patient-provider interaction and patient outcomes by enhancing patients' and health care providers' ability to communicate on clinical and educational issues. Telemedicine can be used to conduct remote consultations between clinicians or between physicians and patients regardless of geographical location. Examples of telemedicine include remote diagnosis and surgery in which a specialist gives advice and assistance to a nonspecialist during actual procedures that are performed in remote locations or in inaccessible environments.

A major advantage of telemedicine is that it provides for a rapid linkage to experts who can help with patient care in underserved areas. It also can enhance the education of providers and patients through the use of Internet-based interactives. Education is facilitated through the creation of telecommunication-linked classes that provide interactive information on care and prevention to places where such information and expertise is not available.