Chapter 8

B.E.L.T. Framework:

1. Bandwith 2. Education 3. Leadership 4. Technology and Interoperability

Benefits of telehealth:

1. Benefits of remote monitoring, diagnosis, and intervention supported by evidence. 2. Increased access to care. 3. Decreased costs of healthcare. 4. Increased healthcare provider productivity. 5. High level of patient satisfaction.

Telehealth services can be classified as:

1. Clinical telehealth (ex. diagnosis, patient communication and education, disease management, triage and advice, remote monitoring, caregiver support, and provider-to-provider tele consultations). 2. Nonclinical telehealth (ex. distance education for healthcare consumers or clinicians, video conferencing or conference call meetings, research, healthcare administration, and healthcare management).

Advantages to patients:

1. Decreased travel time or distance and removal of travel barriers 2. More immediate access to care 3. Early detection of disease processes or health issues 4. Ownership of healthcare and feelings of empowerment 5. Long-term health and independence 6. Caregiver reassurance 7. Patient satisfaction with healthcare

Telehealth:

1. Enables the delivery of clinical care regardless of geographic location. 2. Provides access to health assessment, diagnosis, intervention, consultation, supervision, and information across distance. 3. Evidence-based research supports the effective use of telehealth across most disciplines (teleradiology, teledermatology, telepsychiatry, and telenursing).

Where is telehealth used?

1. Hospitals (rural and urban) 2. Home health agencies 3. Patient homes 4. Dialysis centers 5. Prisons 6. Outpatient clinics 7. Space agencies

Synchronous ("real time"):

1. Live, two-way interactions and/or patient monitoring. 2. Connects a healthcare provider to a patient for direct care or provider-to-provider for collaboration or consultation.

Asynchronous technologies:

1. Personal computer, laptop, tablet, or smartphone for the sender and receiver. 2. Telecommunication technologies such as local area network (LAN) or wireless network. 3. Digital medical devices such as digital camera, x-ray equipment, glucometers, vital sign monitors, and wearable sensors embedded in wearables. 4. Software such as web-based application, encrypted e-mail, specifically designed store-and-forward software, an EHR, a PHR, and an electronic data repository.

Telehealth Technologies:

1. Synchronous ("real time"). 2. Asynchronous ("store-and-forward").

Examples of telehealth technology:

1. Telephone conversations 2. Fax 3. Email 4. Cell phones/mobile applications 5. Video conferencing 6. Web-based, remote patient-monitoring devices (pacemaker or other cardiac devices, remote vital sign monitoring) 7. Transmission of images (tele radiology) 8. eHealth- patient portals 9. Online physician consultation

Asynchronous ("Store-and-forward"):

1. Transmits health-related information, video, images, and audio files when the healthcare provider and patients are not available at the same time. 2. Previously recorded information sent for future review.

Overcoming barriers to care:

1. Underserved populations: Patients with: physical, financial, geographical barriers to care. 2. Geographically challenged: Rural areas with a shortage of healthcare professionals 3. Telehealth can improve the quality, access, equity, and affordability of healthcare in the U.S. and globally

Synchronous technologies:

1. Video conferencing a. Video display devices with monitor and audio components (ex. mic and speakers). 2. Patient monitoring technologies a. Uses devices to remotely collect and send biometric data for interpretation by a healthcare provider (ex. vital signs, glucose readings, peak-flow meters and other devices for home-bound patients). b. Patients can be involved and oversee the process. 3. Uses 2 main components: hardware and software a. Hardware - the base station where patient interacts and enters data. b. Software - enables healthcare providers and technicians to configure the hardware, receive data, and monitor the patient.

Operationalizing Telehealth- steps for success:

1.Planning- needs assessment and analysis to define patient populations and healthcare problems in which telehealth can have a positive impact 2.Work environment with prepared staff using standards and guidelines 3.Technology preparedness- user-friendly technology that enables quality clinical decision making and responsive & accessible technical support 4.Learning how to implement, manage, and support a telehealth project or program

Confidentiality, Privacy, and Informed Patients:

Confidentiality and privacy are still very important in using telehealth Requirements are the same as with in-person care Particular care must be taken with others in the same room but off camera. Patients must give consent for anyone without a need to know to be present either on or off camera

How does telehealth measure up?

Is telehealth equal to or better than in-person care? Telehealth is so effective that in 1997 the World Health Organization (WHO) announced that telehealth has become a part of the WHO's "Health for All" strategy and should be made available to all people Provider-patient encounters were studied and found to be as effective as standard face-to-face visits in a provider's office. Telehealth is an efficient and cost-effective means for improving clinical outcomes and increasing patient involvement in their own care.

Telehealth Clinical Competency:

Telehealth competency is crucial to provide safe and optimal patient care There must be a focus on educating and preparing healthcare providers in telehealth technology, techniques, skills, coordination, and "on camera" communications. Components and competencies include: - Coordinating healthcare provider and patient scheduling, telepresenting skills, the exchange of prior medical record and new telehealth information, and an understanding of video and audio technology. This should begin in academic preparation and continue through continuing education requirements

Define Telehealth:

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.

Define Telemedicine:

The use of medical information exchanged via electronic communications for the health and education of the patient or healthcare provider and for improving patient care, treatment, and services.

Define Telenursing:

The use of telehealth technology to deliver nursing care and conduct nursing practice.

Telehealth and Health Information Technology:

There is a need to integrate all relevant medical device images and data from telehealth technology with the patient's EHR. Interoperability of these systems could dramatically streamline provider workflow and improve healthcare It is key to telehealth success for a provider to have the ability to access a patient's EHR at the time of the encounter—just as it is with a face-to-face visit

Technical Standards in Telehealth:

Until recently, the demand for telehealth was not sufficient to create unified, global technical standards However, telehealth has benefited from technical standards developed for associated markets (i.e. wide-scale video conferencing interoperability)

Scope of Clinical Practice:

Using technology does not change the practitioner's standards of practice, ethics, scope of practice, or legalities of practice. If a consultation is done between practitioners, the consulting practitioner must go through credentialing procedures of the facility Documentation is just as important with telehealth as it is with in-person care. All documentation is required for consultation, documentation of care provided, and billing of telehealth services. *Quality assurance and evaluation processes identify how to improve telehealth procedures, safety, effectiveness, and quality of care.