Telehealth, Ch. 25

Wound ostomy continence nurses (WCONs)

Can make recommendations and follow more clients through the use of telehealth than would otherwise be possible. Internet access for home health clients, and their families, provides convenient access to support groups, treatment information, and electronic communication with their healthcare providers, which decreasing feelings of isolation.

Desktop Videoconferencing (DTV)

A synchronous, or real-time, encounter that uses a specially equipped personal computer with telephone line hookup, DSL, or cable connection to allow people to meet face-to-face and/or view papers and images simultaneously Less expensive than custom-designed videoconference, but is may not be acceptable for telehealth applications that require high-resolution or high-speed transmission, such as interpretation of diagnostic images where slower frame rates produce a jerky image or lengthy transmission times

Historical Background

Began with telephone consults U.S. government−sponsored efforts *NASA *Military *Indian Health Services *Grant monies State-sponsored efforts *Healthcare for inmates Interest declined with a decrease in funding during the 1980s Technical developments in recent years makes telehealth feasible The military developed applications that feed images from the battlefield for the treatment of casualties and robotics equipment for surgery

Telehealth allows healthcare providers to:

Consult with colleagues Conduct interviews Assess and monitor clients View diagnostic images Review slides and laboratory reports Extend scarce healthcare resources Decrease the number of hospital visits for patients with chronic conditions Decrease healthcare costs Tackle isolation and loneliness Provide health education Improve case management services Improve the equity of access to services Improve the quality of client care Improve the overall quality of the client's record

The Center for Medicare & Medicaid Services (CMS)

Provides for telehealth reimbursement for physician follow up consultation when communicating with the patient via telehealth

Medicaid reimbursement

available at the discretion of individual states as a cost-effective alternative to traditional services or as a means to improve access for rural residents

Liability concerns with telehealth

1st - there is the possibility that the client may perceive it as inferior because the consulting professional does not perform a hands on examination 2nd - professionals who practice across state lines deal with different practice provisions in each state and may be subject to malpractice lawsuits in multiple jurisdictions, raising questions about how that liability might be distributed or which state's practice standards would apply

Teleconferencing

Implies that people at different locations have audio, and possibly video, contact, which is used to carry out telehealth applications

Authority to practice telehealth across statelines advantages:

It establishes the nurse's responsibility and accountability to the board of nursing It establishes legitimacy and availability to practice telenursing It provides jurisdictional authority over the discipline of telenursing in the event that unsafe delivery becomes an issue

Two barriers with growth and practice of telehealth

Reimbursement and licensure

Resources for Enhancing Alzheimer's Caregiver Health (REACH)

Sponsored by the National Institutes for Health, exemplifies a support program for caregivers that encourages them to engage in relaxation exercises.

HIPPA issue with telehealth

Technical support staff who are present during the exchange of client information need to be aware of institutional polices as well as laws such as HIPPA that are designed to protect client privacy. These individuals should sign the same sort of statement that clinical personnel sign on the receipt of their information system access codes

Telehealth and Telemedicine

Telehealth encompasses telemedicine but is a broader term that emphasizes both the delivery of services and the provision of information and education to healthcare providers and consumers

The Balanced Budget Act of 1997

The 1st authorized Medicare reimbursement for some services that did not traditionally require a face-to-face meeting between client and practitioner, such as radiology or electrocardiogram interpretation

Telehealth

The use of telecommunication and electronic information to exchange healthcare information and provide and support services such as long-distance clinical healthcare to clients Expansion of telemedicine with preventive, promotive, and curative applications

Telehealth Benefits

Continuity of care Centralized health records Incorporation of the healthcare consumer as an active member of the health team Collaboration among healthcare professionals Improved decision making Education of healthcare consumers and professionals Higher quality of care Removes geographic barriers to care May lower costs of healthcare Improved quality of health record *Allow clinicians to cut travel time without decreasing client contact and help to improve the organization of health record with automatic collection of data and better coordination of care among clinicians.

Driving Forces

Patient safety Cost containment Managed care Disease management Means to improve access to care Means to improve the quality of care delivered Emphasis upon keeping an aging population functional in their own homes as long as possible Means to deal with shortages of certain types of healthcare providers

eHealth (E-health)

A broad term often used interchangeably with the term telehealth to refer to the provision of electronic health information, products, and services using information technologies

State Children's Health Insurance Program (SCHIP)

Benefits Improvement and Protection Act of 2000 but not enough to make a significant difference in Medicaid reimbursement or to encourage other third-party payers in the US to pay for telehealth services. As a result, some physicians and other providers who did teleconsultation do not receive payment for their services. Consequently, increased client volume at referral centers has been regarded as a means to make up for lost revenue.

Videoconferencing

Implies that people meet face-to-face and view the same images through the use of telecommunications and computer technology even though they are not in the same location. It saves travel time and costs, which actually encourages people to meet more frequently. Is an appealing concept that can be used for many applications, especially distance learning and telehealth (although some applications may require high resolution and audio quality and high-speed transmission)

Examples of telehealth application

Monitoring activities; Diagnostic evaluations; Decision-support systems; Storage and dissemination of records for diagnostic purposes; Image compression for efficient storage and retrieval; Research; Electronic prescriptions; Voice recognition for dictation; Education of healthcare professionals and consumers; Support of caregivers

Online Resources include:

Standards of care Evidence-based practice guidelines Computerized medical diagnosis Drug information Electronic prescriptions Abstracts and full-text retrieval of literature Research data Bulletin boards, reference files, and discussion groups on various specialty subjects

6.Which of the following are issues associated with the practice of telehealth and telenursing? a.Lack of reimbursement, privacy and confidentiality concerns, licensure and liability issues b.Difficulties with technical support c.Cost of equipment d.Lack of HIE standards

a. Lack of reimbursement, privacy and confidentiality concerns, licensure and liability issues Rationale: Reimbursement, patient privacy and confidentiality and licensure and liability are all issues with the practice of telehealth and telenursing.

2.______ is the use of telecommunications and computer technology for the delivery of nursing care. a.Telenursing b.Teleconferencing c.Telehealth d.Telemedicine

a. Telenursing Rationale: Telenursing is the use of telecommunications and computer technology for the delivery of nursing care.

5.Which of the following can be used as a tool to facilitate the delivery of telehealth services? a.Webcasting b.Tele- or videoconferencing c.m-conferencing d.Podcasting

b. Tele- or videoconferencing Rationale: Teleconferencing and videoconferencing can both be used as tools to facilitate the delivery of telehealth services.

Telenursing

the use of telecommunications and IT for the delivery of nursing services

eCare (E-care)

the electronic provision of health information, products, and services online as well as the electronic automation of administrative and clinical aspects of care delivery

3.___________ is used to carry out telehealth applications and implies that people at different locations have audio, and possibly video, contact. a.Videoconferencing b.Teleconferencing c.Telehealth d.m-conferencing

b. Teleconferencing Rationale: Teleconferencing is used to carry out telehealth applications and implies that people at different locations have audio, and possibly video, contact.

7.Which of the following is an example of a low-tech telehealth application? a.social media groups b.a home glucose-monitoring program that uses a touch-tone phone to report glucose results c.photosharing d.real-time videoconferencing between a physician and clients with transmission of diagnostic images

b. a home glucose-monitoring program that uses a touch-tone phone to report glucose results Rationale: A home glucose-monitoring program that uses a touch-tone phone to report glucose results is an example of a low-tech telehealth application.

4.A synchronous, or real-time, encounter that uses a computer, webcam, and Internet connection to allow people to meet face-to-face and/or view papers and images simultaneously is called ______________. a.a podcast b.videoconferencing c.interactive video disk (IVD) d.health technology

b. videoconferencing Rationale: The only response that indicates real-time interaction is videoconferencing. Interactive video disks were an early, now outdated, technology used to record and replay educational programs. Health technology is a broad and also vague response. A podcast is recorded rather than real-time and may, or may not, record video images.

8.Which of the following might be considered to be advantages for consumers associated with the delivery of healthcare services via telehealth? a.small facilities and private practices can shorten their revenue cycles b.increased access to otherwise underserved populations, decreased travel time and costs, and access to services for consumers who are "on the road" c.providers can increase their revenue d.providers can provide care from the comfort of their own homes

b. increased access to otherwise underserved populations, decreased travel time and costs, and access to services for consumers who are "on the road" Rationale: Telehealth is a great means to reduce disparities in access to care because persons who live at great distances from providers or reside in underserved areas can receive appropriate care, which also reduces impositions to persons such as the poor or elderly who either lack transportation or lack the ability to travel long distances or cannot afford time away from work or caregiver responsibilities. There is also a large portion of the population that travel routinely for work purposes and who either travel to remote areas or are distant from their providers who can receive care without being forced to wait until they can make a traditional, face-to-face appointment.

10.Which of the following strategies help to ensure successful teleconferences? a.Asking all participants to keep themselves on the mute setting to prevent unacceptable background noise b.Asking participants to load special software immediately prior to the scheduled conference c.Advance preparation as in scheduling in advance, preparing an agenda, and starting and ending on time d.Requesting all participants to make their presence visually via the use of webcams

c. Advance preparation as in scheduling in advance, preparing an agenda, and starting and ending on time Rationale: Scheduling teleconferences in advance, providing a schedule, and starting and ending on on time help to ensure successful teleconferences and are respectful of participant time. Asking participants to load software immediately prior to a scheduled conference is stressful and inconvenient at best, The use of the mute feature, while useful at times, is not conducive to a teleconference but is suitable for webcasts where the participants rarely speak.

1.Telehealth differs from telemedicine in that _____. a.telemedicine is a broader term than telehealth and emphasizes the provision of information to healthcare providers and consumers b.telemedicine uses the Internet to provide professionals with information while telehealth does not c.telehealth encompasses telemedicine, but is a broader term that emphasizes the provision of information to health care providers and consumers d.telehealth is a narrow term referring only to wellness behaviors

c. telehealth encompasses telemedicine, but is a broader term that emphasizes the provision of information to health care providers and consumers Rationale: Telehealth differs from telemedicine in that telehealth encompasses telemedicine, but is a broader term that emphasizes the provision of information to healthcare providers and consumers.

9.Which of the following factors should be considered first when establishing a telehealth link? a.provider expertise with video equipment b.availability of the INS to do initial hands-on training on initiating telehealth links c.availability of on-call information systems support staff d.infrastructure, costs, technical requirements for equipment

d. infrastructure, costs, technical requirements for equipment Rationale: Infrastructure, cost, and equipment are all factors that should be considered when establishing a telehealth link.

Barries of Telehealth applications

regulatory barriers - state laws Lack of reimbursement for consultative services Cost for equipment, network services, and training time Fear of healthcare system changes Lack of acceptance by healthcare professionals Lack of acceptance by users