Telehealth Quiz 1

m-health

2003, expansion in mobile communication tech, improving access to care, tools for education, ICT-based domain, complex and sophisticated tech,

Functionality

All aspects of medical care process involved in prevention, diagnosis, treatment, follow-up and rehab (involves - consultation, diagnosis, monitoring, mentoring) - Missing = intervention

ATA

American Telemedicine Association

Bandwidth

Amount of data that can be passed back and forth on broadband connection, measured in seconds. - Expressed in amount of data carried in a given time (seconds) - Like freeway, all cars travel at same speed; to get more data from internet to computer faster = wider freeway. - 1 Mbps = 1 lane freeway. To download a 5 Mb image - would take ~5 seconds. - Internet is NOT any faster from 1 to 5 Mbps; data is transferred at a faster rate b/c MORE data can be sent at same TIME. More efficient = perceptually faster

Satellite

Another form of wireless broadband, useful for serving remote/sparsely pop areas. - Downstream/Upstream speeds depend on: provider and service package, consumer line of site to orbiting satellite, and the weather. - May be available in certain areas where broadband internet is not yet offered. - Similar to wireless access, satellite connection using modem. - Typical speeds - download = ~500 Kpbs and upload = ~80 Kpbs. - Speeds may be slower than cable but 10 X faster than dial-up internet. - Weather = can disrupt.

Need for reimbursement

Clearly define liability for covered benefits, insurance/ Medicare/ Medicaid

Things that can negatively affect internet speed

Connection type Traffic congestion Bad/old wires/ connections/ equipment Distance

Wireless connection

Connects home/ business to internet using radio frequency bands b/w customer and provider facility. - Can be mobile or fixed. - Using longer-range directional equipment provide broadband service in remote areas (where DSL/cable = costly). - Speeds comparable to DSL/cable. Usually requires external antenna. - Wireless broadband internet over fixed networks: allows consumer to access internet from fixed point/stationary and often require direct line of site b/w wireless transmitter/receiver. - Licensed and unlicensed devices used. - WLANs - Mobile wireless broadband: also becoming available from mobile phone service providers. Generally appropriate for highly mobile ppl and require specific PC card w/ built in antenna that plugs into users laptop. Generally lower speeds, hundreds of Kbps.

e-health

Cost effective and secure use of ICT in support of health and health-related fields, including health-care services, health surveillance, health literature and health ed, knowledge and research (lack of a clear definition throughout - some refer to this in relation to e-processing...)

Broadband over Powerlines (BPL)

Delivery of broadband over existing low and medium voltage electric power distribution network. - Speeds comparable to DSL/ cable modem. - BPL can be provided to homes using existing electrical connections/outlets. - An emerging tech available in limited areas. - Significant potential b/c power lines are installed everywhere

DSL connection

Digital Subscriber Line, 2-wire copper phone line connected to home service, delivered at same time as landline phone service. Can place calls while surfing internet.

State based resources

Each state has its own set of regulations and unique legal requirements

Need for policy

For conclusive data, organizational financing, and care delivery models

Cable connection

Form of broadband access, can access internet over cable TV lines. Fast access to internet

Distance

Further aware you are from your ISL (hub) the longer it'll take for the data to transfer from the internet to your computer

gbps

Gigabits/ second. Hardly used for internet plans, impractical cost for families/ businesses

Broadband connection

High speed internet access (always on, faster) - Method of transferring large amounts of data simultaneously - Uses multiple data channels to send large quantities of info. (broad bandwidth). Connections - DSL, cable = considered high-bandwidth connections.

Application

Includes processes of care virtually across all basic medical specialties and subspecialties (Involves - medical specialty, disease entity, site of care, treatment modality)

Technology

Includes synchronicity, network design and connectivity

kbps

Kilobits/second. Used when talking about dialup and low speed DSL

Interstate practice

Lack of universal licensure and interstate license portability - roadblocks

Bad/ old wires/ connections/ equipment

Like a "freeway" that goes from 5 lanes to 1 all of a sudden. Forces data to bottleneck and take longer to get to you.

Mbps (mbps)

Megabits/ second, most common unit of speed (NOT megabytes)

MBps

Megabytes/ second. Aren't usually used in residential internet plans

Telemedicine

Modality of care that challenged traditional dependence of physical dependence b/w contact and provider - Multidimensional, means many different things to many different people, in need of a taxonomy

Connection types

Plays role in internet speed. Some bandwidth are fixed (can't be widened/ increased), dialup = example.

Purpose of taxonomy

Properly designate a name/ classify each stage so they can be better studied and legitimized for generalized use

Wireless local area networks (WLANs)

Provide wireless broadband access over shorter distances, often used to extend reach of "last-mile" wireline/fixed wireless broadband connections w/in home/business/public internet (hot spots)

Wireless

Radio frequency bands (used in place of phone/ cable networks). Advantage of "always on" connection, can be accessed from any location that falls w/in coverage. Made possible through use of modem that picks up internet signals and sends them to other devices

Dial-up connection

Require users to link their phone to computer to access internet (analog), doesn't permit users to make/ receive phone calls through home phone service while using internet

Asynchronous

Store and forward delivery model Info is captured from Pt at one time and location and is evaluated by specialist at another time and location - Info is captured and "stored" in digital file at one location and then transmitted or "forwarded" to another location for eval - Examples: transition of voice clips, aud. testing results, outcomes of independent client/ Pt practice

Telehealth platforms to support service delivery

Synchronous (direct and in real-time) Asynchronous (indirect and can be offline) Hybrid (both direct and indirect)

ICT health domains

Telemedicine Telehelath e-Health m-Health

Need for research

To define discrete variables, itemize expected outcomes, control different variables and analyze varied results/materials

Traffic congestion

Traffic congestion: the more data being requested/ sent = more bandwidth being used at a time. At some point every "lane" will be taken up so the data will take longer to get to you. Usually happens during peak usage times (everyone using internet at same time).

Symmetrical digital subscriber line (SDSL)

Used typically by businesses for video conferencing (need significant bandwidth - upstream AND downstream)

Internet speed

# they give you, nothing to do w/ speed; allocated bandwidth

Digital Subscriber Line

(DSL) Wireline transmission tech, transmits data faster than traditional copper tech. From several hundred Kpbs to millions bits/sec (Mbps). Availability/speed depends on distance from telephone company facility. - ADSL - SDSL - High data rate DSL (HDSL) & Very High data rate DSL (VDSL) - faster forms of DSL

Consultation

(Functionality) B/w 2 or more physicians, and b/w provider and Pt

Mentoring

(Functionality) Remote guidance typically by surgeons/ other specialists

Monitoring

(Functionality) Telehome care for home bound/ chronically ill/ recent discharge etc.

Diagnosis

(Functionality) Typically remote, relying on transferred images, records and lab results

Telepractice

(General) A way to provide direct and indirect speech/language therapy services - Relatively new to the field of SLP, but has been used by other providers for some time (OT, PT counseling, medicine) - Services are provided through use of high speed internet, web cameras and videoconferencing system in real time

Network design and Configuration

(Technology) Includes virtual private network, open internet and social networks where info is posted and shared

Synchronicity

(Technology) Timing and tech; concurrent presence of interacting participants located at different places - Asynchronous = store and forward, don't interact in real time

Connectivity

(Technology) Wired/ wireless that provide different levels of bandwidth

Benefits to telepractice (ASHA)

- Can provide needed services across the nation - Free and appropriate public Ed - Creates additional or more consistent direct and indirect service opportunities - Enables real-time collaboration w/ team members - Complements traditional, on-site service and energizes student learning - Can be cost effective - Reduces geo barriers and extends clinical expertise

ATA Resources

- Published guidelines (14) specific to medical specialties and practice specifications - 2 types of accreditation programs - Offers accreditation program for organizations providing online Pt consultation (w/ overarching standards) - Posts report cards on updates about each state's telemed adoption based on several indicators

Clinical benefits to telepractice (ASHA)

- Select research = students receiving tele- outperform control groups and national benchmarks on: expressive/ receptive language; social pragmatics and speech sound production/ artic - Speech therapy via tele is emerging as standard of care, w/ equal or better than traditional "table top" therapy - Can be force multiplier for SLPS working in multiple schools - Therapist and client work in online programs in highly motivating digital learning environment - Therapy sessions can be recorded, edited, saved and later viewed online by client, caregivers, family and/or teachers granted permission - Client can go online multiple times to access therapy program for extra practice - Telepractice enables professionals to: educate, communicate and collaborate

ASHA's definition of telepractice

Application of telecommunication tech for delivery of services at a distance - Approved in 2015

Mobile connection

Cell phone/ smartphone providers that offer voice and internet plants. Good speeds and allow you to access internet on the go

Hybrid

Combination delivery model Use components of both live, interactive and store and forward models - Has advantage of making better use of all tech that are available to diagnose, treat and consult w. client and their team and is not limited to single communication channel - Examples: remote monitoring; distance supervision; eConsultation, record and monitor

Telehealth

Commonly used term to describe a rapidly growing aspect of healthcare that aims to " improve quality, access, equity and affordability of healthcare worldwide" (ATA) - More inclusive concept of ICT, politically correct, modern discourse

Synchronous

Direct delivery model Conducted w/ interactive audio & video connection in real time - Live, interactive videoconference sessions, where specialist and client are present at same time but not in same location - Communication is facilitated by using secure digital videoconferencing - Specialist conducts sessions as if they were in same room: "live and interactive" format

Cable modem

Enables cable operators to provide broadband using same coaxial cables that deliver pics/sound to TV sets. - External devices w/ 2 connections - one to wall outlet; another to computer. - 1.5Mpbs or +. - Can access cable modem service by turning on computers (w/o dialing up an ISP). Can still watch cable TV while using it. Transmission speeds vary, comparable to DSL.

Fiber

Fiber optic tech converts electronic signals carrying data to light and sends light through transparent glass fibers (~ diameter of hair). - Fiber transmits data at MUCH higher speeds than DSL/cable modems. Typically, by 10a/100s of Mbps - Actual speed varies b/c of many factors: proximity that service provider brings computer to the fiber; how service provider configures service and amount of bandwidth used. - Same fiber providing broadband can also deliver voice (VoIP) and video service, inc. video on demand. - Telecomm. Providers - sometimes have fiber broadband in limited areas, intend to expand the bundle voice, internet and video services. - Variations of tech run fiber all the way to customer's home/ business, to curb/ outside or to location b/w provider facilities and customer.

ISDN connection

Integrated Services Digital Network, allows users to send data, voice and video content over digital phone lines/standard phone wires. Installation adapter is required at both ends of transmission - use and provider.

Asymmetrical digital subscriber like (ADSL)

Residential customers (internet surfers), who receive a lot of data but don't send much. Allows faster downstream data transmission over same line as voice service (w/o disrupting calls)

Hotspot connection

Sites that offer internet access over wireless local area network (WLAN) by way of router then connects to Internet Service Provider (ISP). Utilize Wi-Fi tech, allowing e-devices to connect to internet/ exchange data wirelessly through radio waves. Phone-based or free-standing, commercial/ free to public

Limitations of telepractice (ASHA)

Space, budget, on-site support, broadband, security concerns, network firewalls, licensure requirements, community awareness, physical manipulation, managing behavioral issues, tech knowledge/ ability to trouble shoot, collaboration w/ on-site staff, difficulties in team training, difficulty promoting carryover skills in classroom, scheduling, overall acceptance

Difference between upload and download speeds

Upload and download speeds are different b/w most internet connections = asymmetric. - Meaning that bandwidth is different size going one way compared to the other. - Most users consume content rather than upload it, bandwidth for download speeds is larger than upload.