What is Telehealth?

by: Rosabel Zohfeld, MSN-Ed, APRN, FNP-C

Telehealth, which can be interchangeable with Telemedicine, is known as the delivery of health services using electronic technology to patients at a distance (Cason & Cohn, 2014).  Due to the increase in the aging population and the prevalence of chronic diseases, there is a need for new care models, and telehealth is one of those new models. The oldest type of telehealth technology system used a two-way communication system using audio and video. Nowadays Telehealth uses equipment to remotely monitor patients’ health conditions. Telehealth encompasses a wide array of applications such as telepresence, telenursing, telehomecare, telemental health, clinic televisits, electronic intensive care units (eICUs), and teletrauma care among others. Technologies included in telehealth are the Internet, videoconferencing, streaming media, store and forward imaging, and terrestrial and wireless communications. While the benefits of telehealth are a growing trend, there are also potential obstacles and issues to account for (Sewell, 2016).

Background and the Current State of Science

Telepresence

The use of technology to provide the appearance of a person’s presence is known as telepresence, even though the person may be located at a remote site. Telepresence is currently under development and requires a 100% reliable system and a very high bandwidth (Sewell, 2016).

Telenursing

Sewell (2016) defines telenursing as a nurse who works with health technologies.  Today’s nurses are constantly using technology.  They use electronic health records; they may use paging systems or carry cell phones during their shift to be located.  In general, nurses collaborate as a team to provide a standard of care. Furthermore, Nursing Informatics allows clinical nurses to voice their concerns about the technology that is constantly changing.  Telenurses work in a variety of settings such as hospitals, clinics, and home health (Odeh, Kayyali, Gebara, and Philip, 2014).

Telehomecare

Telehomecare is available to provide patients care in their own homes.  This cuts the cost of traveling to doctors’ appointments, and for those who do not have access to a private physician (Sewell, 2016).  As part of a study, house calls were an option 24/7; unlike most patients would have to call the nurse hotline then the nurse would have to contact the physician.  In this case, the patient can be directed straight to the doctor (Wahsko, 2016).  

Telehealth Devices

The use of automatic pill dispensers and portable monitoring devices is a wonderful idea for patients.

• The pill dispensers when used properly help with not confusing medications, drug overdose, and the correct time for the medication to be taken or given to the patient.

• The portable monitoring devices are devices such as blood pressure cuffs, fit bits, blood glucose meters, weight scales, blood pressure cuffs, and pulse oximeters. These devices monitor the patient’s vital signs. Having these devices allow the patients to keep track of and or monitor their health on a daily basis (Sewell, 2016).

Telemental Health

The use of telehealth to deliver psychiatric care is known as telemental health. The first group therapy using two-way televisions started in 1961, however; telemental health dates back to the 1920s in Norway. Mental health has always had a stigma in society. With a lack of psychiatrists, telemental health could be effective, affordable, and easily available these days to help those in need of treatment (Lustgarten & Colbow, 2017). Telemental health is also used to care for veterans with post-traumatic stress disorder PTSD. These patients may have difficulties receiving care in busy medical centers. Telehealth also provides a means to deliver evidence-based care for veterans in convenient settings (Sewell, 2016). 

Clinic Televisits

Clinic televisits provide the necessary care for rural areas that may have only family practice physicians or nurse practitioners and are unable to travel outside their area due to cost or transportation. This type of visit usually requires that the patient provide information such as vital signs with the help of portable monitor devices. This can help the specialty provider along with the primary care physician decide what course of action should be taken next. In general, clinic televisist helps provider and patients to maximize their time, by avoiding long waiting room times and reducing the amount of travel (Schaeffer, 2014).

E-ICU

Electronic-Intensive care Units (E-ICUs) monitoring of critical care patients is not a new technology. It has been documented that the use of remote critical care monitoring reduces the hospital mortality by up to 30% and the intensive care unit mortality of patients by a 40%. The E-ICU technology is delivered through telepresence in the form of videoconferences that use cameras, microphones, and speakers in the patient’s room. The bedside team is able to an active team that is able to activate the system during rounds and whenever there is a need for a virtual visit from the intensivists (Sewell, 2016).

Robotics

Robotics is the use of robots and virtual reality in a variety of settings. Robotics uses telepresence as well; these robots are FDA approved for use. The remote teleintensivist experts use RP software and a joystick to control the robot. The software can be used with a laptop or a desktop computer. Some hospitals use robots to provide stroke care and to assist the physicians at remote agencies. Robotics-Telepresence has been used also in the care of sick newborn infants (Sewell, 2016). According to Effker (2014) Robots are also being used in other hospital areas such as pharmacies to restock and fill prescriptions, and even to deliver supplies to nursing units. Pyxis is an example of robots used in nursing units. The use of robotics in surgery is rapidly increasing due to the fact that the robot's "hand" can reach into smaller spaces than a human hand couldn’t reach (Effken, 2014).

Teletrauma Care

Teletrauma care is widely used in rural hospitals and clinics to deliver trauma care. Fortunately, those rural hospitals and clinics are able to obtain reimbursement for these services. Teletrauma, which has been used to obtain second opinions and advice from trauma care experts, has also helped to deliver care in parts of the world plagued with violence and war. According to Sewell (2016), at the University of California, Davis (UC Davis), pediatric intensivists had completed over 200 videoconferencing consultations with remote hospital ED and ICUs by the year 2007. Thirty percent of those consultations were related to pediatric trauma care (Sewell, 2016). Recently, A pilot program at UAMC provided a smartphone to the on-call trauma surgeons and on-call physicians at their rural hospital. The results were, increased access to a trauma surgeon for teletrauma consultations and the elimination of a designated room for teletrauma consults. The smartphones made the telepresence of the trauma surgeon possible at the UAMC rural hospital, proving to be a cost-effective and viable option for teletrauma programs across rural areas in the U.S (Mottl, 2014).

Telehealth and Disaster Care

According to Sewell (2016) Right after Hurricane Katrina hit the Gulf Shore states in 2005, a website named “Katrina” was established in order to assist the victims with accessing their prescriptions and medication records (Sewell, 2016). That is just an example of the many successful ways telehealth has been helping individuals in times of disaster. Telehealth is useful during disasters by providing medical and public expertise at a distance. It helps with minimizing the logistical and safety issues by providing physicians, nurses, and other healthcare professionals from around the world to assist those in need post-disaster. Research also shows a way to help victims in disasters where there is a shortage of specialists and in remote areas, is telemedicine and or telehealth (Ajami & Lamoochi, 2014).

Implications for Nursing Practice and Research

Issues with Telehealth

There are many issues when dealing with telehealth. Technical issues and reimbursement are some of those issues. Technical issues with telehealth can be cost-resistant change, security, and privacy concerns (Laxman, Banu Krishnan, & Dhillon, 2015).  There are also worries that the software being used may crash.  Facilities pay a tremendous amount of money in order to have a successful telehealth communication system.  On the other hand, patients place their trust in electronic health records now, but they may be leering and unsure telehealth programs can affect the quality of their care, especially for the elderly.  HIPPA violations can be a huge part of the security and privacy of our patients.  Providers also worry about choosing the right technology for their practice and whether it will be cost-effective in the future. Currently, only twenty-one states require reimbursement for telehealth by private insurance (Cason & Cohn, 2014). Another issue is media ecological concerns. These issues relate to licensure, liability, and medical malpractice. When the telehealth provider is located in another state or country, licensure can become an issue as certification and licensure requirements are state-level decisions. Liability and medical malpractice are also issues when the licensing and or credentialing laws do not specify the use of telehealth  (Sewell, 2016). 

Security and privacy concerns are among other issues or barriers with telehealth. Hence the importance of healthcare organizations needs to establish rigorous security measures to reduce the chances of a breach in data. The data stored temporarily on telehealth devices such as digital diagnostic tools must be protected as well from possible security breaches (Laxman, Banu Krishnan, & Dhillon, 2015).

Adoption & Usage of Telehealth

According to Adler-Milstein, Kvedar & Bates (2014), about 42% of their sampled hospitals (1,208 of 2,891) had adopted telehealth across the country by the year 2012. The authors found that hospitals with greater technological capacity, those that were part of larger systems, and teaching hospitals were more likely to have adopted telehealth. In contrast, those hospitals that were for-profit were much less likely to have adopted telehealth. In general, only 4 in 10 hospitals across the U.S have adopted telehealth. The suggestion is that the adoption of telehealth is in part driven by the need for access improvement for hospitals in rural areas, more than those located in urban areas (Adler-Milstein, Kvedar & Bates 2014). 

Conclusion

  Telehealth is promising to healthcare, as well as it offers many opportunities for nurses. Telehealth is valuable in education, for professionals, patients, and disaster care. As the use of telehealth grows, there are still issues that need to be resolved. Access to care remains an issue in the U.S. While Medicare has gone a step forward by allowing reimbursement for telehealth services, there are still variations in reimbursement. There is no doubt that the use of telehealth will change the way in which healthcare is delivered for this and future generations. Those changes bring a tremendous amount of opportunities for clinicians and even for the consumer in general. All in all, telehealth is one of the greatest inventions of our time.

References:

Adler-Milstein, J., Kvedar, J., & Bates, D. W. (2014). Telehealth among US hospitals: Several factors, including state reimbursement and licensure policies, influence adoption. Health Affairs, 33(2), 207-15. Retrieved from http://ezproxy.ju.edu:2048/login?url=http://search.proquest.com.ju.idm.oclc.org/docview/1498231664?accountid=28468

Ajami, S., & Lamoochi, P. (2014). Use of telemedicine in disaster and remote places. Journal of Education and Health Promotion, 3, 26. doi:http://dx.doi.org.ju.idm.oclc.org/10.4103/2277-9531.131886

Cason, J., & Cohn, E. R. (2014). Telepractice: An Overview and Best Practices.

Perspectives on Augmentative & Alternative Communication, 23(1), 4-17.

Effken, J. A. (2014). Issues, Impacts and Insights Column: What’s New in Healthcare Robotics? Online Journal of Nursing Informatics, 18(3), 1-1.

Laxman, K., Banu Krishnan, S., & Dhillon, J. S. (2015). Barriers to Adoption of Consumer Health Informatics Applications for Health Self-Management. Health Science Journal, 9(5), 1-7.

Lustgarten, S. D., & Colbow, A. J. (2017). Ethical Concerns for Telemental Health Therapy Amidst Governmental Surveillance. American Psychologist, 72(2), 159-170. doi:10.1037/a0040321

Mei Wa, K., Calouro, C., Nasseri, L., & Gutierrez, M. (2015). The Federally Funded Telehealth Resource Centers. Perspectives On Telepractice, 5(1), 14-23. doi:10.1044/tele5.1.14

Mottl, J. (2014). Smartphone proves to be a useful tool for teletrauma program. Newton: Questex Media Group LLC. Retrieved from http://ezproxy.ju.edu:2048/login?url=http://search.proquest.com.ju.idm.oclc.org/docview/1523855316?accountid=28468

Odeh, B., Kayyali, R., Gebara, S. N., & Philip, N. (2014). Implementing a telehealth service: nurses’ perceptions and experiences. British Journal Of Nursing, 23(21), 1133-1137. doi:10.12968/bjon.2014.23.21.1133

Schaeffer, J. (2014). The Bottom Line on Telehealth. For The Record (Great Valley Publishing Company, Inc.), 26(8), 22-25.e

Sewell, J. P. (2016). Informatics and nursing: Opportunities and challenges (5th ed.). Philadelphia, PA: Wolters Kluwer Health, Lippincott Williams & Wilkins.

Washko, J. D. (2016). It Takes a Team of Teams to Transform Healthcare. EMS World, 45(10), 36-43.