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Telemedicine and its Role in Revolutionizing Healthcare Delivery
Maryam Alvandi, DHS, MHS

Telemedicine and its Role in Revolutionizing Healthcare Delivery

Maryam Alvandi, DHS, MHS
Given the current focus on efforts to contain costs, improve the delivery of care, and meet consumer demand, telemedicine is an attractive tool to use for success in these areas.
ABSTRACT

Telemedicine aims to meet the needs of today’s healthcare consumers and has the capacity to revolutionize the delivery of healthcare. It supports efforts to significantly improve the quality of healthcare by increasing accessibility and efficiency through reducing the need to travel, providing clinical support, overcoming geographic barriers, offering various types of communication devices, and improving patient outcomes. Thus, given the current focus on efforts to contain costs, improve the delivery of care to all segments of the population, and meet consumer demand, telemedicine is an attractive tool to use for success in these areas.

The American Journal of Accountable Care. 2017;5(1):e1-e5
The use of telemedicine has been shown to allow for better long-term care management and patient satisfaction; it also offers a new means to locate health information and communicate with practitioners (eg, via e-mail and interactive chats or videoconferences), thereby increasing convenience for the patient and reducing the amount of potential travel required for both physician and patient. Web-based disease management programs encourage clients to assume greater responsibility for their own care, help healthcare providers to treat clients earlier (when they are not as ill), provide local and less expensive services, extend scarce healthcare resources, enhance follow-up care, improve client access to services, and increase the accuracy and quality of patients’ medical records.1 

Telemedicine connects the convenience, low cost, and ready accessibility of health-related information and communication using the Internet and associated technologies. Beginning with the use of telephone consults, telemedicine has become more sophisticated with each advance in technology, and now involves telecommunication and computers to provide healthcare information and services to clients at multiple locations. The application of this tool covers a wide and diverse scope, including: a) online databases and tools to ensure standards of care, b) critical pathways and patient outcomes, c) computer-assisted diagnosis, d) effective drug information and electronic prescription filling, and e) enhanced availability of research data. Through that information to healthcare professionals and consumers alike. Clinicians are able to handle more patients than traditional care models would typically allow, and with increased access and a more connected level of care, physicians and patients can work together to achieve their therapeutic goals, particularly in the home and hospice care environments.2,3 

This paper presents a critical review of the prevailing literature on telemedicine. 

METHODS

A literature review was established by utilizing databases accessible through the Health Professions Divisions Library at Nova Southeastern University. The following databases were used to search for the sources for this project and identify current research on telemedicine: Citations and Abstracts for Literature of Nursing and Allied Health (CINHAL) plus full text, Cochrane Library, EBSCO host, and OVID. Key search phrases used in the scan included “telemedicine” and “telehealth,” which produced 6563 and 4482 results, respectively. To narrow study selection, Boolean strings were considered for the literature search, with “AND” used with the advanced search pairings, such as “telemedicine AND nursing” and “telehealth AND nursing.” Sources from the last 10 years were considered for inclusion in the review of literature. The subsequent search generated 119 and 272 results, respectively. The abstracts were reviewed and 18 articles were chosen based on their consistencies surrounding the investigation of telemedicine.

RESULTS

Clinical Applications of Telemedicine

There are 4 clinical applications of telemedicine: 1) real-time interactive mode, 2) store-and-forward mode, 3) remote monitoring, and 4) communication via telephone.4 Telephone communication the most basic type of telemedicine that provides communication and remote care delivery. In real-time telemedicine, a link between the involved individuals allows a real-time interaction to take place, but requires sending patient data from one site to a remote location, with an expert available to evaluate the data. These real-time encounters use a specially equipped personal computer with a telephone line hook-up to allow people to meet face-to-face and/or view papers and images simultaneously, even though they are not in the same location. Videoconferencing is one example of this type of application.4 Store and forward ensures that all information, including digital images, video, audio, and data, is captured, stored, and sent electronically to a specialist or clinician at another facility for interpretation and feedback.4 In remote monitoring, devices intelligently acknowledge the patient, record any abnormalities, and transmit data. For example, a cardiac event monitoring device allows patients to record arrhythmia whenever they experience dyspnea, angina, palpitations, or unexplained syncope. They can transmit the data over the phone and the ordering physician is notified immediately in the event of an abnormal rhythm. The benefits of this type of technology allow clinicians to cut travel time without decreasing client contact. In addition, telemedicine services eliminate the need for visas for international patients.1 

Benefits of Telemedicine

Using telemedicine technology to remotely monitor health, such as through the use of smart surveillance cameras and analytical software, can be used with elderly clients to notify their caregivers of changes in activity, falls, or lack of movement. This type of care can reduce costs, potentially keep these older individuals in their own homes longer, and help physicians to more easily tailor treatment according to a patient’s choices and availability of services.5 This is particularly important as the 65-years-and-older population explodes without a concomitant increase in funds for healthcare services. It is estimated that by 2030, individuals 65 years or older will represent 20% of the US population. Therefore, Medicare and Social Security programs will face financial challenges as the ratio of individuals paying taxes to retirees receiving benefits will drastically diminish.3 

Use of telemedicine also has the potential to help patients become more involved in their healthcare plan and increase their autonomy.3 Patients who require wound care are another population that can be managed well at home through telemedicine applications. For instance, telemedicine facilitates communication among: a) a tissue viability nurse at a patient’s home who evaluates the patient’s condition via wound description and photographs that are entered into the database, b) another tissue viability nurse working in an outpatient clinic at a different hospital, and c) a physician who is highly interested in wound care working in a different healthcare facility.6 

A Web-based solution for care coordination can integrate information from biometric measures and diagnostic tests and automatically alert clinician of panic values. As an example, “Health Buddy,” an in-home communication device, can be used to provide heart failure disease management,7 with biometric measurements (eg, heart rate and pattern, blood pressure, respiratory rate, fetal heart rate) able to be monitored at another site. Women with high-risk pregnancies, individuals with diabetes, and cardiac and postoperative patients can also be monitored at home. The device prompts the appropriate patients to take their medicine and keep their legs elevated when sitting and monitors subjective reports of difficulty breathing or increased edema. On the other end of the connection, nurses receive alerts when problems are indicated. 

Legal and Privacy Issues/Resolutions

Liability

Telemedicine is plagued by a number of liability concerns.8 First, there is the possibility that a patient may perceive it as inferior because the consulting professional does not perform a hands-on examination. Therefore, the distant provider, who has not personally examined the patient and may be relying on another presenter, might not be able to render a fully informed opinion or could end up with results that are inaccurate, incomplete, or misleading. Major issues include questions of liability when information provided over the telephone is misinterpreted.1 

Reimbursement and Licensure 

These 2 items represent major barriers to the growth and practice of telemedicine and need to be addressed in the context of technology-enhanced interventions.9 There have been incidents in which practitioners were eligible for reimbursement of the costs associated with telemedicine services and problems with how they are paid. Further, although healthcare professionals are only licensed to practice within certain jurisdictions, telemedicine requires multiprovince licensure, both for their primary province and for the jurisdiction in which services are rendered. Applications for licensure in different provinces can be lengthy and expensive, with the ultimate result being restricting access to services. There are different practice provisions across the country, and the uncertainties related to licensure may be subject to malpractice lawsuits and questions about how that liability might be distributed, which will continue to hamper access to telemedicine.1 

Privacy and Confidentiality

Telemedicine should not create greater concerns about or risks to medical record privacy than any other form of consultations—in the United States, it is subject to Health Insurance Portability and Accountability Act (HIPAA) regulations.1 Although patients require continuous support and education, the privacy, security, and confidentiality of their data must be maintained at all times. Only authorized users—those who are directly involved in the ongoing care and treatment of a patient—and those having a legal right and clear need to approach the systems where the information resides have access to this information. This restricted access increases patient safety and reduces anxiety regarding misuse and availability of personal information. Maintaining the privacy and confidentiality of telemedicine services is crucial to acceptance by consumers and healthcare professionals; these providers must adhere to all data privacy and confidentiality guidelines.4 Nurses and other healthcare professionals need to be mindful of these issues, especially when technicians not bound by professional codes of ethics are present at telemedicine sessions.1 

Security

Protection of information and computer systems should receive top priority. Security mechanisms use a combination of logical and physical restrictions to provide a greater level of protection, including firewalls and antivirus and other software that detects malicious programs and spyware. An example of a logical restriction is automatic sign-off; the operating system should lock down after a specified period of inactivity.1 In addition, the constant creation of new viruses makes it necessary to update antivirus software often. These measures should be reevaluated periodically to determine what modifications need to be made.

Information security training and education are important components in fostering proper system use. Most problems with information system security are primarily related to the human factor rather than the technical one. Support staff should be capable, flexible, and experienced. Technical support staff who are present during the exchange of client information need to be aware of institutional policies, procedures, and laws (such as HIPAA) that are designed to protect client privacy. These individuals should sign the same sort of statement that clinical personnel sign on when receiving their information system access code. In the case of home monitoring, support is crucial to help participants feel comfortable with the technology, particularly when using the internet and Web applications.10 

 
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