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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.
Additionally, secure modems and encryption are particularly useful in conjunction with remote access. System security involves protection against deliberate attacks, errors, omissions, and disasters. Good system management is a key component of a strong security framework because it encompasses monitoring, maintenance, operations, traffic management, supervision, and risk management. Greater awareness, sufficient resources, and an organization-wide commitment to information security are needed.1 

Quality

Speed and access to information at any time, from any place, are essential to maintaining a high quality of service; slowdowns or outages in service are not acceptable.1 Descriptions of some telemedicine applications describe inadequate funding to establish and maintain the technological infrastructure needed.11 In certain cases, nurses are responsible for the set-up and basic support of telemedicine devices. Although the wisdom of this approach may be questioned in light of the limited availability of nurses, it can be used as an opportunity to establish rapport and comfort with the technology.12 Equipment capable of transmitting and receiving diagnostic-grade images can be cost-prohibitive—although costs are declining—but it is significantly less costly than that of an inpatient admission.

There are 2 other major issues surrounding the quality of telemedicine services. The first is that services must be at least of the same quality as traditional services, particularly for reimbursement services. The second is the paradox that geographically isolated populations stand to derive the largest benefits from telemedicine although they have limited access to traditional healthcare services and often have the poorest infrastructure, resources, and capability to support telemedicine.13 Telemedicine visits can require extra time for equipment management and transmittal of prescriptions.14 There is also a need for extensive research to establish effectiveness and cost and quality relationships.15

Other Barriers to Telemedicine

Despite its advocates, many healthcare professionals have been slow to accept the application of telemedicine.16 Some are simply resistant to change unless they see the potential benefits, while other reasons include the perception that telemedicine applications are not indicative of “real” nursing—this may stem from liability concerns and discomfort over not seeing a client face-to-face—and that telemedicine applications will eventually reduce the number of healthcare professionals needed and they fear job loss as more clients can be treated at home.

There are threats to patient safety when telemedicine applications fail to render the same level of care as hands-on care or when problems occur with the use of electrical devices.1 There is also lack of acceptance by users that may arise from discomfort with technology, the relationship with the provider, and concerns over security of information and confidentiality. It is essential to educate the clients and increase public awareness. Healthcare professionals need to hold free information sessions for patients who are interested in more comprehensive information to aid them in making an informed decision and to promote a better understanding of such technology. 

Most discussions of telemedicine include the electronic health record as the primary means to make client data readily available and store diagnostic images. Picture Archiving Communications Systems (PACS) permit remote access to diagnostic images at times that are convenient to physicians. Health personnel need to shape the development of technological standards by determining the adequate image quality for diagnosis. Unfortunately, there has been insufficient funding for further development of PACS technology.17 

Strategies to Establish a Telemedicine Plan

Successful establishment and implementation of a telemedicine plan requires strategic planning and consideration of: a) necessary infrastructure, b) costs and reimbursement, c) human factors, and d) equipment and technology issues. In terms of infrastructure, it is essential to address how telecommunication breakdowns will be handled: will backup be provided? What happens when a power outage in the home severs a link? Technical support must be available to resolve any problems that might arise.1 Additionally, the individuals who will use the system should be involved in its design from the beginning to ensure its effectiveness and uptake. Specific competencies that must be addressed include training time to develop the technical skills needed to set up and use equipment, professional knowledge, interpersonal skills, documentation, professional development, resource management, practice and administrative issues, and security of healthcare information.1 Time is needed for healthcare providers to get accustomed to telemedicine practices; an example of this may be seen in teleradiology, where radiologists must learn how to interpret images using a monitor.17 

Future Directions

Converged devices, such as smartphones, combine the utility of cell phones and personal digital assistants, allowing users to monitor telemetry patients while performing other tasks. These devices provide the potential to increase patient safety, facilitate communication among healthcare professionals, and reduce liability (because orders can be clearly viewed), thus eliminating the errors associated with poor handwriting or verbal instructions.18

The model of “connected health”—a new paradigm of care—promises to reduce costs and improve quality by working with clients proactively. Individuals monitor their own health, which results in fewer visits to physicians and inpatient hospital stays.19 The demand for telemedicine services is expected to grow exponentially as baby boomers age, and home-based care will likely continue its exponential growth as a means to help keep older patients in their own homes and better manage their conditions. Demands for quality, patient safety, and more options will help change the reimbursement picture and open the door for more telemedicine applications, new technologies will emerge to meet this need, and the use of existing measures, such as biometric authentication, will become more common.

DISCUSSION

Telemedicine significantly contributes to the provision of healthcare in underserved areas through services such as telestroke, telecardiology, teledermatology, telepediatrics, telepsychiatry, and teleneonatology care. This tool aims to improve access to care for anyone regardless of their location20 and has the potential to reduce the number of face-to-face visits. Additionally, it can help improve the organization of the health record with automatic collection of data and better coordination of care among clinicians in various locations.

In telecardiology—the transmission of cardiac diagnostic tests in conjunction with electronic stethoscope examinations for second opinions by cardiologists at another site—there may be a reduction in the need for a patient to travel by allowing the specialist to perform an assessment remotely using a digital Bluetooth stethoscope and existing telemedicine equipment. Another example is telestroke, which enhances on-demand emergency acute stroke care by using videoconferencing to connect neurologists with emergency departments at facilities without neurologists on site. With telestroke, neurologists can communicate directly with the patient and family during assessment, discuss the treatment plan with all involved, and provide comprehensive and coordinated acute stroke care. Reducing the time to receive treatment is critical in improving patient recovery. 

During the telemedicine implementation phase, providing support to facilitate transition and communicate accuracy and availability of the electronic system is very important. There is a need to provide continuing education and develop a communication plan, with useful tools like newsletters and posters, to increase awareness of telemedicine and later expand its capability. To promote adoption, a change management plan must be structured in conjunction with the telemedicine implementation design. It is essential to incorporate change agents into the program that will help implementers and users to effectively and meaningfully communicate with each other in order to address any gaps that may exist. The change agents provide education sessions related to the importance of change that are key to having healthcare providers open their minds to change and adapt the system to existing practices.

Change management provides invaluable assistance to healthcare organizations to better manage their resources and improve productivity through the use of continuous positive reinforcement and involvement of supporting resources. They will be able to troubleshoot, and their inputs for change will act as catalysts to get their active involvement in setting up new environment. Timely and ongoing training will allow healthcare educators, providers, and agencies to examine information trends and react to changes proactively. As new rules emerge and technology changes, all organizational members need to participate in the use of telemedicine to ensure wide acceptance.2,4 

CONCLUSIONS

Among other benefits, the use of telemedicine improves follow-up care, ensures patient access to services, and allows providers to treat patients at home and in remote areas. Some telemedicine applications include diagnostic evaluation, decision making, storage and dissemination of records, and education of healthcare professionals. Several factors are essential to establishing and using a telemedicine link: implementers should develop a plan that addresses areas such as compliance with standards, technical requirements, reimbursement, human factor considerations, and strategies to handle telecommunication breakdowns and how to deal with equipment malfunctions. 

Acknowledgments

This paper was also submitted toward a partial completion of Doctor of Health Science at Nova Southeastern University.

Author Affiliations: Department of Health Science, Nova Southeastern University, Fort Lauderdale, FL.

Source of Funding: None.

Author Disclosures: Dr Alvandi reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. She affirms that her academic institution has no financial interest or conflicts. 

Authorship Information: Concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content.

Send Correspondence to: Maryam Alvandi, DHS, Nova Southeastern University, Fort Lauderdale, FL 33329. E-mail: malvandi@yahoo.com. 
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