Telehealth Modern medicine at work Authors: Rachel Atchison Simone Chang Amy Graham Arian McNamara Rita Yeba
Telehealth Topics • Introduction – presented by Amy Graham • Benefits of Telehealth – presented by Simone Chang • Limitations of Telehealth – presented by Rachel Atchison • Regulations that govern Telehealth – presented by Rita Yeba • Types of Telehealth programs that are in use today – presented by Arian McNamara • Conclusion and References – presented by Amy Graham
Introduction: What is Telehealth? • Defined as “the use of technology to deliver health care, health information, or health education at a distance.” (Health Resources and Services Administration) • Also may be referred to as Telemedicine, although this term is not as broad as the term Telehealth.
Introduction: What do you need? • A connection! Wi-Fi, internet, dial up, cellphone service, etc. • A device for visual such as a computer, laptop, notebook, cellphone, tablet, etc. • Don’t forget a device to allow talking and hearing capabilities! Microphone, headset, headphones, speakers, etc.
Introduction: The basics • Telehealth can be broken down into two categories: • Synchronous- both parties are present as care, information, or education is provided. This is also referred to as Real time telehealth. • Asynchronous- only one party is present. For example: X-rays are sent to an orthopedic specialists for diagnosis. The specialist is the only party present during this stage of care. The diagnosis and care information is then sent to the Primary Care Physician who then relays this to the patient. This is also referred to as Store and Forward.
Enjoy the Presentation! • Now that we have drawn you in with the basics, lets take a deeper look into the benefits, limitations, regulations, and types of programs of Telehealth by watching the following presentations. • Hope you enjoy!
BENEFITS OF TELEHEALTH • PATIENTS • Convenient and Saves Time • Reduces Amount of Travel • Promotes Self-Care • Covered By Insurance
BENEFITS OF TELEHEALTH • HEALTH CARE PROFESSIONALS • Improved Access • Efficiency of Care • Minimizes Cost • Increase of Patients
Limitations Of Telehealth By: Rachel Atchison
The Public Telehealth is still not widespread throughout the country to many groups of people Some patients are not comfortable with the idea of not having the practitioner in the actual exam room; they fear the practitioner is too far away from them
The Public • Individuals can be worried about not receiving the same level of care and attention as at a regular office visit • Some patients (especially in the older generation) are not comfortable with the technology that is required to perform telehealth conferencing
The Practitioners Some physicians are not comfortable with using the technology to hold teleconferences with patients This is seen more commonly in the older generation of physicians who also resist the push for EMR system usage.
The Practitioners Can not touch patients as part of their assessment The physician may feel disconnected from their patients. In some instances the patient is on the other side of the country, or even in another country.
Quality Of Care Although telehealth has many advantages, quality of care and the loss of healing touch has to be taken into account It may also be difficult for the physician to fully recognize the patients body language through a screen
Example A patient needs to be told that they have a newly diagnosed life-long illness. The practitioner can not sit down beside them, hold their hand, and tell them bad news. This loss of beside manner could have a negative effect in certain situations.
Electronic Glitches A large amount of telehealth requires internet connection Power outages from bad weather, electronic glitches, and other connection problems can lead to technical issues that can interfere with telehealth appointments
Exceptions To Using Telehealth Some patients would be exceptionally hard to diagnose, assess, and teach through telehealth Example: Dementia patients could be very confused throughout the telehealth appointment and have more trouble following commands than at a conventional appointment
General In the USA the rules governing tele-health are the states’ laws "Telemedicine Rules & Regulation | Telemedicine Jobs," 2014). The states can be categorized in to four groups depending on their stand pertaining to rules governing telemedicine.
State License Laws Different state law agrees that the regulation is based on the patient’s jurisdiction not of the doctor’s ("Telemedicine Rules & Regulation | Telemedicine Jobs," 2014). For the most part health practitioners working in the field of tele-medicine [tele-medicine, tele-health, or tele-radiology] will need to be fully licensed before practicing as a tele-health practitioner in any state("Telemedicine Rules & Regulation | Telemedicine Jobs," 2014).
Role of FDA The US Federal Food and Drug Administration (FDA) regulates the safety and effectiveness of the tele-health medical equipments and soft wares used in tele-health with the Center for Devices and Radiological Health (CDRH) ("Food and Drug Administration and State Regulations - Telehealth Resource Center," 2016).
State License Laws Some states such as Alabama, Montana and Oregon offer tele-health license through their medical board and allow their practitioners with this license to practice in any state that allows this kind of licensure with no other requirement or restrictions("Telemedicine Rules & Regulation | Telemedicine Jobs," 2014).
Face to Face Approval Even though several states are accepting and allowing Telemedicine, it is still required by law to have face to face physician to patient encounter at least once("Telemedicine Rules & Regulation | Telemedicine Jobs," 2014). Any necessary or additional follow ups can be done by tele-health).
Other Necessary Credentials Aside from state laws, some states require additional credential for a practitioner to be able to provide an approved tele-health("Telemedicine Rules & Regulation | Telemedicine Jobs," 2014) If a particular provider wishes to do consultation with another facility, it might be beneficial to visit that facility first and take the necessary course that is approved in that facility to get the necessary credential("Telemedicine Rules & Regulation | Telemedicine Jobs," 2014).
Insurance and Payments Every practicing practitioner needs to check the rules and regulations of tele-health in the state where they have their license as well as the state they are planning to practice ("Telemedicine Rules & Regulation | Telemedicine Jobs," 2014).
Insurance and Payments • According to American Telemedicine association more than 27 states including D.C. have now laws in place to stress the coverage of telemedicine services and about 7 states have partial parity laws ("State Policy Resource Center," 2016).
Insurance and Payments This means that reimbursements are possible outside of the regular state medical insurance depending on the agreement the physician is under in addition to the state they are practicing in ("Telemedicine Rules & Regulation | Telemedicine Jobs," 2014).
Innovations in Telehealth Covering the latest in improved access, cost and quality care outside of the hospital and doctor’s office
Telehealth has increased access to care for today’s military overseas • This can include the following: • -Communication between providers and patients using a mobile device • -Ordering prescription refills from a mobile phone • -Tracking of health related symptoms with the capability to send the information to a provider • -Applications for handheld devices aimed at improving and maintaining sound mental health, for example: Virtual Hope Box app Fun fact: 90% of active duty military have smart phones
At home and on the go assistance for diabetics • Computer and handheld device applications (apps) for carb counting and food diaries • Recipe apps • Blood sugar and weight tracking which can be sent directly to the patients PCP • Online diabetes support groups
Telehealth within the classroom • For busy parents, missing work to pick up a sick child from school or to take a child to see the doctor for a physical can be difficult. Via a webcam a school can now fulfill basic healthcare needs for it’s students in the school nurse’s office. The nurse is able to connect remotely to an online doctors office. This service can increase early diagnose of diabetes and asthma before it becomes an emergency.
Education offerings Telehealth works for the medical professional as well. Continued education in the healthcare workers areas of interest are, many times, provided via online interactive learning -Live seminars can be accessed with web interactions at the workplace -Hospital wide annual education for employees via a user interface with customized username and password to track up to date education requirements and to reference past skills completed -Online bachelor and Masters degrees for healthcare professionals through certified universities including live interactive lecture series -CDSS (clinical decision support system) assisting providers with understanding and diagnosing clients symptoms
Dr. Jerri Nielson Fitzgerald • Many remember the story of Dr. Jerri Nielson Fitzgerald, she performed her own biopsy and breast cancer treatment while trapped in the south pole for work. Due to unsafe conditions it was impossible to bring her home for months. This is a story of early telehealth at work. Jerri treated herself with the help of colleagues via satellite email.
In Closing • Although Telehealth has many benefits and is regulated, there are still areas in which it needs to improve. • It is sometimes the only way to get care to patients that would otherwise go without. • Telehealth is modern medicine at work and just may be the future of medicine.
References • Doctor in Dramatic South Pole Rescue Dies at 57. (2009, June 24). Associated Press. Retrievedfrom http://www.nbcnews.com/id/31524259/ns/health-cancer/t/doctor-gripping-south-pole-rescue-dies/#.Vr4yhtD2qSo • Food and Drug Administration and State Regulations - Telehealth Resource Center. (2016). Retrieved from http://www.telehealthresourcecenter.org/toolbox-module/food-and-drug-administration-and-state-regulations • Harper, J. (2012, July 24). Pros and Cons of Telemedicine for Today's Workers. Retrieved February 17, 2016, from http://health.usnews.com/health-news/articles/2012/07/24/pros-and-cons-of-telemedicine-for-todays-workers?page=2
References • Heart Failure Health Center Wireless Sensor Monitors Heart Failure Patients. (2011, February 9). WebMD Health News. Retrieved from http://www.webmd.com/heart-disease/heart-failure/news/20110209/wireless-sensor-monitors-heart-failure-patients • Hjelm, N. M. (2005). Benefits and drawbacks of telemedicine. J Telemed Telecare Journal of Telemedicine and Telecare,11(2), 60-70. Retrieved February 19, 2016, from http://telemedicina6.unifesp.br/set/curso/2006-06-19-pgsaude/Fundamental_BenefitsandDrawbacksofTelemedicine.pdf • Mayo Clinic Staff. (2014, May 24). Consumer Health. Mayo Clinic. Retrieved from http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-2044878
References • Rules and Regulations Governing The Telemedicine Field. (2014). Retrieved February 17, 2016, from http://www.telemedicine-jobs.com/rules-and-regulations-governing-the- telemedicine-field.php • Schwartz, E. (2014, January 13). The limits of telemedicine. Retrieved February 17, 2016, from http://www.mhealthnews.com/news/limits-telemedicine-mhealth-mobile-regulatory-reimbursement • State Policy Resource Center. (2016). Retrieved from http://www.americantelemed.org/policy/state-policy-resource-center#.VsZwWKTSncu • VA Telehealth Services. (n.d.). Retrieved February 20, 2016, from http://www.telehealth.va.gov/
References • Welcome Telehealth Increases Access to Care for Today’s Military. (2015, September 30). Army OneSource. Retrieved from www.aosresourcecenter.com/learn/training-library/behavioral-health/event/232-telehealth-increases-access-to-care-for-today-s-military • What is Telehealth? (n.d.). Retrieved February 20, 2016, from http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Telehealth/whatistelehealth.html • What is Telemedicine?. (2012). The American Telemedicine Association. Retrieved from http://www.americantelemed.org/about-telemedicine/what-is-telemedicine • Yantus, P. (2014). The Benefits of Telehealth in Today's Healthcare Industry | SightCall. Retrieved February, 2016, from http://www.sightcall.com/benefits-telehealth-todays-healthcare-industry/