Telehealth
Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It facilitates long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. This includes data sharing by way of patient portals and electronic medical records.
Telemedicine is sometimes used as a synonym but is actually a subset of Telehealth, that involves remote clinical services, such as diagnosis and monitoring usually through teleconference, nurse/robot-assisted exams and shared diagnostic data between not only providers but also via phone and computer-mediated conversations. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telemedicine may bridge the gap and can even improve retention in treatment as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. EHealth encompasses a wide range of applications, including but not limited to the following:
- Two clinicians discussing a case via video conference;
- Robotic surgery performed through remote access;
- Physical therapy conducted using digital monitoring instruments, live feed, and application combinations;
- Diagnostic tests transferred between facilities for interpretation by a higher specialist;
- Home monitoring through continuous transmission of patient health data;
- Online consultations between patients and practitioners;
- Video remote interpretation services for clinical visits.
Telehealth versus telemedicine
The United States Department of Health and Human Services states that the term telehealth includes "non-clinical services, such as provider training, administrative meetings, and continuing medical education", and that the term telemedicine means "remote clinical services".
The World Health Organization uses telemedicine to describe all aspects of health care including preventive care. The American Telemedicine Association uses the terms telemedicine and telehealth interchangeably, although it acknowledges that telehealth is sometimes used more broadly for remote health not involving active clinical treatments.
eHealth is another related term, used particularly in the U.K. and Europe, as an umbrella term that includes telehealth, electronic medical records, and other components of health information technology.
Methods and modalities
Telehealth requires good Internet access by participants, usually in the form of a strong, reliable broadband connection, and broadband mobile communication technology of at least the fourth generation or long-term evolution standard to overcome issues with video stability and bandwidth restrictions. As broadband infrastructure has improved, telehealth usage has become more widely feasible.Healthcare providers often begin telehealth with a needs assessment which assesses hardships that can be improved by telehealth such as travel time, costs or time off work. Collaborators such as technology companies can ease the transition.
Delivery can come within four distinct domains: live video, store-and-forward, remote patient monitoring, and mobile health. Audio-based telemedicine, primarily through telephone consultations, has been studied as a tool for managing chronic conditions. A systematic review of 40 randomized controlled trials found that audio-based care was generally comparable to in-person or video care, though with low to very low certainty of evidence.
Store and forward
telemedicine involves acquiring medical data and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. It does not require the presence of both parties at the same time. Dermatology, radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured medical record, preferably in electronic form, should be a component of this transfer. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.Remote monitoring
, also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective. Examples include home-based nocturnal dialysis, improved joint management, and diabetes care using audio-based telemedicine with remote monitoring tools.Real-time interactive
s are possible through interactive telemedicine services which provide real-time interactions between patient and provider. Videoconferencing has been used in a wide range of clinical disciplines and settings for various purposes, including management, diagnosis, counseling, and monitoring of patients.Videotelephony
Videotelephony comprises the technologies for the reception and transmission of audio-video signals by users at different locations for communication between people in real time.At the dawn of the technology, videotelephony also included image phones which would exchange still images between units every few seconds over conventional POTS-type telephone lines, essentially the same as slow scan TV systems.
Currently, videotelephony is particularly useful to the deaf and speech-impaired who can use it with sign language and also with a video relay service, as well as to those with mobility issues or those who are located in distant places and are in need of telemedical or tele-educational services.
Categories
Emergency care
Common daily emergency telemedicine is performed by SAMU Regulator Physicians in France, Spain, Chile, and Brazil. Aircraft and maritime emergencies are also handled by SAMU centres in Paris, Lisbon and Toulouse.A recent study identified three major barriers to the adoption of telemedicine in emergency and critical care units. They include:
- Regulatory challenges related to the difficulty and cost of obtaining licensure across multiple states, malpractice protection and privileges at multiple facilities
- Financial barriers including a lack of acceptance and reimbursement by government payers and some commercial insurance carriers, which places the investment burden squarely upon the hospital or healthcare system.
- Cultural barriers occurring from the lack of desire, or unwillingness, of some physicians to adapt clinical paradigms for telemedicine applications.
An example of telehealth in the field is when EMS arrives on scene of an incident and is able to take an EKG that is then sent directly to a physician at the hospital to be read, allowing for instant care and management.
Telenursing
Telenursing refers to the use of telecommunications and information technology in order to provide nursing services in health care whenever a large physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telehealth, and has many points of contact with other medical and non-medical applications, such as telediagnosis, teleconsultation, telemonitoring, etc.Telenursing is achieving significant growth rates in many countries due to several factors: the preoccupation with reducing the costs of health care, an increase in the aging and chronically ill population, and the increase in coverage of health care to distant, rural, small or sparsely populated regions. Among its benefits, telenursing may help solve increasing shortages of nurses, reduce distances and travel time, and keep patients out of hospital. A greater degree of job satisfaction has been registered among telenurses.
In Australia, during January 2014, Melbourne tech startup Small World Social collaborated with the Australian Breastfeeding Association to create the first hands-free breastfeeding Google Glass application for new mothers. The application, named Google Glass Breastfeeding app trial, allows mothers to nurse their baby while viewing instructions about common breastfeeding issues or call a lactation consultant via a secure Google Hangout, who can view the issue through the mother's Google Glass camera. The trial was successfully concluded in Melbourne in April 2014, and 100% of participants were breastfeeding confidently.
Telepalliative care
is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. In the past, palliative care was a disease specific approach, but today the World Health Organization takes a broader approach suggesting that palliative care should be applied as early as possible to any chronic and fatal illness. As in many aspects of health care, telehealth is increasingly being used in palliative care and is often referred to as telepalliative care. The types of technology applied in telepalliative care are typically telecommunication technologies, such as video conferencing or messaging for follow-up, or digital symptom assessments through digital questionnaires generating alerts to health care professionals. Telepalliative care has been shown to be a feasible approach to deliver palliative care among patients, caregivers and health care professionals. Telepalliative care can provide an added support system that enable patients to remain at home through self-reporting of symptoms and tailoring care to specific patients. Studies have shown that the use of telehealth in palliative care is mostly well received by patients, and that telepalliative care may improve access to health care professionals at home and enhance feelings of security and safety among patients receiving palliative care. Further, telepalliative care may enable more efficient utilization of healthcare resources, promotes collaboration between different levels of healthcare, and makes healthcare professionals more responsive to changes in patients' condition.Challenging aspects of the use of telehealth in palliative care have also been described. Generally, palliative care is a diverse medical specialty, involving interdisciplinary professionals from different professional traditions and cultures, delivering care to a heterogenous cohort of patients with diverse diseases, conditions and symptoms. This makes it a challenge to develop telehealth that is suitable for all patients and in all contexts of palliative care. Some of the barriers to telepalliative care relate to inflexible reporting of complex and fluctuating symptoms and circumstances using electronic questionnaires. Further, palliative care emphasizes a holistic approach that should address existential, spiritual and mental distress related to serious illness. However, few studies have included the self-reporting of existential or spiritual concerns, emotions, and well-being. Healthcare professionals may also be uncomfortable providing emotional or psychological care remotely. Palliative care has been characterized as high-touch rather than high-tech, limiting the interest in applying technological advancements when developing interventions. To optimize the advantages and minimize the challenges with the use of telehealth in home-based palliative care, future research should include users in the design and development process. Understanding the potential of telehealth to support therapeutic relationships between patients and health care professionals and being aware of the possible difficulties and tensions it may create are critical to its successful and acceptable use.