Telehealth

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Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities at different ends of the globe.

Telehealth is an expansion of telemedicine, and unlike telemedicine (which more narrowly focuses on the curative aspect) it encompasses preventative, promotive and curative aspects. Originally used to describe administrative or educational functions related to telemedicine, today telehealth stresses a myriad of technology solutions. For example, physicians use email to communicate with patients, order drug prescriptions and provide other health services. One of the most significant increases in telehealth usage is the home monitoring of conditions by patients whose clinical trials in the UK have shown to improve mortality by around 47%, however the case for telehealth is still being actively debated, with a study on a separate US project showed remote telemonitoring was associated with increased mortality in vulnerable patients.

Clinical uses[edit]

  • Transmission of medical images for diagnosis (often referred to as store and forward telehealth)
  • Groups or individuals exchanging health services or education live via videoconference (real-time telehealth)
  • Transmission of medical data for diagnosis or disease management (sometimes referred to as remote monitoring)
  • Advice on prevention of diseases and promotion of good health by patient monitoring and followup.
  • Health advice by telephone in emergent cases (referred to as teletriage)

Nonclinical uses[edit]

  • Distance education including continuing medical education, grand rounds, and patient education
  • administrative uses including meetings among telehealth networks, supervision, and presentations
  • research on telehealth
  • online information and health data management
  • healthcare system integration
  • asset identification, listing, and patient to asset matching, and movement
  • overall healthcare system management
  • patient movement and remote admission

Modes[edit]

Store-and-forward[edit]

In store-and-forward telehealth, digital images, video, audio, observations of daily living (ODLs),[1] and clinical data are captured and "stored" on the client computer or mobile device; then at a convenient time they are transmitted securely ("forwarded") to a clinic at another location where they are studied by relevant specialists. The opinion of the specialist is then transmitted back. Based on the requirements of the participating healthcare entities, this roundtrip could take between 1 minute to 48 hours. In the simplest form of telehealth application, basic vital signs like blood pressure, weight, pulse oximeter, and blood sugar values are monitored and trended for long term chronic care. In many specialties, such as dermatology, radiology and pathology, an immediate response is not critical, making these specialties conducive to store-and-forward technologies. Automated screening and diagnostic tele-audiology is fast becoming another specialty conducive to store-and-forward audiology.

Real-time[edit]

In real-time telehealth, a telecommunications link allows instantaneous interaction. Videoconferencing equipment is one of the most common forms of real-time (or "synchronous") telemedicine. Peripheral devices can also be attached to computers or the video-conferencing equipment which can aid in an interactive examination. With the availability of better and cheaper communication channels, direct two-way audio and video streaming between centers through computers is leading to lower costs.

Examples of real-time clinical telehealth include:

In the UK Stoke-on-Trent Primary Care Trust together with mediaburst and the West Midlands Strategic Health Authority have sponsored the development of a low cost Simple Telehealth system "Florence" which primarily operates using text messaging (SMS) and a web application.

Remote patient monitoring[edit]

Telehealth Blood Pressure Monitor

In remote monitoring, the patient has a central system that feeds information from sensors and monitoring equipment, e.g. blood pressure monitors and blood glucose meters, to an external monitoring center. This could be done in either real time or the data could be stored and then forwarded.

Examples of remote monitoring include:

Remote training[edit]

Telehealth also provides opportunities for health care professionals in remote locations to receive training. In the United States, the Extension for Community Healthcare Outcomes or ECHO project uses a telehealth platform to help urban medical center specialists train primary care doctors in rural settings. The training allows these general practitioners to provide specialty care, especially chronic condition services, that would otherwise be unavailable to patients in these areas.[3]

Electronic consultation[edit]

Electronic consultation (E-Consult), a TeleHealth modality, is a mechanism that enables primary care providers (PCPs) to obtain specialists' inputs into a patient's care treatment without requiring a patient to go in for a face-to-face visit.[4]

Benefits[edit]

Telehealth adds a new paradigm in healthcare, where the patient is monitored between physician office visits. This has been shown to significantly reduce hospitalizations and visits to the Emergency Room significantly, while improving patient's quality of life. Telehealth also benefits patients where traditional delivery of health services are affected by distance and lack of local specialist clinicians to deliver services. In 2003, the University of Arkansas for Medical Sciences implemented a telehealth program to enhance access to care for high-risk pregnant women living in rural areas. The Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS) program provides real-time telehealth consultation among patients, their local physicians, and medical center specialists through a statewide telemedicine network. The program has reduced the state's 60-day infant mortality rate by 0.5 percent by increasing the number of low birthweight infants delivered at a medical center.[5] In Alaska, the Alaska Federal Health Care Access Network (AFHCAN) connects approximately 180 Alaska Native community village clinics, 25 subregional clinics, 4 multiphysician health centers, 6 regional hospitals, and the Alaska Native Medical Centerin Anchorage. More than 3,000 providers have engaged in 160,000 telehealth clinical consultations since 2001. It is estimated that in 2012, the AFHCAN telehealth program saved the state of Alaska $8.5 million in travel costs for Medicaid patients alone.[6]

The UK's Department of Health's Whole System Demonstrator (WSD)[7] launched in May 2008. It is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients and 238 GP practices across three sites, Newham, Kent and Cornwall. Three thousand and thirty people with one of three conditions (Diabetes, Chronic Heart Failure and COPD) were included in the telehealth trial. The trials were evaluated by: City University London, University of Oxford, University of Manchester, Nuffield Trust, Imperial College London and London School of Economics.

  • 45% reduction in mortality rates
  • 20% reduction in emergency admissions
  • 15% reduction in A&E visits
  • 14% reduction in elective admissions
  • 14% reduction in bed days
  • 8% reduction in tariff costs

Another UK trial of telehealth, this time for patients suffering from infertility, demonstrated a reduction in the cost of care of approximately 95%. The remote patient monitoring product and service used cost $800 per patient, compared to $15,000 as the average cost of a cycle of in-vitro fertilization (IVF), and showed (for suitably selected patients) the same pregnancy rate.[8]

The rate of adoption of telehealth services in any jurisdiction is frequently influenced by factors such as the adequacy and cost of existing conventional health services in meeting patient needs; the policies of governments and/or insurers with respect to coverage and payment for telehealth services; and medical licensing requirements that may inhibit or deter the provision of telehealth second opinions or primary consultations by physicians.

There may also be some significant carbon reductions for the NHS to be gained from developing Telehealth and therefore reducing the need to travel (often, in the case of patients, by car) as well as encouraging healthy, sustainable behaviour through monitoring and improved communications and reducing the requirements to expand sites to meet increases in Healthcare demands.

Criticism[edit]

Although several studies have demonstrated a positive impact from the use of telehealth and remote patient monitoring, there are dissenting studies.[citation needed]

A US study of 205 elderly patients with a high risk of hospitalisation showed a significant increase in the mortality rate over 12 months, with rates over 12 months for the telemonitoring group at 14.7%, compared with 3.9% for the usual care group (Source: Arch Intern Med 2012, online 16 April, and Pulse, April 20, 2012 - Telemedicine trebles death rate in elderly patients).[citation needed]

As a result, there is controversy in the UK regarding the government's determination to proceed with Telehealth despite conflicting findings from the studies undertaken.[citation needed]

The state of the market[edit]

Projections for the growth of the telehealth market are optimistic, and much of this optimism is predicated upon the increasing demand for remote medical care. According to a recent survey, nearly three-quarters of U.S. consumers say they would use telehealth.[9] At present, several major companies along with a bevy of startups are scrambling to establish a foothold in a market that is widely expected to grow rapidly. One startup that has seen success internationally and is being termed the "eBay" of healthcare is Diagnose.me

However, varing definitions of what to include in the telehealth market,[10] and consistely slower-than-expected adoption, have given rise to a range of industry reports repeatedly predicting "explosive growth in the next 5 years". For example, a 2007 Datamonitor report gave the 2007 market value as $0.9Bn and a 2012 prediction of $8Bn, a growth-rate of 56%,[11] whilst an InMedica report in 2011 put the 2010 market value at $0.16Bn, with a market prediction of $1Bn by 2016, a 44% growth rate.[12]

In the UK, the Government's Care Services minister, Paul Burstow, has stated that telehealth and telecare would be extended over the next five years (2012–2017) to reach three million people.

See also[edit]

References[edit]

  1. ^ Health in Everyday Living Robert Wood Johnson Foundation primer.
  2. ^ Andreas Pierratos, MD. Nocturnal hemodialysis: dialysis for the new millennium Canadian Medical Association Journal, November 2, 1999; 161 (9), 2 November 1966.
  3. ^ "Focusing on Priority Populations: An Interview With Cecilia Rivera Casale, Senior Advisor for Minority Health, AHRQ". Agency for Healthcare Research and Quality. 2013-04-017. Retrieved 2013-08-27. 
  4. ^ Overview for Healthcare Professionals, L.A. Care Health Plan. (2012).
  5. ^ "Statewide Telehealth Program Enhances Access to Care, Improves Outcomes for High-Risk Pregnancies in Rural Areas". Agency for Healthcare Research and Quality. 2013-05-08. Retrieved 2013-05-10. 
  6. ^ "Telehealth Improves Access and Quality of Care for Alaska Natives". Agency for Healthcare Research and Quality. 2013-05-22. Retrieved 2013-05-22. 
  7. ^ "Whole Systems Demonstrators An Overview of Telecare and Telehealth". 2009-06-11. 
  8. ^ Chausiaux, O., Hayes, J., Long, C., Morris, S., Williams, G. and Husheer, S. 2011. Pregnancy Prognosis in Infertile Couples on the DuoFertility Programme Compared with In Vitro Fertilisation/Intracytoplasmic Sperm Injection. European Obstetrics & Gynaecology, 2011;6(2):92-4.
  9. ^ "Survey: Consumers Keen on Telemedicine". Retrieved 2010-04-26. 
  10. ^ "AMD Telemedicine Calls on Analyst Community to Report on Telemedicine and Other Telehealth Niche Markets; Asks Journalists to Cover Niche Beats". Retrieved 2012-06-30. 
  11. ^ "Homecare telehealth expected to grow despite current barriers to adoption". Retrieved 2012-06-30. 
  12. ^ "Global Telehealth Market Set to Exceed $1 Billion by 2016". Retrieved 2012-06-30. 

Further reading[edit]

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