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Dan Wilding

on 23 March 2013

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Transcript of Telemedicine

Exploring New Horizons in Healthcare Telemedicine Learning Objectives Modes of Delivery of Telemedicine Applications Examples of Telemedicine Programs Telemedicine Limitations Define telehealth and telemedicine.
Identify the different modes of delivery for telemedicine programs.
Describe the benefits and limitations of telemedicine programs.
Describe future directions for telemedicine programs in Canada. Telemedicine Benefits Access to health care in rural and remote locations.
Telemedicine provides rural residents an alternative to travel by providing health care to previously under-serviced regions.
Internet access provides doctors with the capability of managing chronic diseases from a distance reducing travel time and cost to the healthcare consumer. Historical Perspective Definitions of Telehealth and Telemedicine 1.First Nation’s Tele-medicine Program in Northwestern Ontario A sense of depersonalization with use of teleconsultation.
Teleconsultation might not be experienced as being real by either party (Hjelm, 2005).
Resistance of the elderly to indirect interactions between two parties as opposed to face-to-face consultation.
Videoconsultations are limited by the fact that the entire physical examination cannot be carried out over a video link (Hjelm, 2005).
Technology cannot replace direct "hands-on" contact. Anne Marie Rock
Dan Wilding
Donna Roberts
Michele Brodie
Shannon Statham At the end of this presentation classmates will be able to: The terms “telehealth” and “telemedicine” are often used interchangeably. For the purposes of this presentation, the following definitions will be used: •Telehealth – “Telecommunication technologies used to deliver health-related services or to connect patients and healthcare providers to maximize patients’ health status” (p. 594). •Telemedicine-“Health services delivered by telecommunications-ready tools supervised or directed by a physician.” (p. 594). Telemedicine is “medicine at a distance” covering a whole range of medical activities, including treatment and education. It is a process, not a technology, and provides valuable resources to remote or rural communities where there are relatively few doctors or other health care professionals (Hernandez, 2005). Hernandez, 2005; McGonigle, & Mastrian, 2012 Hernandez, 2005; McGonigle, & Mastrian, 2012. 1. Telephony – telephone monitoring is the most basic type of TM (McGonigle & Mastrian, 2012). 2. Real Time TM – videoconferencing communications between a patient and a consultant for live interaction. Peripheral devices can be added to the equipment such as an otoscope, patient camera, and stethoscope. Canada is a global leader in this area, with one of the largest site networks in the world (Canada Health Infoway, 2011). 3. Store and Forward Solutions – images, video, audio and clinical data are captured, stored and transmitted via a secure network and forwarded to a specialist for review and interpretation (Canada Health Infoway, 2011). Examples include: tele-dermatology, tele-radiology, tele-pathology. 4. Remote monitoring – devices are used to capture and send biometric data. Examples include: monitoring nocturnal dialysis, cardiac monitoring, home telehealth which can monitor vital signs, and chronic disease management (McGonigle & Mastrian, 2012). Vision: “KOTM will improve the health for all First Nation communities through a sustainable First Nations telemedicine program that is holistic, community driven and culturally appropriate.” KOTM has a unique TM model which builds community capacity by hiring local residents as community telemedicine coordinators who are trained in the facilitation of TM consults. Currently, there are 26 FN TM sites. KOTM has facilitated over 10,000 events including clinical, educational and social development projects since its inception in 2002. Observed Benefits:
More timely patient care delivery in geographically isolated FN communities.
Bringing health care to home.
Reduced patient travel burden.
Reduce health professional isolation.
Increased capacity development.
Reduced carbon emissions resulting from less travel.
FN ownership in the program.
Integration of e-Health service development resources.
Translators available for interpretation in Oji-Cree if needed. Limitations:
More bandwidth needed to run some of the applications.
Communities need to upgrade internet connections.
Concerns about privacy 2. Rural Program in B.C. Tele-home monitoring program for CHF.
Data are transmitted to R.N. for daily assessments.
Tele-thoracic monitoring program. 3. Canada Infoway Video M.D.’s perspective on using technology efficiently.
Example of a 2 year old boy who suffered an intense burn on his hand.
Parents and child live 8 hours away from specialist who is located in the Hospital for Sick Kids in Toronto. Beaton, Kakepaspan, & O'Donnell, (2012); KO e-Health Services, (2013) Telemonitoring to improve the quality of care for patients with chronic conditions.
Telemonitoring appliances can be left at patients' homes to monitor their vital signs and collect information about symptoms (Lawton, 2010).
Pt's home progress is monitored through teleconsultation with a dedicated telehealth nurse.
Significant reduction in re-hospitalization because constant feedback is available between the patient and the telehealth nurse (Hjelm, 2005). Telemedicine developed as various technological inventions and innovations allowed physicians and other health care professionals to reach out to people in remote areas. In the early part of the 20th century, telegraphs and telephones were the first technologies used to exchange health-related information. As television and video conferencing evolved, patients and health care professionals could see as well as hear each other. The internet has allowed the transmission of vast amounts of information in a variety of formats. Although technologies have advanced remarkably since then, and will continue to do so, the impetus to reach out to those who live outside of major city centres remains. Improved Communication between periphery and tertiary hospitals.
Early advice from tertiary center to periphery hospitals based on teleradiology from the peripheral hospital.
Improves quality of care for patients because tertiary centres have many specialists to advise lone physicians in the periphery.
May reduce unnecessary transfer of patients to tertiary centers. Improving Patients experience with health care.
Telemedicine provides patient reassurance knowing that a health care personnel is monitoring them 24-hour support available to patients at home. Improved access in primary care.
Consultation through video link with GP's for minor ailments such as respiratory and gastrointestinal infections, back pain and renewal of prescriptions (Hjelm, 2005).
Beneficial for patients not well enough to travel. The broad use of telehealth technology is beneficial to many practice settings ranging from pediatrics, oncology to gerontology.
Use of Pediatric surgical telehealth was found to decrease the cost and stress to families in rural and remote areas (Sevean, Dampier, Spandoni, Strickland, & Pilatzke, 2008).
Telehospice for end-of-life care found that telehealth greatly decreased travel time, time away from support systems, and client and family loss of income due to travel, reducing emotional and financial stress (Britton, 2003). Telemedicine and legal obstacles.
In many cases, telemedicine via the internet is growing faster than laws can be written to cover the legal aspects of doing business over the internet (Hernandez, 2005).
Legal obstacles include state licensure laws, malpractice liability, privacy and security concerns and how insurance will cover the cost of internet services (Hernandez, 2005). The lack of third-party reimbursement threatens the future of telemedicine (McCarty & Clancy, 2002).
The telemedicine consultations Medicare pays for are tightly restricted, and often viewed as insufficient by the providing physician (McCarty & Clancy, 2002).
Use of telemedicine may require a radical change in the way the services are provided and paid for to encompass future advances in telemedicine (Wooten, 1996). Trusting in the technology.
Both the patient and the professional must trust the technology is safe and effective.
In some cases, decisions made by an unseen professional via telemedicine are seen as less trustworthy than those made face to face (Cook, 2012). Inequity in service provision (or Access to Telemedicine applications).
Variations in access to technology can translate into inequity in service provision (Cook, 2012).
Older people, individuals with physical disabilities and those with lower incomes may not have internet access. Overdependence on technology that may be unreliable and expensive to purchase.
Technology users require the skills to operate the equipment efficiently preventing user and equipment errors.
Fear that telemedicine is market-driven rather than user-driven, with the risk of market-driven abandonment of products and technologies (Hjelm, 2005).
Fear of technological obsolescence resulting from rapid technological advances (Hjelm, 2005). Group Position/Conclusion Telemedicine is an innovative approach to providing care especially to those who have difficulties accessing care due to geographical location or limited specialist availability. Using telemedicine appropriately presents great possibilities to providing care, yet the approach is under utilized. By overcoming barriers and mitigating limitations, telemedicine can provide quality care that is timely, easily accessible, and patient-centered. Anker, S., Koehler, F., & Abraham, W. (2011). Telemedicine and remote management of patients with heart failure. Lancet, 378(9792), 731-739. doi:http://dx.doi.org/10.1016/S0140-6736(11)61229-4

Beaton, B., Kakepaspan, C., & O’Donnell, S. (2012). KOTM Report: Survey of KOTM use in Northwestern Ontario. Presentation from Levis, Quebec, October 25-27, 2012.

Britton, B. (2003). First home telehealth clinical guidelines. Home Healthcare Nurse, 703-706.

Canada Health Infoway (2011). Telehealth benefits and adoption: Connecting people and providers across Canada. A study commissioned by Canada Health Infoway.

Cook, R. (2012). Exploring the benefits and challenges of telehealth. Nursing Times, 16-17.

Gagnon, M., Duplantie, J., Fortin, J., & Landry, Rejean. (2006). Implementing telehealth to support medical practice in rural/remote regions: What are the conditions for success? Implementation Science, 1(18). doi:10.1186/1748-5908-1-18

Gibson, K.L., Coulson, H., Miles, R., Kakekakekung, C., Daniels, E. & O’Donnell, S. (2011). Conversations on telemental health: Listening to remote and rural First Nation communities. Rural and Remote Health, 11, 1656-1674. Retrieved from http://www.rrh.org.au

Hernandez, N. (2005). Telemedicine and the Future of Telemedicine. AMT events, 74-77.

Hjelm, N. M. (2005). Benefits and drawbacks of telemedicin. Journal of Telemedicine and Telecare, 60-70.

Jennett, P., & Watanabe, M. (2006). Healthcare and telemedicine: ongoing and evolving challenges. Disease Management & Health Outcomes, 149-13.

KO e-Health Services (2013). KOTM brochure. Retrieved from http://www.telemedicine.knet.ca/files/KOTM%20Brochure.pdf

Lawton, G. (2010). Telehealth Delivers Many Benefits But Concerns Linger. PT in motion, 16-23.

Martin, A., Probst, J., Shah, K., Chen, Z., Garr, D. (2012). Differences in readiness between rural hospitals and primary care providers for telemedicine adoption and implementation: findings from a statewide telemedicine survey. Journal of Rural Health, 28, 8-15.

McCarty, D., & Clancy, C. (2002). Telehealth: Implications for Social Work Practice. Social Work, 153-161.

Ohinmaa, A. H. (2002). Telemedicine, Outcomes and Policy Decisions. Disease Management Health Outcomes , 269-276.

Reed, K. (2005). Telemedicine: benefits to advanced practice nursing and the communities they serve. Journal Of The American Academy Of Nurse Practitioners, 17(5), 176-180. doi:http://dx.doi.org/10.1111/j.1745-7599.2005.0029.x

Sevean, P., Dampier, S., Spandoni, M., Strickland, S., & Pilatzke, S. (2008). Bridging the Distance: Educating Nurses for Telehealth Practice. The Journal of Continuing Education in Nursing, 413-418.

Sevean, P., Dampier, S., Spadoni, M., Strickland, S. & Pilatzke, S. (2008). Patients and families experiences with video telehealth in rural/ remote communities in Northern Canada. Journal of Clinical Nursing, 18, 2573-2579. doi: 10.1111/j.1365-2702.2008.02427.x

Simms, C., Gibson, K., & O’Donnell, S. (2011). To use or not to use: Clinician’s perceptions of telemental health. Canadian Psychology, 52(1), 41-51. doi:10.1037/a0022275

Taylor, D.M., Stone, S.D., & Huijbregts, M.P. (2012). Remote participants’ experiences with a group-based stroke self-management program using videoconference technology. Rural and Remote Health, 12, 1947 [Epub].

Wooten, R. (1996). Telemedicine: a cautious welcome. Information in Practice, 1375-1377. References
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