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Emily Hayes

on 17 November 2014

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Transcript of TELEMEDICINE

design by Dóri Sirály for Prezi
Remote care delivery or monitoring between healthcare provider and patient outside of a clinical health facility, most often in their place of residence
Aging global population = chronic diseases
Monitoring and early intervention
Enhanced disease management
"Aging in place"
The Future
{Emily Hayes}
"The use of medical information exchanged from one site to another via electronic communications to improve a patient's clinical health status"
Telehealth or Telemedicine?
Variety of settings and applications
Home/ Local Clinics
Smaller/ Rural Hospitals
Other Professions/
Ethical, Legal & Regulatory Issues

Aging global population
2013 - In the US, 80% of older adults had 1 chronic condition
50% had at least 2 chronic conditions
Health care is often urban centric
80% of rural areas are medically underserved
(Schwamm, 2014)
Let's Start Here:
(Sevean et al., 2008)
(Rutledge et al., 2014)
Barriers to Rural Health Care
Lack of healthcare facilities and providers
Limited public transportation services
Poor health
Educational limitations
Burden to travel
(Rutledge et al., 2014)
(Stevean et al., 2008)
Patient centered care
Timely (more time for providers & live time)
Reduce readmissions
Prevent unnecessary transfers
Decrease travel and time expenses

Supplement traditional care - emphasis on prevention and early intervention
Evidence based
Back to the 6 domains:
Safe, Effective, Patient-Centered, Timely, Efficient, Equitable Care
"Prove it"
5 year study - 1,665 participants
Typical care versus Telemedicine
Hemoglobin A1c
0.34% improvement compared to 0.07%
Low density lipoprotein cholesterol
Statistically insignificant
Blood pressure
Systolic/ diastolic change 4.51 and 4.22 mm Hg respectively
1.70 and 5.06 mm Hg
A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Management
"For many rural trauma victims, geography is destiny"
Frequent changes in diagnostic or therapeutic interventions
Quicker transfers/ retaining patients
Unifying providers / specialists
Recruit and retain providers
Reducing costs
Higher patient satisfaction
School nurse = leader and coordinator of health care provided to students
Increased number of students with medical needs
Lack of convenience / access to primary care provider
Improved communication and collaboration
Chronic conditions managed more effectively
Better attendance
Cost effective
Six domains of quality care:
(American Telemedicine Association, 2012)
(Lu, Chi, Chen, 2013)
(Shea et al., 2009)
(Schaeffer, 2014)
(Bjorn, 2012)
Chronic Condition Management
Increased number of symptom free days by 83%
Better control of symptoms
Improvement in functional health status
Reduction in asthma attacks
Type 1 Diabetes
Fewer hospitalizations and ED visits
Lower hemoglobin A1c levels
Indication of better blood glucose control in 6 months
Evaluation in realistic setting
(Raynolads & Meughan, 2014)
(Raynolads & Meughan, 2014)
TeleMental Health
TeleOccupational Therapy
TeleSpinal Cord Injury/Disorder
Tele Pulmonology
TeleAmputation Clinics
(VA Telehealth Services, 2014)
Assess access to health care at regular appointments to evaluate if telemedicine would be an efficient option

Posters advertising telemedicine resources are displayed in hospitals and clinics offering these services
Nursing schools set policies to teach/ expose students to telemedicine

Teach patient that qualifies how to use technology (blood pressure cuff, glucose monitor, etc.)

Send out surveys to telemedicine users to assess satisfaction and experiences
Local government supports telemedicine program by providing funding to the clinic

Telenurses evaluate trends in patient's data since implementing telemedicine and alert patient of abnormal results
Telenurses contact residents with known chronic conditions to discuss use of telemedicine for monitoring and early intervention
Multidisciplinary team holds a conference discussing benefits and barriers to telemedicine as well as interpreting statistics of outcomes
Patients "taken away"
Lack of internet access
Legal/ administrative issues
Provider & Patient comfort
Equipment Cost
Protection of privacy
(Fredrick, 2013)
(Stephens, 2014)
Provider Guidelines
Malpractice Insurance
Patient Protection and Affordable Care Act (2010)
Medicare / Medicaid
Change in traditional care
(American Telemedicine Association, 2010)
Physical Therapy
Mental Health
Public Health
80 million Americans live in a mental health professional shortage area
Less than 1/4 of the estimated 45 million American adults who have a mental illness receive treatment
Can't access care

(Novotney, 2011)
White House Office of Science and Technology Policy
Engineers in Massachusetts, Texas, Washington D.C. and University of California Berkeley
Remote control robotics and skype-like communication
(CBS News, 2014)

"Telemedicine complements, but still isn't designed to replace"
Patient safety takes priority
Consultations & Adherence
As needed

(Stephens, 2014)
(Ju, Chi, Chen, 2013)
American Telemedicine Association (2012). What is telemedicine.
American Telemedicine Association.
Retrieved from http://www.americantelemed.org/about-telemedicine/what-is-telemedicine#.VGgfq1YmV95

Bjorn, P. (2012). Rural teletrauma: Applications, opportunities, challenges.
Advanced Emergency Nursing Journal
, 34 (3), 232-237. doi:10.1097/TME.0b13e31825f6237

CBS News (2014). Robots versus ebola.
CBS News
. Retrieved from http://www.cbsnews.com/news/robots-vs-ebola/

Lu, J., Chi, M., Chen, C. (2014). Advocacy of home telehealth care among consumers with chronic conditions.
Journal Of Clinical Nursing
, 23(5/6), 811-819. doi:10.1111/jocn.12156

Novotney, A. (2011). A new emphasis on telehealth.
American Psychological Association
42(6), 40. Retrieved from http://www.apa.org/monitor/2011/06/telehealth.aspx

Reynolds, C. A. & Maughan, E. D. (2014). Telehealth in the school setting: An integrative review.
The Journal Of School Nursing
, 1-10. doi:10.1177/10598405145400534

Rutledge, C. M., Haney, T., Bordelon, M., Renaud, M., & Fowler, C. (2014). Telehealth: Preparing advanced practice nurses to address healthcare needs in rural and underserved populations.
International Journal Of Nursing Education Scholarship
, 11(1), 1-9. doi:10.1515/ijnes-2013-0061

Schaeffer, J. (2014). The bottom line on telehealth.
For The Record,
26(8), 22-25.

Schwamm, L. H. (2014). Telehealth: Seven stratagies to successfully implement disruptive technology and transform health care.
Health Affairs
, 33(2). 200-206. doi:10.1377/hlthaff.2013.1021

Sevean, P., Dampier, S., Spadoni, M., Strickland, S., & Pilatzke, S. (2009). Patients and families expereinces with video telehealth in rural/ remote communities in Northern Canada.
Journal Of Clinical Nursing,
18(18), 2573-2579. doi:10.1111/j.1365-2702.2008.02427.x

Shea, S., Weinstock, R. S., Teresi, J. A., Palmas, W., Starren, J., Cimino, J. J., ... Eimicke, J. P. (2009). A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel study.
Journal Od the American Medical Informatics Association,
16(4). 446-456. doi:10.1197/jamia.M3157

VA Telehealth Services (2014). Real-time clinic based telehealth.
U.S. Department of Veterans Affairs.
Retrieved From http://www.telehealth.va.gov/real-time/index.asp
Full transcript