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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. Advantages Provides cost efficient care.
Saves travel time.
Increases patient involvement in self care.
Healthcare Treatments can be provided in remote locations.
Allow home bound patients to receive treatment. Benefits Legal and Ethical Issues Technology difficulties.
Healthcare provider unable to physically assess patient.
Ethical dilemmas for health providers. According to Sarhan; three legal and ethical issues related to telehealth are:
Responsibilities and potential liabilities of healthcare professionals
Duty to maintain confidentiality and privacy of patients' records
With many available forms of e;electronic access to patients and their electronic health record there is also equal opportunity for potential breakdown in patient confidentiality.
Jurisdictional problems associated with cross-border consultations.
Although both legal and ethical issues are present in current practice, new concerns arise as the telehealth era continues to develop. Telemedicine can be used to monitor patients' health from a distance, offers remote monitoring, advice and treatment follow-ups via telecommunications.
Other benefits- telemedicine offers educational opportunities for healthcare professionals and ease access of travel/cost for patients. Megan Jimison
Latonya Johnson Teleheath Disadvantages R.D. Silverman address four different legal and ethical topics as listed:
The doctor- patient relationship
Malpractice and cross-border licensure
Standards of care
Approximately twelve states permit that examination of a first time physician-patient encounter to take place electronically (most often describing two-way, audio-video technology), while confirming to an appropriate standard of care (World Health Organization, 2009). Telehealth includes such technology as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices, which are used to collect and transmit patient data for monitoring and interpretation (Telemedicine, 2011). Telehealth Services Cont... While they do not meet the Medicaid definition of telemedicine they are often considered under the broad umbrella of telehealth services. Even though such technologies are not considered "telemedicine," they may nevertheless be covered and reimbursed as part of a medicaid coverable service, such as laboratory, x-ray and/or physician services (under section 1905 (a) of the Social Security Act) (Telemedicine, 2011) History of Telehealth Telehealth can be linked to the mid to late 19th century with one of the first published records occurring in the early 20th century when electrocardiograph data were transmitted over telephone wires (Patterson, 2005).
Telemedicine , as we know it today, started in the 1960s and was driven by the military and space technology arenas (World Health Organization, 2009).
In 1996, Senate Bill 1665 (M. Thompson; Chap 864, Stats of 1996) enacted the "Telemedicine Development Act of 1996" which imposed several requirements governing the delivery of health care services through telemedicine and also made several changes to different sections of law, which are also related to telemedicine. History of Telehealth Cont... In 2011, AB 415 repealed existing law related to telemedicine and replaced this law with the Telehealth Advancement Act of 2011, which revises and updates existing law to facilitate the advancement of telehealth as a service delivery mode in managed care and the Medi-Cal program (World health Organization, 2009).
Over the past decade advancements, availability and utilization of information and communication technologies by the general public have been key in the continued development of telehealth (World Health organization, 2009). History of Telehealth Cont... The introduction of digital communication methods, combined with the decrease in the cost of information and communication technologies have:
Sparked intrest in the application of telemedicine among health-care providers (Patterson, 2005).
Enabled health care organizations to envision and implement new and more efficient ways of providing care (Patterson, 2005). History of Telehealth Cont.... The internet has increased the pace of information and communication technology advancements of telemedicine to include:
Conferences via the Internet
Multimedia approaches (Who Health Organization, 2009) Specialities of Telehealth Mental health
In Nebraska most people live in rural areas or 73 counties are Medically Underserves areas, 89 of the state's 93 counties are designated as Mental Health Professional Shortages that exist in 47 of the counties.
“As a patient with type II diabetes, this service will provide me with specialized information I need to monitor and control my condition,” said patient Bill Paslawsky of Hometown. “Because I work full time it is sometimes difficult to make appointments with an endocrinologist especially when I would have an hour's drive to the doctor's office. Now, I have the opportunity to speak with a physician without having to leave the area and can work it into my busy schedule. To me, this service is invaluable.” Specialities of Telehealth More than 25 specialties are available for telehealth appointments. The top five most common specialties used for telehealth are optometry, psychiatry, dermatology, endocrinology and pediatric neurology. Roles/Responsiblities of Telehealth Professionals There are several key roles required for a telehealth program to be successful.
The program champion should have an excellent understanding of telehealth and its benefits to the patient and the organization. Necessary qualities include engaging, leadership, clinical experience, and credibility.
Project and Program Manager
This duty is some times done by the program champion. the Project/Program manager manages the telehealth program, but they will also provide ongoing management and review of outcomes with a goal of refining and expanding the program. This person must also have a solid understanding of the organization’s policies and procedures, workflow, and patient care processes… And of course, an affinity for technology!
The person filling the role of Education Manager depends upon the size of your organization and the resources available. In some cases, there is a dedicated Education Manager, but in other cases it may be a few people educating when their schedules allow. Roles/ Responsibilities Cont... Device Manager
The Device Manager is responsible for transportation, installation, de-installation, and cleaning devices.
Installers are nurses, they will educate the patient about how to use the devices. In some cases this will be at an install visit; in other cases a follow-up visit may be required. The Installer needs to have expert knowledge of device functionality, utilization, and proper technique for taking vital sign measurements, as well as experience educating adults.
To implement an effective telehealth program, someone clinical on staff (typically the Telemonitoring Nurse) will need to identify and evaluate telehealth candidates, enroll and manage patients, verify physician orders and patient consent, as well as manage device inventory and utilization. Frequently, the intake coordinators, installers, and admissions nurses will assist the Telemonitoring Nurse in these tasks.
A telehealth program is a great marketing tool. It’s important to identify someone in your organization with sound marketing skills to effectively market your program to referral sources. Equipment Equipment must be reliable, accurate and flexible enough to meet varying needs.
PC adapter Cords
Video overlay cards
External speakers on existing PCs with broadband switches
Special adaptive tools, such as an electronic stethoscope. Telehealth Services Cont.. (Department of Health and Human Services, 2012) Telehealth Services
According to the Department of Health and Human Services, Centers for Medicare & Medicaid Services: (Department of Health and Human Services, 2012) Asynchronus: Transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous or “store and forward” applications would not be considered telemedicine but may be utilized to deliver services. (Department of Health and Human Services, 2012) Telehealth Services Cont... Telehealth services, sometimes referred to as Telemedicine; are medical services delivered other than in person. Telehealth growing trends utilizes various forms of communication, such as; telephone communication or audiovisual interaction.
Telehealth services allows homebound patients and those living in rural areas to receive treatment from the comfort of their own homes. This unique service allow a healthcare provider to be in two places at once and the advantages of use outweigh all disadvantages.
Telehealth services offer real time care on demand Summary of Telehealth Services Legal and Ethical Issues Cont.. References Describe essential concepts and fundamentals of telehealth along with the necessary equipment and services provided
Identify key benefits as well as discuss advantages and disadvantages of telehealth within healthcare
Explain the primary duties and responsibilities of telehealth professionals, including the legal and ethical issues of telehealth medicine
Analyze telehealth, it’s participants and its’ influence on healthcare consumers
Discuss the history of telehealth and the future direction of the healthcare industry
Evaluate the impact of telehealth on the quality and efficiency of patient care Objectives Q & A Is online therapy as good as in-person therapy?
Yes, You will be having an in-person therapy session that is just like meeting your therapist in an office. The only difference is that you will save your time and gas money not driving across town for weekly appointments.
Is online therapy more expensive than an office visit?
No, the cost for telehealth online therapy is the same as services provided in the office and is covered by most major insurance. You will save a great deal of time, hassle, and travel expenses by conveniently receiving services at your location
Can remote critical care services be reported when utilizing telemedicine?
Yes. In order to report remote video-conferenced critical care, the physician(s) in the distant site must have real-time access to the patient's medical record including progress notes, nursing notes, medications, vital signs, laboratory tests, and radiographic images. The physician must also be able to enter orders, videoconference with the on-site health care team, speak to family members, and observe the patient
Are the services reported differently if you are the hosting facility vs. the consulting provider?
Yes. CMS requires the reported telemedicine services include both an originating site and a distant site. The originating site is the location of the patient at the time the service is being furnished. The distant site is the site where the physician or other licensed practitioner delivering the service is located.