Use of Telehealth in Health Provision - Term Paper Example

Critical Review of Telehealth 2009 Introduction The literal meaning of telehealth is “healthcare provision at a distance” (Wooton et al, 2009). It is not a technology per se but “the use of telecommunications and information technology to provide healthcare services at a distance, to include diagnosis, treatment, public health, consumer health information, and health profession education” (US Department of Commerce, 2004). Telemedicine or telehealth came into existence first in the 1980s when management systems were introduced in health facilities. With the progress of Information Technology as well as telecommunication in the 1990s and 2000s, telehealth has become more and more sophisticated and pervasive (Darkins and Cary, 2000). It is a multidisciplinary way of providing healthcare at a distance. The World Health Organization (WHO) has differentiated telemedicine and telehealth: “If telehealth is understood to mean the integration of telecommunication systems into the practice of protecting and promoting health, while telemedicine is the incorporation of these systems into curative medicine, then it must be acknowledged that telehealth corresponds more closely to the international activities of WHO in the field of public health. It covers education for health, public and community health, health systems development, and epidemiology, whereas telemedicine is oriented towards clinical aspects” (quoted in Darkins and Cary, 2000). Typically, healthcare provision is considered to be face-to-face interaction between the patient and service providers for the purpose of diagnosis and treatment. Through telehealth services, healthcare provision is accessed on a real time basis from a distance through various electronic telecommunication platform like videoconferencing, transmission of still images on the Internet, e-health including health portals, remote monitoring of vital symptoms, continuing medical education with the help of the e-mail and nursing call centers (americantelemed.org cited in docstoc). The terms ‘telehealth’, ‘telemedicine’, ‘online health’, ‘e-health’, ‘connected health’, etc. are used synonymously for the purpose of dissemination of health information, diagnostic and advice for health (Wooton et al, 2009). Typically, it is the provision of clinical care, public health, medical education, health administration and research with the help of Information Communication Technology (ICT). It is aimed to enhance medical care, improve the quality of service delivery and effectiveness of public health and primary care interventions It is also aimed to balance the shortage of global healthcare providers, particularly in developing countries or remote areas. For example, patients can access healthcare through telehealth services from remote Arctic villages, Native American reservations, prisons or rural communities as long as they have access to electronic telecommunication (US Department of Commerce, 2004). In this paper, I will discuss various aspects of telehealth, including its use in health provision in developed and developing countries, the required retrieval mechanism and its pros and cons. I will also provide some bookmarks of telehealth links and an appendix that will detail how an end user can access the service. Use of Telehealth in Health Provision ICT can be used in the healthcare system in many ways. Through access to information and knowledge about health provided through the Internet, research and healthcare enterprises can get access to relevant information, research, literature and training material that would provide support for comprehensive evidence-based management for acute and chronic medical conditions. For the user of health services, it provides awareness and access to information on preventive medical knowledge. Through networking and collaborating on the electronic space, health providers, community health services, health institutions, policy makers and advocacy groups can collaborate, exchange knowledge and respond quickly and effectively in situations of disasters and disease management. For example, the European Union has initiated a number of surveillance mechanisms among member countries for the purpose of public health strategies, threat management and disease control. All of these surveillance mechanisms are undertaken with the help of electronic monitoring systems (EVM, 2002). ICT may also be used for the purpose of collecting, organizing and disseminating information for the purpose of advocacy, practice and policy. ICT enables the modeling of social health in terms of income, employment and social status affecting the health status for particular demographics. ICT can also be used for direct support to education and training for health professionals, including pre-service and in-service. Outreach to special population groups, like women and girls, be achieved through telehealth. ICT also provides greater transparency of public health provision, improve the regulation and monitoring mechanism for a decentralized public health system. ICT can support efforts to prevent diseases, promote health status through education, and assist diagnosis and treatment. Delivery of health services can be extended to remote rural areas through telehealth (Wooton et al, 2009). For the purpose of telehealth, Broadband Internet connection is required for distance delivery of healthcare services, consultations, prescription and purchase of medicines, using text information, still and video pictures and voice (Wooton et al, 2009). In the United Kingdom, the National Healthcare Service (NHS), which is the main health service provider has the entire process, beginning from prescription transmission to purchase of medicines by the clinics are on the electronic platform. The quality of delivery of healthcare through electronic means will therefore depend on the technology standards, privacy protection standards and costs. For the purpose of maintaining patient record archives in order to facilitate research as well as healthcare delivery, there needs to be a digitization process of all paper information, which too is expensive and has issues with privacy protection. As said by a practicing physician, “With medical knowledge expanding every day, no physician can keep up without help. By using high-tech medical communication, high-performance computers, high-resolution video, and fibre-optic information “superhighways”, we have been able to put the entire world of medical science at the fingertips of even the most isolated rural doctor” (quoted in US Department of Commerce, 2004). Most of the telehealth service providers market their offerings directly to the healthcare providers like large hospitals rather than to the end users, that is the patients and the managers of the healthcare providers are often reactive rather than proactive to patient needs (Darkin and Cary, 2000). Self-educated Internet-using patients collect health information through the telehealth services and can demonstrate the inequities that exist in most healthcare systems around the world. As a result, telehealth has changed the antiquated hospital infrastructures in many traditional societies. Retrieval mechanism Telehealth is not expected to replace in-person care; rather it is expected to be complementary to the latter. Telehealth is particularly beneficial in certain therapeutic areas, like for example remote psychiatric consultation through e-mail for the young who have resistance to in-person consultation. For specialities like dermatology which depend to a large extent on sight, high quality webcam may be sufficient for first diagnosis. It is also helpful in cases of emergencies when help can be sought on emails. Patients can access service through a number of stages: 1) live operator: when the patient is connected to the healthcare provider through inbound (patient to operator) or outbound (operator to patient) video calls; 2) pre-recorded video tutorials for simple tasks like how to measure blood pressure; 3) interactive media platform through media streaming engine which gives access to any video terminal complaint with standard telecommunication protocols 4) service logic application with embedded service features integrated with external application servers (Mirial, 2009). Pros and cons In the 21st century, the greatest challenge is to provide healthcare for all populations, according to the United Nations Millennium Goal (Wootons et al, 2009). Telehealth is one mechanism through which health information and access to diagnosis and treatment can be forwarded to a greater number of people, particularly in the developing nations. The use of telehealth has also been found to be useful in countries like Norway where the geographical distances that large sections of populations face from the amenities available in the cities may be compensated through the use of telehealth facilities like videoconferencing. This is particularly so when attracting doctors to remote areas where patient population is low becomes difficult (Darkins and Cary, 2000). This explains why acceptance of telemedicine and telehealth was the earliest in Norway. In Australia, there are 5.8 specialist psychiatric physicians per 1000 population in cities and 2.7 in remote areas (Conrick). Through telehealth, travel time and expenses can be reduced greatly. However, the opportunities for telehealth, which is wider in terms of public health education, than telemedicine which is concentrated in the clinical aspect, are larger because there is often resistance from within the profession on the adoption of telemedicine which is largely dependent on the quality of services provided. Even professional practices need to change if telehealth leads to cost saving on the part of users (Darkins and Cary, 2000). A customer-based approach needs to be developed in telehealth if it is to succeed. Besides developing guidelines and protocols for telehealth, clinicians too need to be trained for the provision of services on the electronic platform. This is essential for providing uniform quality of telehealth services, establish consistent training programs, clinical risk and claims management through telehealth, provide clear and unambiguous information to patients and for effective management of the system (Darkins and Cary, 2000). Telehealth breaks the barrier of national boundaries as it is disseminated electronically. This allows for fragmentation of research and development across countries but it also required close collaboration between telehealth suppliers (manufacturers and service firms), providers (clinics and clinicians), payers (third party insurance companies) and other stakeholders including public health organizations and governments of all participating countries (US Department of Commerce, 2004). One of the major challenges is to integrate it with clinical medicine even though advanced medical techniques, growing acceptance of the Internet and Information Technology is taking the system ahead. This is despite the fact that various regulatory issues arise in different countries. For example, the telehealth community in many countries including the United States has failed to convince health insurers to reimburse many of the implications like stores (US Department of Commerce, 2004). Telehealth often faces the barrier of intellectual property since a large proportion of innovation in healthcare occurs locally. Many of the telehealth innovators which are small companies often choose not to apply for intellectual property rights hence much of the information provided by them fall open to be misused. Telehealth has not yet been part of mainstream healthcare provision in most countries because of the financial barriers. Besides, the digital divide that exists in developing countries prevent the spread of telehealth where it is needed the most. In these countries, technology is prohibitively expensive for institutions as well as individuals. Furthermore, lack of literacy, education and awareness hinder telehealth even further. Telehealth has been proven to be effective in surveillance of cross-border threats to health and safety. But, the achievement of ICT in terms of improving quality and reducing costs of healthcare is still falling short of expectations (Wooton et al, 2009). Conclusion Telehealth has progressed in the 21st century on the back of development in Information Technology. What was earlier known as telemedicine, the remote access of health services can now be accessed by end users not only through telephone but also through telecommunication platforms like the Internet and videoconferencing. The major advantage of telehealth is to provide healthcare services for whom in-person care is difficult to access, primarily because of geographical distances. However, telehealth has not yet become integrated with mainstream because of the lack of literacy and education in developing countries, and because of issues with regulatory mechanisms and intellectual property in developed countries. Bookmarks http://www.ucdmc.ucdavis.edu/cht/ http://www.nexdose.com/ http://ehealthvirginia.org/ http://www.connectyx.com/ http://www.mobih.org/ Appendix: Mechanism for access by an End-User E-mail: Follow-up on in-person clinical care Videoconferencing: Through telehealth service providers on the internet Health portals: Access to information on chronic and acute health conditions Telephone Customer care: Access to Nursing and other healthcare providers Works Cited Docstoc, Case Study: Telehealth and Electronic Medical Records in Marshfield Wisconsin, http://www.docstoc.com/docs/509716/Case-Study-Telehealth-and-Electronic-Medical-Records-in-Marshfield-Wisconsin Wooton, Richard et al (ed.). Telehealth in the Developing World. Royal Society of Medicine Press, 2009 United States Department of Commerce, Innnovation, Demand and Investment in Telehealth, 2004, http://www.atp.nist.gov/eao/innovation_demand_invest_telehealth_022004.pdf European Vaccine Manufacturers (EVM), Communicable Disease Surveillance in Europe: Developing the basis for rational disease prevention strategies, 2002, http://www.evm-vaccines.org/pdfs/surveillance.pdf Darkins, A W and M A Cary, Telemedicine and Telehealth: Principles, Policies, Performance and Pitfalls, Springer Publishing Company, 2000 Conrick, M, Health Informatics: Transforming Healthcare with Technology, 2006 Mirial, An Interactive Video Communication: Architecture Proposal for Telehealth, White Paper, 2009, http://www.mirial.com/pdf/Whitepaper/Interactive_Visual_Comm_architecture_for_Telehealth.pdf Read More