Analysis of Telemedicine - Literature review Example

Telemedicine Name Course Lecture Date Introduction Telemedicine refers to using the internet and other telecommunication technologies to convey information about diagnosis and disease management. The practice has gotten recent attention following the promise by Federal Government to give AU$392 million to develop it, along with the suggested countrywide broadband network that may enhance telemedical services’ efficiency. Australian Medical Association has endorsed telemedicine and has several applications. Nevertheless, the most publicized application is the idea of online interactive sessions with a health practitioner instantaneously via a Skype-like platform. In the future, telemedicine has a likelihood of playing an important role in the healthcare profession and thus, there is a need to understand its limitations and benefits (Indraratna 2011). This report will include an evaluation of the benefits and limitations of telemedicine in Australia to patients alongside their families, providers including doctors, nurses and specialists, the government and society. It will also discuss the requirements for effective delivery of telemedicine services, including technology, training/educational, environmental requirements, funding and equipment. Moreover, it will compare Australian telemedicine context with international context and give the necessary recommendations. Benefits and limitations of telemedicine Patients and their families Moffatt & Eley (2009, p.276) maintain that, there are several benefits that accrue from telemedicine for patients along with their families. To start with, telemedicine is cheaper compared to the traditional one-on-one consultation with health specialists. In the latter, patients and their families incur high costs in terms of time and money on transport and other effects since they have to travel from their residential area to the health facility in order to receive medical attention. On the other hand, in telemedicine a patient receives consultation services from a specialist in their homes and do not need to travel to the hospital. In addition, telemedicine reduces inconveniencea in the access of specialist medical services. Some of the inconveniences include a case where a patient and his family members go to the hospital to receive treatment from a particular health practitioner and then the practitioner is absent. Other inconveniences include long queues in the hospital and limited working hours for health facilities. In telemedicine, a patient can access 24-hour healthcare services from a specialist immediately. Moreover, telemedicine is associated with enhanced access to high quality health services, especially for Australians in the rural areas. Most rural areas lack health facilities with highly qualified health specialists, which make access to health services difficult. However, through telemedicine, people in the rural areas are able to access doctors located in the urban areas who are highly qualified (Moffatt & Eley 2009). Despite the many benefits that patients and their families gain from telemedicine, there are some limitations to the effectiveness of the practice. First, a big percentage of patients, especially those in remote areas, lack the skills and equipment needed for telemedicine to occur between a patient and a health specialist, such as internet access and laptops for videoconferencing. Without such skills and equipment, it becomes impossible for patients to enjoy the benefits of telemedicine (Indraratna 2011). In addition, in telemedicine, the distant health specialist is not able to carry out a physical examination on the patient. This type of practice is best suited for health services, such as psychiatry, dementia syndromes and dermatology, where adequate examination is possible through videoconference. However, for certain health conditions, such as fever, pregnancy and fractures, telemedicine may not be helpful since physical examination ought to be done on the patient to establish his or her status. Furthermore, confidentiality is paramount in health practice and thus, there are concerns regarding the security of patients’ information in online videoconferencing. While it is hard to hack a video conference, there are concerns about unauthorised access to information where consultations are recorded and stored (Indraratna 2011, p.12). Providers (doctors, specialists, nurses) Drawing from Moffatt & Eley (2009), one of the reported benefits of telemedicine to healthcare providers is constant professional and educational development. This is made possible where providers receive training on different health topics through videoconferencing, which in turn help them acquire new or advance their existing skills on such areas. Moreover, professional development is achieved where a less experienced health professional is able to consult a more experienced one online during the consultation session with a patient. Another benefit of telemedicine to providers is the ability to provide improved local services. Unlike in the past when accessing and providing health care services to patients in local areas was difficult, telemedicine enables providers to provide services to patients regardless of their location. Moreover, telemedicine facilitates collaboration and networking among healthcare providers. Through video conferencing, different health practitioners can combine efforts in rendering specialized health services to a given patient. Telemedicine facilitates networking for providers by enabling health professionals to meet and befriend other professionals as well as clients (Moffatt & Eley 2009). According to Tracy et al. (2008, p.991), funding and time constitute a major limitation in the adoption of telemedicine. There are insufficient funds for specialists, GPs and doctors along with their staff to carry out telemedicine consultations, especially those doing them at remote sites. Moreover, telemedicine is costly for practitioners in terms of time since it involves more tasks. For instance, estimations have been that a teledermatory session might take around 30 minutes compared to the 15 minutes estimated for traditional consultations (Muir 2007). In addition, certain skills are required to operate new or existing equipment in different ways. There are urban as well as rural doctors who lack the skills to carry out a telemedicine session. Some of the lacking skills include IT skills and skills for operating X-ray equipment. Infrastructure is also another limitation of telemedicine for providers. This denotes poor access to internet in remote and rural Australia, as well as the limited ability to acquire or access the needed equipment. Broadband is not available in the remote areas (Eley & Moffatt 2011, p.3). The government The main benefit of telemedicine for the Australian government is reduced spending in building health facilities. The government spends large amounts of money every year in building, expanding or renovating hospitals, dispensaries and health centres across the country. In telemedicine, health specialists attend to patients from their homes, which reduce the need for many hospital rooms to carry out consultation services (Indraratna 2011). On the contrary, telemedicine cannot totally replace the conventional way of delivering health services and with the increase in Australian population, construction of more health facilities remain inevitable for the government. Besides, the government require huge funds for paying practitioners, which is not readily available. In boosting telemedicine practice, the government has proposed to pay general practitioners $100 for every consultation established and $180 for every consultation to specialists (Indraratna 2011). Society Moffatt & Eley (2009) assert that, telemedicine has resulted in a reduction in rural-urban health disparities. Following the introduction of telemedicine in Australia, access to healthcare services especially in the rural areas has improved. This is unlike in the past when it was difficult to easily access health services due to a limited number of health facilities in the rural. However, the adoption of telemedicine in rural Australia is still uneven and thus, rural-urban health disparities are still pronounced in a certain areas. Moreover, professional development openings and support from health specialists through telemedicine contribute to enhanced rural medical personnel recruitment as well as retention. This leads to availability of highly qualified health staff to render high quality health services to the community. Besides, telemedicine generally improves the access to health services among the Australian society, which in turn results into a healthier nation. In spite of the numerous benefits that the Australian society enjoy from telemedicine, poor internet access and lack of skills and equipment, such as laptops and projectors for conducting live consultation and videoconferencing stand as a key limitation to the adoption of telemedicine (Eley & Moffatt 2011). Requirements for effective delivery of telemedicine services According to Watson et al. (2001), successful delivery of telemedicine services has a number of requirements. In the first place, different technological aspects, including fast internet connection, Skype software and videoconferencing are needed in order to conduct online consultation in an effective manner. Fast internet access is important in telemedicine since it facilitates the exchange of clear images, sound and wording between the patient and the health specialist in relation to diagnosis and the appropriate treatment that the patient should undergo. The Skype software plays a central role in telemedicine since through it the patient can see the health practitioner and vice versa. This is important especially where the practitioner want to make physical observation on the patient’s body for health conditions such as skin rashes and inflammation. Videoconferencing is needed where more than two individuals are involved in the delivery of health services. For instance, a doctor can conduct a videoconference involving him, a specialist and the patient. Additionally, in order to put telemedicine into practice, healthcare providers as well as patients and their relatives or caregivers ought to learn about how to use the equipment used in telemedicine, such as laptops, projectors and medical equipment. Moreover, providers and patients require IT knowledge and skills in order to know how to use Skype, the internet and videoconference. In other words, more than just the basic computer skills and knowledge are needed for telemedicine services to be delivered effectively. Furthermore, healthcare providers should have an extensive knowledge on different medical conditions, their signs, effects and treatment, since during the consultation they may not have time to consult other providers about a given disease (Eley & Moffatt 2011). Delivering telemedicine services in an effective way requires a lot of funds. Money is needed for the purchase of laptops, projectors, public address system and for the installation and maintenance of internet connection. Moreover, telemedicine is quite an involving and demanding practice compared to the traditional healthcare services. Therefore, health practitioners need to be compensated accordingly in order to motivate them to adopt telemedicine and to effectively deliver high quality healthcare services to patients. In this case, funds for paying providers’ incentives and related benefits are needed (Eley & Moffatt 2011). Eley & Moffatt (2011) further maintain that, several equipments are important for delivery of health services. A laptop or any other gadget with a webcam is crucial for conducting video chats between the patient and the doctor. Moreover, projectors are needed by health practitioners to aid in displaying images, statistics and information that relate to a certain disease or medical area when conducting consultation or training specialists. Space and conducive environment is also another requirement for delivering telemedicine services effectively. Dedicated videoconferencing rooms with proper lighting and free of interruptions and noise. The rooms should also be in a convenient location to clinical areas. Comparison of the Australian situation with the international context Similarities Smith & Gray (2009, p.16) has identified inadequate funding as a feature that is common in Australia as well as in the international arena. Providers of telemedicine services, including doctors, specialists, and GPs, are not receiving adequate incentives for carrying out the practice. As a result, the effectiveness of telemedicine services is yet to be achieved since lack of funds forms a great drawback to the practice. In addition, telemedicine practice in both Australia and other nations, such as New Zealand entails industry partnership between the health sector and technology manufacturers. Though such partnership has several potential benefits, there is also a need to have safeguards for ensuring that telemedicine services’ direction is not excessively influenced by business imperatives (Kazley, McLeod, & Wager 2012). The practice of telemedicine in certain regions of Australia, such as Western Australia is still new and under development. Actually, telemedicine services in this region are provided in government hospitals only, no private providers (Kazley, McLeod, & Wager 2012). Similarly, in Asia, telemedicine is comparatively new, with the greatest research in the field being conducted in India, Hong Kong and Japan. Thus, majority of telemedicine activities are being carried in the three countries, while in other Asian countries telemedicine is yet to evolve (Durrani & Khoja 2009). Differences One of the differences in telemedicine practice is that, in Australia GPs do not undergo specific training for the use of telemedicine technologies, such as videoconferencing and Skype and on delivering telemedicine services (Indraratna 2011). On the contrary, in certain countries like in the UK, GPs’ specific training is considered valuable for effective telemedicine services and is done on a regular basis. An example of a facility where such training is conducted is Virtual Outreach Project (Wallace et al. 2004). Moreover, videoconferencing is the most common technology that is used to carry out consultation under telemedicine practice in Australia. On the other hand, a bigger percentage of telemedicine applications in Asian countries such as Hong Kong, India and Japan depend on ISDN for connection and majority of services are conducted on a store-and-forward basis. The use of videoconferencing in these countries is minimal (Durrani & Khoja 2009). Furthermore, telemedicine services in Australia are mainly carried out by GPs through the assistance of specialists, while in nations, such as in the United Kingdom, nurse practitioners and practice nurses participate in a number of video consultations (Kazley, McLeod, & Wager 2012). Recommendation on the next steps for telemedicine adoption in Australia Several recommendations are made based on the benefits and limitations of telemedicine, requirements for delivering the services effectively and comparison of telemedicine in the Australian context with international context. First, poor internet access or lack of broadband for use by healthcare providers as well as patients continues to be a major limitation for telemedicine in Australia. Accordingly, fast internet connection is an essential component for the adoption of telemedicine in Australia in the future. This will make telemedicine services effective by facilitating quick transfer of data and information. The Australian government should support efforts for the installation and distribution of broadband across the country, especially in remote regions, where the problem of internet access is more pronounced. This will aid in improving the access to quality health services by all Australians regardless of their location. The adoption and use of telemedicine in the future require heavy funding. The government should devote itself in providing adequate financial resources for carrying out telemedicine activities. Providers of these activities, including GPs, doctors and specialists, should be given adequate incentives to support them in their practice. Thus, the government should fulfil its promises of paying $100 and$180 to general practitioners and specialists respectively. Given that online consultation is very involving, adequate incentives will boost the morale for providers to conduct it. Moreover, enough equipment for carrying out videoconferencing and other telemedicine related activities should be provided to health providers. The government should ensure that all health facilities have the necessary equipment for telemedicine. Rural Australia seems to need telemedicine services more and thus, future projects for the supply of such equipment should begin in the rural areas. However, providers are not the only people who require the equipment. Patients need the equipment as well. Some patients in the remote areas cannot afford equipment for telemedicine and thus, the government should put in place plans for supplying patients with the equipment. Furthermore, nurses should take part in a number of the consultations instead of GPs. The government has limited resources for paying the incentives for general practitioners. Nurses are paid less compared to GPs. Thus, slotting in nurses in telemedicine services will increase the cost-effectiveness of the services and enhance the skills for nurses. In addition, all the individuals involved in the delivery of telemedicine, including GPs, doctors, patients and their families, should receive training on the use of technology for conducting online and video consultations. Lack of the necessary skills has been cited as a barrier to effective telemedicine and thus, training will equip patients and providers with the skills for use of telemedicine in the future. For providers, the training can be incorporated in the training and development programs for their respective organizations. Besides the training, continuous technical support should also be provided to healthcare providers. For patients and families, training should be undertaken in form of civic education forums. Compared to people in the urban areas most of whom have at least basic IT skills, individuals in the countryside know very little about computer or IT skills if any. Thus, they require the training the most. Though industry partners for the health sector may play a central role in the delivery of telemedicine services, overreliance on them should be avoided. Technology is important in telemedicine and so are the manufacturers of the technology, but these are organizations that are doing business. Over-depending on them may lead to compromise of the quality of services that patients receive under telemedicine, especially in relation to the safety of patients’ information. As a result, several reliable providers of technologies should be used to avoid a case where a single supplier influences the telemedicine practice. Moreover, measures for guarding patients’ information should be taken in order to ensure quality services. Conclusion Telemedicine has several applications, but online interactive session with health specialists is the most common. The benefits of telemedicine for patients along with their families include reduced costs, convenience and enhanced access to high quality health services, while the limitations are lack of skills and equipment, no physical examination and unauthorised access to patients’ information. The benefits for providers include constant professional and educational development, provision of improved local services and collaboration and networking, while the limitations include funding and time, lack of equipment skills and poor infrastructure. The benefit of telemedicine to the government is reduced spending in building health facilities, while the main limitation is limited funds. The Australian society benefits from telemedicine in terms of reduction in rural-urban health disparities, improved access to health services and recruitment and retention of healthcare providers. Effective provision of telemedicine services requires technologies such as internet connection, and videoconferencing. It also requires IT skills, funds, equipment and space. The similarities of Australian telemedicine and that of other countries include inadequate funding, industry partnership and underdevelopment of the practice in certain areas. The differences include lack of specific training, use of different technologies and different providers. List of References Durrani, H & Khoja, S 2009, A systematic review of the use of telehealth in Asian countries, Journal of Telemedicine and Telecare, 15 (4), 175-181. Eley, D & Moffatt, J 2011, Barriers to the up-take of telemedicine in Australia – a view from providers, Rural and Remote Health, 11 (1581), 1-6. Indraratna, P 2011, Telemedicine: The possibilities, practicalities and pitfalls, Australian Medical Student Journal, 2 (1), 11-12. Kazley, A, McLeod, A & Wager, K 2012, Telemedicine in an international context: definition, use, and future. Advances in Health Care Management, 12, 143-69. Moffatt, JJ & Eley, DS 2009, The reported benefits of telehealth for rural Australians, Australian Health Review, 34 (3), 276–281. Muir, J 2007, Teledermatology: is web-based teleconsultation effective? Expert Reviews of Dermatology, 2 (3), 271-275. Smith, A & Gray, L 2009, Telemedicine across the ages, Medical Journal of Australia, 190 (1), 15-19. Tracy, J, Rheuban, K, Waters, R, DeVany, M & Whitten, P 2008, Critical Steps to Scaling Telehealth for National Reform, Telemedicine and e-Health, 14 ( 9), 990-994. Wallace, P, Barber, J, Clayton, W, Currell, R, Fleming, K & Garner, P 2004, Virtual outreach: A randomised controlled trial and economic evaluation of joint teleconferenced medical consultations, Health technology assessment, 50, 1-106. Watson, J, Gasser, L, Blign, I & Collins, R 2001, Taking telehealth to the bush: Lessons from north Queensland, Journal of Telemedicine and Telecare, 7 (2), 20-23. Read More