Telehealth is a growing healthcare trend.
What is Telehealth?
Simply put, telehealth is health information and services delivered “via telecommunications technologies”. This could include a variety of scenarios, including healthcare professionals consulting over the phone or remote robotic surgery. Telehealth is really “an expansion of telemedicine”. Telemedicine covers just the “curative aspect”, but telehealth incorporates “preventative, promotive and curative aspects” of healthcare. Professionals can use email for patient communications, prescription orders, and other healthcare services. Telehealth is useful for “home monitoring of conditions of patients”, such as during clinical trials. Diagnostic images could be forwarded, education and videoconferencing can be performed, medical data may be transmitted, advice and follow-up could be shared, and even teletriage are all possible aspects of this growing trend. Teletriage is “health advice by telephone in emergent cases”. Aside from clinical uses, telehealth also includes distance education, administrative uses, online information, and more. Information can be stored and forwarded or shared in real time. Remote patient monitoring, remote training, and electronic consultation (E-Consult) are all ways to share information without being face-to-face.1
Interactive videoconferencing allows patients to talk with physicians in real time. Some types of consultation fall under the “store-and-forward” category, which means the patient’s information is captured at the patient’s site, and then it is evaluated and analyzed at the physician’s site. A hybrid consultation is when live and interactive healthcare is combined with the stored information. Some of the services of telehealth are not clinical. These consist of provider training, continuing medical education, administrative meetings, health administration, and patient education. The American Telemedicine Association and the Telehealth Resource Centers have additional information on telehealth services.2
Uses in Rural Areas
Telehealth could provide more access to quality healthcare in rural areas. Patients can see specialists without leaving communities, and experts are able provide care to patients that are far away, in a timely manner. One example would be patients and doctors communicating via videoconference, but “the use of electronic information and telecommunications technologies” is also included. Education, health administration, public health, and clinical healthcare all fall under the scope of telehealth. Images, data, and video can be transmitted, and patients could be monitored remotely. Rural communities may benefit from many specialties, including the following: audiology, cardiology, behavioral healthcare, dentistry, management of chronic conditions, emergency care, dermatology, gastroenterology, long-term care, hepatology, obstetrics, pharmacy, radiology, ophthalmology, and many more types of healthcare interventions. The TRCs, or Telehealth Resource Centers, which “are funded by the Office for the Advancement of Telehealth,…assist healthcare organizations, healthcare networks, and healthcare providers” and “provide technical assistance” and educational webinars to help the programs that serve rural and underserved populations. Affordable broadband is needed, however, to most effectively serve these rural communities, and that is one of the challenges faced in telehealth. Mobile health (mHealth) can be used to communicate with patients and for remote monitoring. Telecare is the remote monitoring service provided for the disabled and elderly, so that they can live in their homes independently.3
Uses in Urban Areas
According to Commerce Department research, telemedicine is “more prevalent in urban populations” than in rural ones. In fact, “internet users…in urban areas are twice as likely to participate in telemedicine”.4 Many urban areas lack specialists in certain fields, such as stroke care and dermatology. Telehealth can improve the access to specialty care in underserved urban regions. There are many benefits to telehealth, including reducing healthcare costs, increasing clinicians’ opportunities, allowing patients to seek healthcare close to home, and decreasing the wait time to receive specialized care. For physicians, the patient’s condition can be managed remotely, and for the patient, it becomes less necessary to travel or receive transport for appropriate care, saving time and money. Providers can be more productive, as well.5
There are telehealth grant programs. One of them is EB TNGP, or Evidence-Based Tele-Emergency Network Program, which is a grant program meant to “expand capabilities in remote emergency departments” as well as “determine the effectiveness of tele-emergency care for rural patients”. Various states can cooperate in a grant program for Licensure Portability. The Telehealth Network funds projects to improve services for underserved rural, frontier, and urban communities. The TRCs or Telehealth Resource Centers are part of a grant program designed to help healthcare providers to implement cost-effective programs for the medically underserved and rural populations.6
Benefits and Challenges
Telehealth has its benefits in home monitoring for chronic conditions, psychiatric treatment and evaluations, treatment of stroke patients, care for patients with limited mobility, neurology patients, and “remote ICU monitoring for patients in critical conditions”. However, there are three major types of obstacles for telehealth. The first is “state licensing and prescribing laws”. Doctors have to comply withlaws in multiple states if their patients are located in different states. The second challenge is “reimbursement”. Private payers are covering treatments, in some cases, but it may be difficult for some providers to get reimbursed through Medicaid, Medicare, and insurance companies. The third issue is “HIPAA privacy and security”. Sensitive data is transmitted and held electronically, so it is crucial that the data is handled by the right people and that the information is secured.7 There are several successful telehealth programs that have been recently studied. Three of them used “a remote patient monitoring system” with the goal of reducing the re-hospitalization rates of their Medicare patients”. Providers monitored patients, intervening when necessary, and in some of the situations patients were able to access a 24-hour call center. One of these successful programs was the Veterans Health Administration. This program had “led to a 40% reduction in overnight stays for patients” and “a significant decrease in hospital utilization for eight major conditions”. In fact, “85% of patients said they were satisfied” with the system. Partners Healthcare had found “a 51% reduction in heart failure readmission rates” and “readmissions that weren’t related to heart failure decreased by 44%.” Centura Health reduced their readmission rates by 62%, and greatly decreased the number of visits to the emergency department for participants in their telehealth program. The keys to success include patients being held accountable for their health, “real-time feedback” on how lifestyle choices affect the patients’ conditions, patients being enrolled in the telemedicine program “before they left the hospital” so that they were informed that this was a part of their “on-going care”, and doctors providing information about the program to the patients so that they would be more engaged in their own treatment options.8
The telemedicine market grew, globally, from “$17.8 billion in 2014 and will reach $28.9 billion in 2019”. The market segments that are the largest are “telepathology, teleradiology, teledermatology and telepsychology”. Technology is advancing, and the internet and telephones are more accessible now. Clinics and hospitals can focus on the “critically ill”, while other patients can receive consultations through videoconferences or phone calls. As the population ages, healthcare costs rise, chronic diseases increase, and hospital infrastructures are lacking, the telemedicine market will continue to grow. The barriers to the market are “nations which lack sufficient resources for the telemedicine market” as well as “high technological costs, lack of physician support and poor cases of implementation”.9 There are many benefits to this healthcare paradigm, however, as patients can be monitored between visits, thus reducing ER visits and hospitalizations.10