Monday, August 27, 2018

Telemedicine: Embracing Virtual Reality to Improve Healthcare Access


Sarah Neller, PhD Student
College of Nursing | University of Utah



Imagine living in a place where it was difficult to access healthcare, where specialty healthcare providers refused to practice, and where it was more than 50 miles to the nearest hospital. This may seem like a remote possibility, but it’s the reality for many Americans who live in rural areas. Access to care continues to be a challenge that divides socioeconomic strata and creates disparities that could be reduced with appropriate access. Telemedicine is one avenue that can bridge the gap to reach those around the world who otherwise would not receive appropriate care.


What is telemedicine and how is it different from telehealth?
You may be asking yourself, “What’s thedifference in telehealth vs. telemedicine?” A lot of entities use these terms interchangeably, so if you’re researching the topic, it’s important to determine how the article or entity defines their terms. Telehealth is really an overarching term that encompasses all parts of health or anything related to healthcare that is mediated through technology – this can include non-clinical services including training, continuing education, even health advice, like talking to a health coach online through your insurance company. 

rmmagazine.com

Telemedicine on the other hand, is a subset of telemedicine that involves clinical services mediated through technology – think anything that would involve the EHR or seeing a provider – physical assessment, diagnosis, and ordering of labs, tests, and treatments.


History of telemedicine
The history of telemedicine trackswith the development of communication over time. In ancient times, signals like smoke and light were used to communicate plague outbreaks. Inventions of the telegraph and telephone were early mediums of telemedicine. In the 1950s, specialties like radiology and cardiology began to use telemedicine as we know it today to transmit medical data such as x-rays and electrocardiograms (EKGs). The growth of the internet has allowed for continued development of telemedicine capabilities including virtual office visits, like those projected by this Jetsons cartoon from 1962, because it allowed for easier and cheaper applications.
       

How is telemedicine delivered?

There are many different modalities of telemedicine. It can involve a patient to provider interaction or provider to provider interactions. Note that these interactions can go both ways (though it’s important to note that the patient’s primary provider does need to obtain consent from the patient before sharing information with the consulted provider to comply with HIPAA laws). These interactions can occur synchronously, which is in real time or asynchronously, which does not occur in real time. Examples of synchronous interactions can include “office” visits, which are mediated through technology like video conferencing, and asynchronous interactions could involve messaging through an electronic health record (EHR) portal or even communication with wearable patient monitors like pacemakers, Holter monitors, etc.



Benefits and uses of telemedicine
Uses: There are multiple uses for telemedicine including telestroke, teleresuscitation, and telehealth emergency care. Additionally, specialties like stroke, cardiology, dermatology, psychiatry are well suited for telemedicine.  New York Presbyterian Hospital offers virtual OnDemand urgent care visits, so you can access a provider from the comfort of your living room.

Benefits: There are so many benefits to telemedicine including increased access to high quality health care from primary care and specialty providers, increased patient engagement with the healthcare system (largely because they now have increased access to it), and fewer costs related to transportation and time off work. It also offers convenience which can improve patient’s ability to initiate care and maintain ability for follow-up care if needed. Multiple studies have shown that telemedicine aids to lower hospital readmission rates for certain conditions. Through telemedicine consultations, patients in rural areas are able to stay in their communities for treatment rather than be transferred to a larger medical center for a higher level of care. This is beneficial to the patient because it prevents transfer to the big city and keeps them close to their family support system, and it’s beneficial to the community because it can help keep the rural hospital open, which preserves access to care and maintains jobs. In short, it makes healthcare easier for the patient!

Challenges: What’s the hold up?
So why isn’t telemedicine an option everywhere? What’s the hold up?  First of all, not all specialties are suited for telemedicine. Telemedicine should not be used when an in-person exam is required due to high acuity, when there is a language barrier without available interpreter, or when the health care worker on the patient side does not have enough training or experience to aid the remote provider. It is frequently not implemented due to perceived high cost of implementation, provider hesitancy, or state policy.

A changing trend in healthcare
Telemedicine has opened the doors to the ability to deliver healthcare in new and innovative ways around the world. Mobile health units are a way that telemedicine has been able to be utilized in remote areas around the globe, during disasters, and in the fight against opioid abuse. Patients are now able to connect to their health care provider from the comfort of their own home or own community. In the 115th Congress, there have been 1 Senate bill and 2 House bills related to telemedicine that have been passed since December 2017. There are 15 Senate bills and 28 House bills related to telemedicine that are pending for this congressional session. As funding increases and regulation improves, telemedicine will quickly become a recognized standard of care that will improve affordability and accessibility for patients across the globe.


 References
American Telemedicine Association. (2017). Telemedicine/telehealth bills in the 115th Congress. Retrieved from https://higherlogicdownload.s3.amazonaws.com/AMERICANTELEMED/3c09839a-fffd-46f7-916c-692c11d78933/UploadedImages/advoca_115th_Congress_bills_advocacy.pdf
Arndt, R. Z. (2017). Telehealth education leads to lower readmission for West Virginia hospital system. Retrieved from http://www.modernhealthcare.com/article/20170213/NEWS/170219977
Ben-Assa, E., Shacham, Y., Golovner, M., Malov, M. Leshem-Rubinow, E. Zatelman, A., Shamir, O….Roth, A. (2014). Is telemedicine an answer to reducing 30-day readmission rates post-acute myocardial infarction? Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association, 20(9), 816 – 821.
Kim, E. J., Navarro, S. M., Michel, S., Soyars, C., Hilmers, D. Anandasabapathy, S. (2018). Development of a rapidly deployable mobile medical unit for emergency disaster settings. The Lancet Global Health, 6(2), S50.
MD Portal. (2015). History of telemedicine. Retrieved from http://mdportal.com/education/history-of-telemedicine/
New York Presbyterian. (n.d.) Mobile stroke treatment unit. Retrieved from https://www.nyp.org/neuro/services/stroke/mobile-stroke-treatment-unit
New York Presbyterian. (n.d.) Urgent care. Retrieved from https://www.nyp.org/ondemand/urgent-care
Tu, J. H., Profit, J. Melsop, K., Brown, T., Davis, A., Main, E…Lee, H. C. (2017). American Journal of Perinatology, 34, 259-263. Retrieved from http://dx.doi.org/10.1055/s-0036-1586505.ISSN 0735-1631.
Wicklund, E. (2018). Mobile health units are latest telehealth tool to fight opioid abuse. Retrieved from https://mhealthintelligence.com/news/mobile-health-units-are-latest-telehealth-tool-to-fight-opioid-abuse
Zachrison, K. S., Hayden, E. M., Schwamm, L. H., Espinola, J.A. Sullivan, A. F., Boggs, K. M…Camargo, C.A. (2017) Characterizing New England emergency departments by telemedicine use. Western Journal of Emergency Medicine, 18(6), 1055-1060.


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