Telehealth A Driving Force in Healthcare

Telemedicine in today’s healthcare environment is the newest trend. The wealth of technology available is driving the increase of telehealth solutions.  New obstacles in healthcare management have created a need for innovative uses of ever evolving technology. The most challenging healthcare system’s problems such as distribution of limited providers, access to care and cost effective delivery can be positively impacted by telehealth. Telehealth can transform the present structure of care and allow for improved access and high-quality health outcomes. The need to provide high quality healthcare to the population has reached a crisis dimension where telehealth is becoming more and more evident that it is the foundation of the solution.

History of Telehealth

Telehealth is a word utilized to incorporate interactive videoconferencing, remote monitoring of vital signs, patient portals, and electronic exchange of information.  Telehealth is the transmission of electronic information through the telecommunication infrastructure to provide long-distance clinical services remotely and professional health-related education. Telemedicine is a related word that denotes the distribution of remote clinical services.  The history of telehealth started in 1906 when Dr. Willem Einthoven, inventor of the EKG, invented a way to convey this data over telephone lines. Between 1800 and early 1900’s the wireless radios became the foundation of future wireless communications. The utilization of these radios converted to an accepted form of remote communication.1 In 1955 the first form of modern telehealth was developed when a remote clinic from Nebraska communicated with another hospital through a closed circuit television connection.2 There was a high importance on telemedicine in 1972 where the funding was provided by the Department of Health, Education and Welfare in the United States for seven telemedicine projects.

Because of the accelerated development of technology and science at the turn of the century, the acceptance of technology in our society stimulated the extensive use of this technology that included the diffusion of portable devices in people’s everyday life (Zundel, 1996).

The continuation of higher quality and innovative technology in many areas such as schools, organizations and homes is contributing to the emerging research in telehealth and the expansion and promotion of education and prevention.

The technologies involved in the telehealth process include videoconferencing, the internet, streaming media, store-and-forward imaging, and wireless communications (HRSA, 2015). Telehealth is an expansion of telemedicine that incorporates contributive, preventive and therapeutic aspects of care. Telehealth plays a vital role in promoting a better preventative care for the aging and chronic disease population. Competition in healthcare is merging into the virtual world, where many healthcare organizations could profit from the benefits of telehealth solutions. The impetus towards increasing access of care through the use of health information technologies is generating an exhilarating central platform for innovation and implementation of new and sophisticated methods for service distribution.

Remote Patient Monitoring (RPM)

Remote patient monitoring (RPM) is a form of ambulatory healthcare permitting patients with chronic diseases to utilize mobile digital technologies to check biometrics, track activity, health related questions and transmit this data to healthcare professionals remotely. The RPM technology involves daily monitoring devices such as blood pressure, weight scale and glucose meters for patients with diabetes or cardiac diseases. The data collected by the healthcare organization is transmitted securely for further assessment and recommendations.

The telehealth nurses are monitoring the patients remotely on a daily basis, and they are the key in coordinating the care plans and acting on the information received. Caswell (2015) wrote an article where he mentioned a report from Tractica, an intelligence company focusing on technology and it’s affect on human interaction. The report is an analysis of technological development in the market place concerning health devices and applications used in homes and project the use of hardware and services for users from 2015 through 2020. According to the Tractica report the home health technologies the patients are using will escalate from 14.3 million to 78.5 million by 2020.

Implications for Patients

Providing high quality care is one of the major challenges that the U.S. healthcare system is facing due to the large section of the population with geographic limitations and socioeconomic conditions that have limited access to specialty physicians. It has been validated that the delivery of healthcare remotely through the use of technology as a feasible method of surmounting obstacles to care, predominantly for populations living in remote and rural areas. In most developing countries, as the number of the aging populations grows and their health status evolves with fluctuating lifestyles, there is amplified pressure on healthcare and medical effectiveness. To this extend, home healthcare is rapidly rising and offers several advantages to the population. To increase the patient’s role in self-health management, the use of remote patient monitoring strategies in post-acute care, helps accomplishes this positive outcome. Enhancing self-management skills and behavior, is seen to have a positive influence for the evolvement of remote patient monitoring devices in the market. The utmost risk element for chronic conditions is aging, where the mounting geriatric population is predicted to intensify the vulnerability for chronic conditions including cardiovascular disorders, diabetes and respiratory conditions. That is why it is very important that these types of populations should benefit from RPM by having access to these remote monitoring technologies to improve their health. A Leading Age, Center for Aging Services Technologies (CAST) case study was performed where they explored how the “On4Care” system from CAST supporter Panasonic was utilized to monitor the health status of 22 older adults from Pleasantville Senior Center in New York (Kolosky, Enrlich & Cappola, 2015). Jerry Kolosky, Senior Healthcare Advisor, Office of the CTO, Panasonic, stated, “Integrated, sub-acute eldercare delivered in a setting that embraces the social, clinical, and behavioral dimensions of health & well-being represents a microcosm in which a device-agnostic, coordinated-care platform can serve as a model for system-wide, technology-enabled population health.”

With the RPM technologies, patients felt more engaged with their healthcare regime and are more likely to follow health goals and improve negative behaviors. Significantly, people who use remote health monitoring are likely to take on more responsibility for their own health resulting in better health outcomes. The CAST study performed in Pleasantville NY by Panasonic revealed that several patients conveyed positive interest in better understanding the assembly between Remote Patient Monitoring and health self-management. The general feedback from the patient’s view was highlighted by the desire to have this linkage explained and frequently reinforced (Kolosky, Enrlich & Cappola, 2015).

Some of the most important benefits are the improvements in the management of chronic diseases such as hypertension, congestive heart failure, and diabetes, as well as real time support in interventions, and medication adherence. The author, Silver (2015) described a joint study performed between Panasonic and Jewish Home Lifecare (JHL) where they utilized a home gateway system that uses the patient’s televisions to provide biometric monitoring, health self- assessment questionnaires, and educational videos to support disease self-management. The data obtained from patients is transmitted to a remote clinical dashboard via the internet where a nurse reviews all the information. If the data is abnormal it creates a red flag for the nurse. For example, a patient with heart failure has to monitor weight daily. If the weight is higher than three pounds, that will create a red alert to the nurse. Based on the weight change the nurse will contact the patient to make sure that the patient is taking the medications or if there are any other reasons for this weight change in order to provide the proper intervention. Shea, et al, (2006) performed a review of many studies where they analyzed the blood pressure of patients with hypertension by monitoring the patients resulting in improvements in both systolic and diastolic blood pressures readings. The outcomes of the study showed that the medication adherence was 96-99%, the patient satisfaction with the system was 95% and patient feeling safer at home was 100%. The help of the technology and RPM gives the patients a greater freedom and flexibility in participating in their own health care.

Implications for Organizations

The use of telehealth after hospital discharge is rising as a necessity where not only patients appreciate and use the system. Hospitals, for example are able to avoid federal fines for patient that are re-admitted within 30 days of discharge. Insurance companies and other providers are discovering the savings over all by this lack of re-admissions. The benefits of costs savings in telemedicine is getting amplified because of rising costs of medical care. These costs are deemed a significant factor relating to the adoption of telemedicine by many providers, healthcare organizations and policy makers. As healthcare organizations are moving towards the concept of accountable care, the RPM system is a significant opportunity because of its advantages. Many research studies demonstrated that RPM reduces readmissions and subsequent hospitalizations in particular for patients with chronic diseases. The Panasonic study with JHL revealed that hospitalizations with JHL cohort utilizing the RPM system where 69% less than the other dually eligible average and Medicare Advantage with RPM was a 44% reduction compared with previous claims data. The emergency room visits for JHL cohort were 74% less than dually eligible average, and Medicare advantage 43% less compared with the previous data. The study also demonstrated that the medication adherence was within 96-99% range (Silver, 2015). Healthcare organizations and providers benefit from utilizing the RPM with their patients by providing the ability to cost effectively cover a large patient population, allowing better follow up, decreasing the need for travel, and improving patient’s quality of life.

Challenges in Telehealth Practice

Because chronic diseases management is diverse there is no single approach in telehealth for managing patient care. For this technology to be successful, a variety of user needs must be tailored using various methods with the help of technological advances that engage patients in their own care. Patients will need to be educated in learning new skills to actively put into use the essential information that will see them through the preliminary stages of their use of the new technology.

Medicaid and Medicare covers most healthcare costs and private insurance companies may follow federal regulations where they have the capability of deciding who is eligible for reimbursement and which telehealth services will be covered, which places limits on the utilization of telehealth (Medicaid, 2016). Considering the opportunities available in applying predictive analytics as the utilization of RPM becomes more uniform and omnipresent, organizations are already developing and using monitoring dashboards for chronic conditions such as heart failure, hypertension or diabetes.

Keeping up with current advances in technology as well evidence-based practice methodologies of managing healthcare is cumbersome for healthcare organizations and clinicians. Telehealth requires a lot of training and practice on equipment that may be unfamiliar to many patients. Continuous monitoring and proper training, together with analytics, can assist the healthcare system shift into the area of more personalized care by better understanding the full meaning of patients’ healthcare needs allowing providers to respond appropriately to changes.

Future of Telehealth

The future of home telehealth relies in research, ongoing education, training and a multidisciplinary approach. In January 2013 analysts from Berg Insight Company released a study where they predicted that the technology of remote monitoring will increase by 26.9 percent annually between 2011 and 2017. They claim that approximately 9.4 million people worldwide will be utilizing these healthcare systems (Fayerberg and Kurkinen, 2015). This trend will amplify in the next several years due to the escalating need for mobile health applications.

Conclusion

The future progress of the telehealth programs rely on current investment in research, growth, and education. Telehealth encourages a healthier population because it provides a series of benefits such as consultations, triage abilities, and help with identifying treatment options. Telehealth practice is improved everyday with the use of best practices and support from the telehealth society. Telehealth can reduce healthcare costs by improving health outcomes and increasing patient satisfaction by encouraging cooperation by all members of the healthcare system. Telehealth is a way of enhancing an organization’s aptitude to provide quality care in patients’ homes and reduce the need for expensive hospital admissions, delivering the opportunity to gain considerable medical insights by analyzing continuous health data.

References

Written by Dr. Cristina Cassano RN, DNP
Dr. Cassano is a Doctor of Nursing Practice in Informatics who is working as a Nurse Informatics educator for the Saint Helena Napa Valley Hospital part of Adventist Health. Dr. Cassano has 28 years nursing experience. She earned her BSN at Chamberlain College of Nursing in 2010. You may email her direct at: criscassano@aol.com

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