Telehealth – Flashcards
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What does telehealth have to do with HIT and informatics?
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Focus on support systems: Electronic records E-prescrbing Management information systems Electronic payments
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What is telemedicine focused on?
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Patient care: telehealth, mobile health, remote monitoring, outsourced specialty services
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What does tele mean?
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operating at a distance
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What is telehealth?
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Use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration
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How are telehealth health services delivered?
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By telecommunications-ready tools, such as the internet, telephone, videoconferencing, streaming video and wireless communication
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What does telehealth allow?
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Us to improve care delivery services even more of the population
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What are worldwide drivers for telemedicine?
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Accelerating demands and costs, shortages of health professionals, and global public health concerns, demographics, nursing/health care worker shortages, chronic conditions, the new, educated consumers, excessive costs of health care services that are increasing in need and kind
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What should telehealth technology be included in?
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To fill the gap resulting from an overabundance of patients and a scarcity of health care providers
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What are primary chronic conditions used in telehealth?
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Cardiac/COPD/mental health/diabetes
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What are Hub benefits of telehealth?
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Transfer of appropriate patients arriving in better conditions, increased reimbursement for downstream treatment, reduced transfers of inappropriate patients, increased relationships with community hospitals in surrounding areas, service to network community
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What are spoke benefits of telehealth?
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Increased admissions, reimbursement, achieve primary stroke center status, on demand access to specialists, enhanced reputation, service to community
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What are telemedicine service contracts?
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Prisons, oil rigs, ships, international
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What are telemedicine outsourced services?
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Teleradiology, neurology, mental health
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What is a broader definition of telehealth?
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Does not always involve clinical services; videoconferencing, transmission of still images, remote monitoring of vital signs, continuing education, nursing call centers
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What are transmission formats?
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Store and forward Real time Remote monitoring Telephony
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What is store and forward?
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Digital information is stored on client computer or device; then, at a convenient time, the data are transmitted securely to a specialist or clinician at another location for interpretation
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What is real time?
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Real time or live interactions
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What is remote monitoring?
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Devices are used to capture and transmit biometric data
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What is telephony?
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Monitoring via telephone
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What are advanced technologies?
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Robotics, remote surgery, live monitoring via cell phones
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What are examples of real-time clinical telehealth?
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Telehealth mental Telerehabilitation Telehomecare Teleconsultations Telehospice/telepalliative care
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What is telenursing?
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Regers to the use of telecommunications and information technology for providing nursing services in health care to enhance care whenever a physical distance exists between patient and nurse, or between any number of nurses
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What is the most developing area of telenursing today?
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Home telehealthcare. More than 90% of seniors want to remain independent at home and age in place
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What can home care telenursing involve?
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Other activities such as providing: customized patient education in dietary or exercise needs, nursing teleconsultations, review of medical tests and exams, and assistance to primary care providers in the implementation of medical treatment protocols.
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What are telehealth patient populations?
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Homehound, limited access to transportation, lack of primary care and emergency resources in rural or remote populations.
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What is acute care?
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Strategy to reduce hospital length of stay.
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What populations does telehealth manage?
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Major disaster, large scale nuclear/bio-chemical attack or in the case of an outbreak of highly infectious disease
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What do chronic disease patients have?
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Significant risk of having an acute episode when subtle but significant changes in their medical condition occur.
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What can a kiosk be used for in assisted living facilities or subacute care centers?
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To obtain vital signs for large groups of people
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What then can happen to the vital sign reports?
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Then be forwarded on a regularly established schedule to physicians and other involved in the patient's care
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What is monitoring workers and offter wellness program used for?
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Reduce absenteeism and increase productivity Lower healthcare costs and associated insurance premiums Create financial incentives for achieving healthcare objectives such as appropriate weight, reduced blood pressure, and levels of exercise
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What are tools for home telehealth?
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Central station/web server Peripheral biometric devices, vital signs, blood glucose meters. Video cameras, videophones Personal emergency response systems (PERS)
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What is the most familiar household communication tool used in telehealthcare?
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Telephones
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What telehealth tool can be in home?
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Portable sensor and activity monitoring systems can track activities of daily living
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What are medication management devices?
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32 Million people are taking 3 or more medications daily, with even more medications typically being taken by those 65 years of age or older
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What does home telehealth software allow?
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Creation of a digital health record.
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What does a DHR do?
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Information to be recorded over time Trend information can also be developed for groups of patients or populations, allowing for population based analyses of interventions Set an acceptable range of values for an individual patient when he or she is enrolled in the monitoring program
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What does advanced telemonitoring software have?
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Sophisticated electronic notification protocols
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What are examples of sophisticated electronic protocols?
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Readings for multiple pieces of equipment on a sign patient to calculate risk of acute episode. Protocols can be developed related to both routine and alert information organizing communications with physicians, nurses and caregivers
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How do home telehealth programs differ?
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Depending on the type of technology used and the focus of the telehealth programs
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What must be obtained?
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Informed written consent from the client or designee before the beginning use of the telehealth consultations.
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What are legal and ethical aspects of telehealth?
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Nurses must be licensed to practice in all of the states in which they provide telehealth services. Scope of practice and accountability for practice must be defined. Nurses must be vigilant about keeping extensive documentation of their visits on and off site.
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What must information ensure?
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A high level of data security
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What should patients and family have?
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The opportunity to revise consent after they fully understand the intrusiveness of home monitoring.
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What must all involved parties, including the technical staff assistants have?
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Appropriate training in privacy and confidentiality issues.
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What are some considerations for patients?
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Elders may have sensory, cognitive, and motor disabilities. Usability testing need to be sure system works for patient.
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What are ethical concerns?
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How provider or patient-centric is the technology? Does the shift to remote services promote rationality and efficiency at the expenses of values traditionally at the heart of caregiving? How does the design affect home life and family dynamics? To what extend should technology usage involve attempts to manipulate users into different behaviors?
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What are other ethical concerns?
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How might the replacement of human contact by new technologies be ameilorated? To what extend is the deployment of technology an end in itself, aimed not toward the improvement of health or well-being, but to create market needs? How do we identify the boundaries between genuine solutions and futility in light of technologies that may shift them?
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What does knowledge acquisition involve?
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The nurse's receiving the information from the teleheatlh devices via a variety communication modes
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What is knowledge processing?
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Understanding a set of information and ways it can be useful to a specific task.
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What happens after processing information?
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The nurse is able to target the appropriate next steps involving knowledge generation and knowledge dissemination.
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What does the nurse consider?
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All of the data as it applies to this patient, and decides which is the best course of action to be taken and acts on the data
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What are social and cultural structures affecting telehealth?
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Technical Religious/Philosophical Economic Educational Kinship/social Cultural values/Beliefs Political/legal factors
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What is the challenge for consumers and health care professionals with internet information?
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The proliferation of information on the internet and the need to learn how to recognize when information is accurate and useful for the situation at hand.
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What is consumer empowerment?
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Trend of people interested in taking control of their health, not satisfied being dependent on a health care provider to supply them with information.
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What is the digital divide?
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The gap between those who have and those who do not have access to online information.
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What is the grey gap?
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A term used to reflect the age of disparities in computer connectivity; there are fewer persons over age 65 who use computer technology than those in younger age groups.
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What is health literacy?
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The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
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What is the eHealth Initiative (eHI)
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Was developed to address the growing need for managing health information and to promote technology as a means of improving health information exchange, health literacy and health care delivery
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What must web sites of organizations be and do?
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Most offer physician search capabilities, enewsletters, and cell-center tie-ins. Must be a sincere commitment to keeping information current and easily accessible. Web designers must pay particular attention to the aesthetics, the ease of use, and the literacy of those in the intended audience
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What does promoting health literacy in school aged children present?
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Special challenges to health educations/
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What do e-health programs need to be?
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Developed specifically to appeal to the generational (highly connected and computer literate) and cultural needs of this group.
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What is internet a source of?
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Health information for patient education and health literacy.
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What does the internet provide?
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Instant information about health maladies.
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What does the Health on the Net (HON) Foundation survey describe?
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Certifications and accreditation symbols that identify trusted health sites.
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What were identified as two of the most common symbols that power users look for?
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HONcode and Trust-e.
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What does HRSA work to do?
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Increase and improve the use of telehealth to meet the needs of underserved.
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How does HRSA increase the use of telehealth?
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Fostering partnerships within HRSA, and with other Federal agencies, states and private sector. Administering telehealth grant programs. Providing technical assistance. Evaluating the use of telehealth technologies. Developing telehealth policy initiatives to improve access to quality health services. Promoting knowledge exchange about "best teleheatlh practices"
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What are adoption issues?
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1. Historic resistance to change 2. Lack of consistent adoption and integration pathways 3. Changing service delivery models and payment coverage.
