Introduction to Telehealth

Original Editor - Tarina van der Stockt

Top Contributors - Jess Bell, Kim Jackson, Tarina van der Stockt, Admin, Vidya Acharya, Tony Lowe, Naomi O'Reilly and Jorge Rodríguez Palomino

Telehealth Introduction

Telehealth is the delivery of health-related services and information via telecommunications technologies. It has been defined as the use of electronic communications to share medical information from one place to another with the intention of improving a patient’s health. Telehealth is an expansion of telemedicine, but unlike telemedicine (which focuses on curative aspects of health) it encompasses preventive, promotive and curative aspects of health and many different healthcare professions are involved in its delivery. It is a broad term and can include both patient and healthcare professional education as well as public health and health administration.

Teleheatlh is not a new concept. There are reports of its use since the early 20th century when providers used two-way radios for communication. Then from the 1960s, health professionals used telephones to provide advice and guidance to patients. However, with the introduction of various new technologies, telehealth is now challenging the way healthcare is delivered.

Over time, new telehealth terminology has developed based on the field of health care (teleradiology and telepsychology) or the purpose of the intervention (telerehabilitation or telecare).

Telemedicine is specifically defined as the exchange of information one area to another using electronic communication in order to improve the health status of a patient. This includes different forms of technology including email, smartphones, video calls, wireless and other communication technology

The term digital practice is also sometimes used. 'Digital practice’ is considered to be more comprehensive than ‘tele’ because it represents a range of different technologies and their impact on practice and service models, both now and in the future.  The WCPT/INPTRA Digital Physical Therapy Practice Task Force proposed that the term digital practice includes not only healthcare service delivery, but also support and information that is delivered remotely using digital communication and devices. They concluded that the goal of digital physical therapy/physiotherapy practice is to facilitate the “effective delivery of physical therapy services by improving access to care and information and managing health care resources”. Telehealth is more recognised globally and so the term telehealth will be used instead of digital practice.

The Purpose of Telehealth

Telehealth aims to overcome barriers and provide equitable access to health care services and interventions. Telehealth also helps to overcome barriers to face-to-face consultations, such as problems with scheduling, adverse weather, and illness.

Different Models of Telehealth

• Synchronous telehealth is when health information is delivered in real-time through a live telehealth consultation. This is done through interactive video with the patient and physiotherapist present at the same time.
• Asynchronous telehealth is when store-and-forward is used in physiotherapy consultations. Store-and-forward is when patient information is collected at the patient site and then assessed and analysed by a therapist located at another site. An example of this is a patient tracking their activity or steps in a day - this information is then sent to the physiotherapist to monitor.
• Hybrid telehealth is where both in-person and telehealth services are provided to the patient. It can also include a combination of live telehealth (synchronous) and store-and-forward therapy (asynchronous) consultations.

The Benefits of Telehealth

Telehealth has many benefits for patients, physiotherapists and society.

The benefits to the patient include:

• Access to physiotherapy services otherwise unavailable in remote locations
• Removal of barriers such as travel time, parking, and waiting rooms
• Improved safety for patients who are too ill to travel or have mobility restrictions
• Not location dependent
• An increase in the patient’s autonomy to manage their health through online self-management and monitoring
• More flexibility for patients as they can schedule therapy at times that suit them
• More cost-effective therapy in terms of travel, leaving work early or leaving children or family with a caregiver

The benefits to the physiotherapist/ physical therapist include:

• Improved efficiency as there is less travel between clinic locations
• Standardised service user pathways
• Greater consistency in terms of patient self-management at home and monitoring standards of care and outcome
• Opportunities for improved creativity in the standard of care with evolving technology

The benefits to society include:

• Better use of public resources
• Employer benefit, with less worker absenteeism
• The patient/society is more autonomous and informed
• Reduction in dependence on the medical system and increased encouragement for patient's to self-manage their health
• Fulfilment of people’s expectations to be more digitally connected.
• More equitable access to healthcare
• Decreased environmental footprint due to less travel

Nonclinical Uses of Telehealth Technologies

There are various non-clinical uses of telehealth technologies, including:

• Distance education including continuing medical education, grand rounds, and patient education
• Administrative uses including meetings among telehealth networks, supervision, and presentations
• Research on telehealth
• Online information and health data management
• Healthcare system integration
• Asset identification, listing, and patient to asset matching, and movement
• Overall healthcare system management
• Patient movement and remote admission

Clinical Uses of Telehealth Technologies

Clinical uses of telehealth technologies include:

• Transmission of medical images for diagnosis (often referred to as store and forward telehealth)
• Groups or individuals exchanging health services or education live via videoconference (real-time telehealth)
• Transmission of medical data for diagnosis or disease management (sometimes referred to as remote monitoring)
• Advice on prevention of diseases and promotion of good health by patient monitoring and followup
• Health advise by telephone in emergent cases (referred to as teletriage)

Current Limitations in Telehealth

This form of physiotherapy delivery also has many limitations that should be considered before delivering this service.

Patient-related limitations:

• Decision making regarding vulnerable individuals or groups i.e. older people and children - in which type of conditions should caregiver or parent be present
• As the telehealth market grows it may be easier for patients to “shop around” more and gain the opinions of different service providers - this can cause confusion and discontinuity in the service/care provided
• Consideration of cultural specific conditions such as eye contact, gender, recording of images, etc
• Language barriers - if an interpreter is necessary, is this person familiar with telehealth?
• There is a need for strong communication skills on the part of the therapist, as there is a shortage of the usual visual cues present in face-to-face consultations.

Technological limitations

• Internet connectivity - if poor or unreliable another communication pathway needs to be utilised
• Both parties (therapist and patient) need to be familiar with the technology used and to be able to use it easily
• The integrity of the software implemented plays a role in the success of the consultation as well as the “safeguard” of the consultation
• The physical set up (proper lighting, camera set-up, audio, background) contributes to the quality of the telehealth consultation
• Virtual behaviour is different from in-person care. For example, to make eye contact participants (patient and therapist) need to look into the camera and not only at the video/on-screen material
• Not all individuals (patients and therapists) will have access to the necessary technology to engage in telehealth.

Insurance and funding (medical aids) limitations

• Therapists and patients need to be aware if telehealth is recognised by healthcare insurers/medical aids. Reimbursement remains a key challenge in rolling out telehealth services.

Education limitations

• Staff members need to be knowledgeable about telehealth and properly trained in the skills required to successfully conduct telehealthcare.

Research limitations

• An evidence-based approach should be adapted to providing telehealthcare
• Clinicians/therapists should always apply clinical reasoning and follow the correct standards of practice and relevant codes of conduct.
• Clinicians/therapists should assess the delivery of telehealthcare and determine if the relevant outcomes are reached/achieved.

Regulations

• Different countries have different regulations about telehealth. These regulations and the changing thereof (if needed,) may affect the progress of telehealth.
• It is the responsibility of each health care professional to make sure they are not violating privacy and HIPAA laws and to abide by all local, state and government laws concerning telehealth.