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

About Telehealth

Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth is an expansion of telemedicine, and unlike telemedicine (which more narrowly focuses on the curative aspect) it encompasses preventive, promotive and curative aspects as well as different healthcare professions. It is a broad term and can include both patient and health care professional education as well as public health and health administration.

New Telehealth terminology also develops over time based on the field of health care like Teleradiology, Telepsychology or the purpose of the intervention like Telerehabilitation, Telecare.

Telemedicine is when information is exchanged from 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 health care service delivery but also the support, and information provided 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

To overcome barriers and provide equitable access to health care services and interventions.

The Benefits of Telehealth

There are benefits to the patient, the physiotherapist, and society.

The benefits to the patient:

• Can be used by patients in remote locations or when physiotherapy is not available in their area
• Barriers such as travel time, parking, and waiting rooms are overcome
• Improved safety for patients who are too ill to travel or have mobility restrictions
• Not location dependent
• Improves 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 will suit them
• More cost-effective in terms of travel, leaving work early or leaving children or family with a caregiver

The benefits to the physiotherapist/ physical therapist:

• Improved efficiency due to 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
• Provides opportunities for improved creativity in the standard of care with evolving technology

The benefits to society:

• Better use of public resources
• Employer benefit, with less worker absenteeism
• The patient/society is more autonomous and informed
• Reduces the dependence on the medical system and encourages self-management
• It can fulfil in people’s expectations to be more digitally connected.
• Access to care is more equitable
• Decreased environmental footprint due to less travel

Nonclinical uses of telehealth technologies

• 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

• 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?

Technological limitations

• Internet connectivity - if poor or unreliable another communication pathway needs to be utilised
• Both parties involved (therapist and patient) needs to be familiar with the technology used and 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.

Insurance and funding (medical aids) limitations

• Therapists and patients need to be aware if telehealth is recognised by healthcare insurers/medical aids.

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.