Advancing the Frontiers of Medicine

Advances in Telehealth

By Alyssa Alpers and Nicole Breninger

Imagine a world in which medicine and access to medical world is only a few clicks on a computer away. A world in which you can access face to face advice from a medical professional from the comfort of your own home. It seems crazy and years into the future, but in reality the technology is in existence and is becoming more popular with years to come. This revelation in the medical community is knowns as Telehealth. Telehealth is defined by the American Physical Therapy Association (APTA) Board of Directors as “The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health…” (Shaw 2009). The term Telehealth is mostly used as an umbrella term for all of the health-related services it provides including physical therapy, consulting, emotional therapy, and many other services. While the concept of Telehealth is easily accessible and good in theory, Telehealth still has a lot of of negative aspects and ethical concerns, in addition to the positive aspects.

Figure 1: Almost everything that can be done in doctor’s office, a doctor can essentially do through Telehealth

Source: Think Stock

When talking about the effects and impacts of telehealth it is natural for the term Telemedicine to arise. According to APTA Board of Directors Telemedicine is defined as “The use of telecommunications technology for medical diagnostic, monitoring, and therapeutic purposes when distance separates the users” (Shaw 2009). As one may see, Telehealth and Telemedicine are very closely related in the fact that both terms need the use of Telecommunications in order to work and be successful. Where Telehealth and Telemedicine differ is in the fact that Telehealth has more to do with the care of a patient and Telemedicine has more to do with the actually testing and diagnosing of a patient. However, while both terms are technically different, Telehealth and Telemedicine are frequently used synonymously.

Telemedicine is said to first be introduced in the early 1900s through the use of radio communications and was first in introduced to the American public on the cover of Radio News, the cover displayed an illustration of a doctor looking at his patients through the radio (Shaw 2009).  However, the next big move for telehealth was when the National Aeronautics and Space Administration (NASA) started using telehealth to monitor the physical health data from the astronauts in space in the 1960s (Shaw 2009). From then on after, the telehealth “market” took off and there became instance after instance of new technology coming out that would better the medical world (Shaw 2009).

Telehealth can be used in various ways, not just “FaceTiming” as some may assume. Patients can communicate with their physicians over email and text, as well as video conferencing and monitoring and sending of patient vital signs (Neville 2018). In the past Telehealth was hard and expensive for patients to obtain, many healthcare insurance companies did not recognize the technology as necessary and did not cover the expensive equipment needed (Neville 2018). However, in the more recent years telehealth has become more recognized by various insurance companies including, Medicare and Medicaid, the biggest health insurance company in the United States (Neville 2018).

One of the major concerns involving telehealth is whether or not a patient would require certain medical devices for diagnostic purposes. Telehealth uses four different methods to treat patients or educate them on medical needs. The methods that telehealth uses are live video conferencing, mobile health apps, store and forward electronic transmission and remote patient monitoring (NEJM Catalyst, 2018). One of the most influential ways that telehealth is treating patients that may not be able to make it to the doctors is through video conferencing. With video conferencing, telehealth has allowed rural communities to provide healthcare services in specialized fields such as: radiology, psychiatry, ophthalmology, dermatology, dentistry, audiology, cardiology, oncology, and obstetrics (Rural Health Information Hub, 2019).

In order to accurately treat a patient without actually seeing them, telehealth uses the store and forward method. This method gathers MRI’s, photos, videos, emails, CAT scans, X-rays and text-based patient data to be sent to specialists and their medical team to accurately evaluate and assist patients in their treatments (NEJM Catalyst, 2018). A concern for the store and forward method is how does telehealth get this data? Telehealth uses an app called mHealth. mHealth uses many healthcare applications that allow patients to track their health, make appointments or schedule reminders for appointments. There are applications that can help patients with asthma, diabetes, weight loss, or even help quit smoking (NEJM Catalyst, 2018). mHealth allows providers and patients to communicate via video conferencing or texting.

Another way that telehealth retrieves data is through remote patient monitoring (RPM). Remote patient monitoring requires patients to collect data, report it to a telehealth provider, evaluate what steps need to be taken. RPM technologies help remind patients to collect data and report it to their providers. It is very easy to collect data like blood pressure, cardiac stats, respiratory rates, and oxygen levels through devices such as a fitbit or apple watch (NEJM Catalyst, 2018)

One of the most beneficial parts to telehealth is that it improves access of medical care to rural areas. Since telehealth is mostly digital, it can reach places where there may not be a lot of citizens, it can reach inmates without endangering people’s lives, and allows doctors to create a larger clientele. Telehealth allows small town doctors offices’ to treat more than common colds, it allows them to treat patients using radiology or dermatology. Telehealth expands the possibilities that medical centers may not of had before (Rutgers Online).

Another benefit to telehealth is the financial impact. Telehealth is reported to decrease transportation costs, lost wages, hospital staffing costs, and local lab and pharmacy costs. These are just the quantifiable benefits to telehealth, the non quantifiable benefits include access to specialist, timely care, comfort, benefits to the provider, and improved patient outcomes (Rural Health Information Hub, 2019).

While Telehealth can be beneficial, there are also many drawbacks and limitations to Telehealth that have yet to be worked out. The major problems with Telehealth that arise primarily center around the patient and health professional relationship (Hjelm, 2005). One of the first problems has to do with the fact that communication between health professionals and patients is all indirect communication, meaning there is no physical contact between them (Hjelm, 2005). Much of the personal connection made during the first part of a traditional consultation in a health professional office is lost during a video consultations (Hjelm, 2005). It is thought that this is a result of not correlating the face of the health professional(s) seen on the monitor with a real person; this is especially prevalent in older individuals with very little knowledge about Telehealth and the inner workings of the internet (Hjelm, 2005).

Another limitation that occurs with Telehealth is that in order for Telehealth, more specifically video consultations, to work both parties internet connection and equipment need to be working properly in order for the consultation to run smoothly or even at all (Hjelm, 2005). It is a struggle, especially for health professionals, to make time for all their patients in a traditional health setting; so, when it can be a problem when valuable time gets halted because there are technical difficulties on one side of the call or the other. It also becomes a problem when both the patient and health professionals have trouble operating the specific Telehealth “program” and equipment that is needed to run the video consultation/ appointment. It is difficult for both the health professional and patient to learn all of the details of the “program” and equipment. One of the last major drawbacks of Telehealth is the fact the while appointment is done over video conference and not face-to-face, so if for some reason the health professional needs to physically touch the patient to get better understanding of the condition, that can’t happen (Hjelm, 2005). The health professional has to either rely on second-hand knowledge from a previous health professional a patient went to go see, or rely on what the patient is telling them which could possibly result in a false diagnosis (Hjelm, 2005).

Along with the limitations and drawbacks of Telehealth, there are also a handful of ethical concerns and issues including, ethical considerations of Telehealth being implemented in nursing homes and hospice (Oliver & Courtney, 2006). Implementing Telehealth into nursing homes seems like an idea that would save time for health professionals that see the patients in the nursing homes and hospice and it would save money for the families who put their loved ones in the nursing homes or hospice. However, Telehealth in nursing homes and hospice could potentially cause more harm than help. One of the first things to remember with Telehealth is that the main idea is that it is done purely “online” with little to no human contact. So, when considering putting this technology in nursing homes and in hospice situations, the families and health professionals need to decide whether or not human contact and touch will have an effect on the patient in question (Oliver & Courtney, 2006). Human touch and contact has been shown in many studies to have an effect on patients in both their mood and their health; physical contact reminds that they are in fact human beings. An additional ethical problem to consider, among many others that are likely to arise, is that implementing Telehealth in specifically hospice situations could refute the idea of what hospice is (Oliver & Courtney, 2006). If Telehealth is implemented into the homes of hospice patients the problem of turning the home into a “medical setting” could arise (Oliver & Courtney, 2006). Most patients who go into hospice go because they want to go home and be away from the typical “doctor setting”; if there are multiple medical monitors around their home, and if they feel like they are being “watched” or monitored multiple times a day then did they really leave the “doctor setting” (Oliver & Courtney, 2006)?

An additional ethical consideration concerning Telehealth is the fact that there may be more significant threats to patient privacy and health records (Mehta, 2014). Patients, since they are not directly going into a doctor office, and do not know exactly who they are meeting there is possibly a great risk of fraud and scams (Mehta, 2014). There may also be an issue with the fact that almost all a patient’s medical records are kept online, so if there ends up being an employee leak issue, a breach in the medical record security, or even if the Telehealth company shuts down.

All in all, telehealth is a great investment to rural areas to help provide medical care. Telehealth is always improving and companies are creating and upgrading their technologies to help increase the use of telehealth. There are some ideas that telehealth groups are trying to work through but when you can increase the health of the community while saving money and not putting lives in danger, are the ideas as big of a deal as people are making it to be?

References

Demiris, G., Oliver, D. P., & Courtney, K. L. (2006). Ethical Considerations for the Utilization of Telehealth Technologies in Home and Hospice Care by the Nursing Profession. Nursing Administration Quarterly, 30(1), 56–66.

Hjelm, N. M. (2005). Benefits and drawbacks of telemedicine. Journal of Telemedicine and Telecare, 11(2), 60–70. doi:10.1258/1357633053499886

Mehta, S. J. (2014) Telemedicine’s Potential Ethical Pitfalls. AMA Journal of Ethics: Virtual Mentor 16(12)1014-1017. https://journalofethics.ama-assn.org/article/telemedicines-potential-ethical-pitfalls/2014-12

NEJM Catalyst. (2018) What Is Telehealth? NEJM Catalyst  https://catalyst.nejm.org/what-is-telehealth/ (accessed May 2, 2019).

Neville, C. W. (2018) Telehealth: A Balanced Look at Incorporating This Technology Into Practice. SAGE Open Nursing 4:1-5  https://journals.sagepub.com/doi/full/10.1177/2377960818786504 (accessed May 2, 2019).

Rural Health Information Hub. Telehealth Use in Rural Healthcare Introduction. https://www.ruralhealthinfo.org/topics/telehealth (accessed May 2, 2019).

Rutgers Online. The Pros and Cons of Telehealth. https://online.rutgers.edu/blog/pros-cons-telehealth/ (accessed May 2, 2019).

Shaw D. K. (2009). Overview of telehealth and its application to cardiopulmonary physical therapy. Cardiopulmonary physical therapy journal, 20(2), 13–18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845264/