Tele health the cutting edge of healthcare

Darlene Cunningham

Rachel Driscoll

Amber Swanger

Vida Milligan-Shangoo

Alondrea Hill

Tara Stewart

Jacksonville University

Abstract

Tele health is defined as the delivery of health-related services and information via telecommunications

technology for clinical and non-clinical purposes and encompasses telelmedicine (Healthcare Intelligent

Network, 2015).

There are many healthcare organizations that are currently using tele health. Tele health targets the elderly

population, those living in remote, poor, and rural areas. This power point will discuss the origination of tele

health, the different types, laws and regulations, pros and cons as well as the liabilities with tele health as it

relates to malpractice. There are many organizations that are turning to Tele health to lower costs and improve

efficiencies while expanding patients’ access to services – particularly in rural areas (Healthcare Intelligent

Network, 2015). Furthermore, telecommunication technology delivers clinical diagnosis, services and patient

consultations.

What is Tele

health?

Tele health uses communication and information technology to provide excellence in health care delivery to

the nation’s veterans. The term means using technology to provide clinical care and patient education when the

patient providers are in separate locations.

Tele health began more than 50 years ago, in 1960, TLC began installing and financing hotel and hospital

television systems throughout the US and had emerged as one of the leading companies serving the hospitality

and healthcare industries by the late 1970s. In 1984, TLC created the Tele Health Services division to focus

exclusively on healthcare television systems. Tele Health Services’ product line included one of the first

computer-based interactive systems, the Tele Computer (N.A., 2015).

Since its inception, Tele Health has been an innovator in custom-engineering televisions and other

technologies to meet the ever-changing needs of hospitals. Tele Health partnered with DIRECTV in 1997 to

expand hospital channel line-ups and reduce costs. That same year, Tele Health became the exclusive US

distributor of the Philips healthcare televisions (N.A., 2015).

Tele health and the Origination

Tele health and the Origination

In 2006, Tele Health acquired Hospital Communication Systems, and in 2008 Tele Health Services acquired Instant

Health Line, the second-largest hospital educational television company in the United States. In 2010, Tele Health

Services partnered with Samsung Electronic America, Inc. to design and market Samsung’s ground-breaking healthcare

TVs to hospitals (N.A., 2015).

In 2012, Tele Health Services launched and installed its iTigr interactive system. The iTigr system expands upon

Tigr’s “pull” system, meaning information is “pulled” by the user, to being a “push” system, meaning that information can

be “pushed” specifically to a patient. The iTigr system provides advanced care plan, management tools with workflow and

integration capabilities for hospitals. Tele Health's full suite of patient systems, the scalability of the Tigr and iTigr

platforms, and its long-standing leadership position in the industry allows Tele Health to assure hospitals the best value

and operability in system and secure effectiveness and efficiency (N.A., 2015).

The Regulations Governing Tele health

Telemedicine and Tele health have some legal and privacy issues such as reimbursement

and licensure. Two of the major barriers to the growth and practice of health are

inconsistency with reimbursement when it comes to integration of tele health. The

insufficient payment affects payment, resources and policies (Hebda & Czar, 2013). Some

rules about tele health are:

Physician must see their patients face to face at least once before commencing with any

online healthcare for this builds a good rapport with the patient and a pleasant atmosphere.

Physician’s who have done this makes the patients feel more at ease under his/her care.

State regulatory barriers state laws are either unclear or may forbid practice across stated

lines unless there is an exception provision within it licensure laws. Accreditation and

regulation requirements according to the JACHO practitioners are required to be

credentialed and have privilege at the site where the client is located (Hebda & Czar, 2013).

Who is the targeted population ?

Rural Areas

Elderly

People served at rural low income clinics

Tele health targets the elderly population, those living in remote, poor, and rural

areas.

Levels of tele health:

• Level 1 – using emails or faxes to transfer medical data over telephone lines;

• Level 2 – transmitting still images or “store and forward” information such as

electrocardiogram strips, pathology slides and/or x-rays;

• Level 3 – transmitting synchronous, interactive, audio-visual communications.

This requires satellite, telephone and microwave or internet technology; (N.A.,

2015).

Tele health interventions are based on patients or professionals obtaining an opinion

on treatment or care from someone who is more experienced or an expert in a

particular field. Accordingly, tele health interventions could be classified on the

basis of the type of interaction and information transmitted between patients and

professionals (N.A., 2015).

Target Populations and Levels and types of Tele health

Impact of Tele health on Healthcare

Pediatrician visits from the

comfort of your home.

Tele health impacts healthcare by increasing the communication between patient and the healthcare

provider via phone, email, video transmission and conferencing and remote monitoring systems. The

health providers are able to receive and access patient information, such as labs, EKG and view x-rays,

anywhere on smart phones, iPads, and laptops (Hebda & Czar, 2013). Additionally, the “web-base disease

management programs encourage clients to assume greater responsibility for their own care.” (Hebda &

Czar, 2013).

• Reducing inappropriate visits to high cost setting, such has ER.

• Reduce cost of managing chronic patient population.

• Reduce unnecessary care requested by patients.

Remote monitoring of patients, such as elderly patients in their home, notifying a caregiver or

healthcare provider if activities of patient change or of a fall. It impacts health care by transcending

geographical boundaries by using GPS to direct rescue/ambulance to the nearest trauma, heart or stroke

facility for patient treatment (Hebda & Czar, 2013).

Impact of Tele health on Patients

Further impacts as it relates to patients is that it reduces cost, less travel time, and less wait time

because appointments are made online. Less travel time is due to the population ability to be seen at the

local health clinics by using tele health (Hebda & Czar, 2013).

.

Pros and Cons from a Nurses’ Prospective

Pros

Patients can be treated at home without traveling to a clinic.

Nurses can monitor process/deterioration and discuss treatment via telephone and liaise

with other team members.

Cuts down clinic list.

Saves time and effort and is therefore cost effective (Field, 2006).

Cons

Quality of picture;

Not knowing the exact location of the wound;

Unable to assess the cause, for example, mattress, toilet

seat, shower chair, transfers;

Unable to assess home environment;

No networking (Field, 1996).

Tele health Malpractice and Liability

For tele health “face-to-face” encounters involving direct care of patients, most medical malpractice

insurance covers only “face to face” encounters within the State in which the doctors practice and is

licensed. Doctors who provide tele health services to patients outside of the State in which they are

licensed can be exposed to uninsured claims, if State law requires the physician to be licensed in the

State where the test results are delivered (Tele health, 2015).

Some carriers assert that they are only require to make claims against providers when the provider is

performing medical services in the state where the carrier agreed to cover the provider. Some states

protect providers of tele health services by forcing insurers to cover claims against the providers even if

the claim arises from out of state patients. Other states either exempt the insurer from providing the

coverage or fail to address the issue at all. Obligations of malpractice insurance carrier must be

examined on a state-by state basis. Insurance underwriters are also offering separate policies for

clinicians who provide interpretive tele health services, such as tele radiology (Tele health, 2015).

Conclusion

When reviewing the 36 economic analyses of delivering health services by synchronous video

communication, it was learned that this form of tele health offers valuable health care, and it suggested key factors

that are associated with the setting and specific models of health service deliveries. It was discovered that the

patients health equity improved tremendously compared to conventional care, with two minor exceptions that did

not compromise the care of the patients (Wade, Karnon, Elshaug, & Hiller, 2010). Therefore the decision as to

whether or not to introduce a tele health service can be made using cost-effectiveness criteria and consideration of

the model of care. It is concluded that synchronous video delivery is cost-effective for home care, and for on-call

hospital specialists, and it can be cost-effective for regional and rural health care, depending upon the particular

circumstances of the service (Waller, Karnon, Elashaug, & Hiller, 2010).

However, it is not cost-effective, from the health services perspective, for local delivery of

service between hospital specialists and primary care, particularly due to additional health care

staffing. Across settings, equipment and connectivity costs have been major factors in setting up

tele health services, but even as these costs reduce, this will not necessarily make tele health more

cost-effective, unless the other factors such as health workforce and facility space are also

addressed. Improvement in the quality of economic analyses is also needed to provide data for

more accurate modeling of the effects of widespread introduction of tele health into the health care

system (Wade, Karnon, Elashaug, & Hiller, 2010).

Conclusion

Hebda, T., & Czar, P. (2013). Handbook of Informatics (5th ed). Boston, MA: Pearson.

N.A. (2015). Tele health. Last reviewed 2/11/2015. From website: http://www.telehealth.com/our-history.

Wade, V.A., Karnon, J., Elshaug, A.G., Hiller, J.E. (2010). A systematic review of economic analyses of telehealth

services using real-time video communication. BMC Health Services Research 10.233

, doi:10.1186/1472-6963-10-233.

References