Telemedicine & Telehealth Efforts of the U.S. Government by Michael Erbschloe - HTML preview

Introduction

Telemedicine seeks to improve a patient's health by permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment. The implementation of telemedicine in routine health services has been impeded in many setting because of a lack of scientific evidence for its clinical and cost effectiveness.

But things are changing. Based on advances in information and communications technologies, medical professionals as well as other "health and care" providers can now offer increasingly robust, remote (from their location to another), interactive (two-way) services to consumers, patients and caregivers.

The terms used to describe these broadband-enabled interactions include telehealth, telemedicine and telecare.  "Telehealth" evolved from the word "telemedicine."  "Telecare" is a similar term that you generally hear in Europe.  All three of these words are often – but not always – used interchangeably.  They can also have different meanings depending on who you ask.  And that's precisely why you should ask your doctor, your insurance provider, your nurse, anyone who's part of your health and care universe.

Telemedicine can be defined as using telecommunications technologies to support the delivery of all kinds of medical, diagnostic and treatment-related services usually by doctors. For example, this includes conducting diagnostic tests, closely monitoring a patient's progress after treatment or therapy and facilitating access to specialists that are not located in the same place as the patient.

Telehealth is similar to telemedicine but includes a wider variety of remote healthcare services beyond the doctor-patient relationship. It often involves services provided by nurses, pharmacists or social workers, for example, who help with patient health education, social support and medication adherence, and troubleshooting health issues for patients and their caregivers.

Telecare generally refers to technology that allows consumers to stay safe and independent in their own homes.  For example, telecare may include consumer-oriented health and fitness apps, sensors and tools that connect consumers with family members or other caregivers, exercise tracking tools, digital medication reminder systems or early warning and detection technologies.

Although the terms “telemedicine” and “telehealth” are often used to describe similar types of technologies, the term “telemedicine” has historically been used to refer specifically to bilateral, interactive health communications with clinicians on both “ends” of the exchange (e.g., video conferenced Grand Rounds, x-rays transmitted between radiologists or consultations where a remote practitioner presents a patient to a specialist). Whereas, the term “telehealth” incorporates not only technologies that fall under “telemedicine,” but also direct, electronic patient-to-provider interactions and the use of medical devices (e.g., smartphone applications (“apps”), activity trackers, automated reminders, blood glucose monitors, etc.) to collect and transmit health information, often with the intent to monitor or manage chronic conditions. Currently, there are four basic modalities, or methods, of telehealth:

1. Live video (synchronous): Live, two-way interaction between a person (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology. While these videoconferences had historically and exclusively been provider-to-provider telemedicine encounters, many companies such as Teladoc and LiveHealth Online are now videolinking patients directly to clinicians on a daily basis.
2. Store-and-forward (SFT): Transmission of videos and digital images such as x-rays and photos through a secure electronic communications system. As compared to a “real-time” visit, this service provides access to data after it has been collected. Generally, diagnostic information (e.g., x-rays, CT scans, EEG printouts) are recorded or captured at the patient’s site of care, and then sent to a specialist in another location. Because of the lag, or delay, between the time an image is sent and when it is interpreted, SFT is often referred to as “asynchronous.”
3. Remote patient monitoring (RPM): Personal health and medical data collection from an individual in one location, which is transmitted to a provider in a different location. RPM is used primarily for the management of chronic illness, using devices such as Holter monitors to transmit information including vital statistics (e.g., blood pressure, blood oxygen levels) to clinicians.
4. Mobile health (mHealth): Smartphone apps designed to foster health and well-being. These apps range from programs which send targeted text messages aimed at encouraging healthy behaviors to alerts about disease outbreaks to programs or apps that help patients with reminders to adhere to specific care regimens. Increasingly, smartphones may use cameras, microphones, or other sensors or transducers to capture vital signs for input to apps and bridging into RPM.

Link: https://www.healthit.gov/playbook/patient-engagement/#Telehealth

In the current environment of a shortage of healthcare professionals, greater incidence of chronic conditions, and rising healthcare costs, telemedicine offers a potential tool to improve efficiency in the delivery of healthcare. The need for telemedicine is further compounded by the following factors:

•  Significant increase in the U.S. population—estimated growth of 20 percent (to 363 million) between 2008-2030
•  Shortage of healthcare professionals being educated, trained and licensed
•  Increasing incidence of chronic diseases around the world, including diabetes, congestive heart failure and obstructive pulmonary disease
•  Need for efficient care of the elderly, home-bound, and physically challenged patients
•  Lack of specialists and health facilities in rural areas
•  Adverse events, injuries and illness at hospitals and physician’s offices
•  Need to improve community and population health

Link: http://ita.doc.gov/td/health/telemedicine_2009.pdf

The Connect2HealthFCC Task Force is working to raise consumer awareness about the value of broadband in the health and care sectors. The FCC’s Connect2Health Task Force and its work on consumer health issues can be found at www.fcc.gov/health.