Telehealth
Encyclopedia
Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities at different ends of the globe.
Telehealth is an expansion of telemedicine
, and unlike telemedicine (which more narrowly focuses on the curative aspect) it encompasses preventive, promotive and curative aspects. Originally used to describe administrative or educational functions related to telemedicine, today telehealth stresses a myriad of technology solutions
. For example, physicians use email
to communicate with patients, order drug prescriptions and provide other health services.
(ODLs),
and clinical data are captured and "stored" on the client computer or mobile device; then at a convenient time they are transmitted securely ("forwarded") to a clinic at another location where they are studied by relevant specialists. The opinion of the specialist is then transmitted back. Based on the requirements of the participating healthcare entities, this roundtrip could take between 1 minute to 48 hours. In the simplest form of telehealth application, basic vital signs like blood pressure, weight, pulse oximeter, and blood sugar values are monitored and trended for long term chronic care. In many specialties, such as dermatology, radiology and pathology, an immediate response is not critical, making these specialties conducive to store-and-forward technologies. Automated screening and diagnostic tele-audiology is fast becoming another specialty conducive to store-and-forward audiology.
equipment is one of the most common forms of synchronous telemedicine. Peripheral devices can also be attached to computers or the video-conferencing equipment which can aid in an interactive examination. With the availability of better and cheaper communication channels, direct two-way audio and video streaming between centers through computers is leading to lower costs.
Examples of real-time clinical telehealth include:
In an effort to enhance the real-time telehealth experience, Google Health
, a personal health information centralization service, recently began establishing relationships with telehealth providers that will allow their users to sync the data shared during telehealth consultations with their online health records. To date, partnerships have been formed with the following companies: MDLiveCare
and Hello Health.
In the UK Stoke on Trent Primary Care Trust together with mediaburst and the West Midlands Strategic Health Authority have sponsored the development of a low cost Simple Telehealth system "Florence" which primarily operates using text messaging (SMS) and a web application.
device monitors the electrical activity of a patients brain
and then transmits that data to a specialist. This could be done in either real time or the data could be stored and then forwarded.
Examples of remote monitoring include:
clinic
ians to deliver services.
The rate of adoption of telehealth services in any jurisdiction is frequently influenced by factors such as the adequacy and cost of existing conventional health services
in meeting patient needs
; the policies of governments and/or insurers with respect to coverage and payment for telehealth services; and medical licensing requirements that may inhibit or deter the provision of telehealth second opinions or primary consultations by physicians.
There may also be some significant carbon reductions for the NHS to be gained from developing Telehealth and therefore reducing the need to travel (often, in the case of patients, by car) as well as encouraging healthy, sustainable behaviour through monitoring and improved communications and reducing the requirements to expand sites to meet increases in Healthcare demands.
Telehealth is an expansion of telemedicine
Telemedicine
Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities...
, and unlike telemedicine (which more narrowly focuses on the curative aspect) it encompasses preventive, promotive and curative aspects. Originally used to describe administrative or educational functions related to telemedicine, today telehealth stresses a myriad of technology solutions
Timeline of medicine and medical technology
- Antiquity :* 2600 BC – Imhotep wrote texts on ancient Egyptian medicine describing diagnosis and treatment of 200 diseases in 3rd dynasty Egypt.* 1500 BC – Saffron used as a medicine on the Aegean island of Thera in ancient Greece...
. For example, physicians use email
Email
Electronic mail, commonly known as email or e-mail, is a method of exchanging digital messages from an author to one or more recipients. Modern email operates across the Internet or other computer networks. Some early email systems required that the author and the recipient both be online at the...
to communicate with patients, order drug prescriptions and provide other health services.
Clinical uses of telehealth technologies
- Transmission of medical imagesMedical imagingMedical imaging is the technique and process used to create images of the human body for clinical purposes or medical science...
for diagnosisDiagnosisDiagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
(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 dataMedical recordThe terms medical record, health record, and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdiction....
for diagnosis or disease management (sometimes referred to as remote monitoring) - Advice on prevention of diseasesPreventive medicinePreventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
and promotion of good health by patient monitoring and followup. - Health advice by telephone in emergent cases (referred to as teletriage)
Nonclinical uses of telehealth technologies
- Distance educationDistance educationDistance education or distance learning is a field of education that focuses on teaching methods and technology with the aim of delivering teaching, often on an individual basis, to students who are not physically present in a traditional educational setting such as a classroom...
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
Store-and-forward telehealth
In store-and-forward telehealth, digital images, video, audio, observations of daily livingObservations of Daily Living
Observations of Daily Living are cues that people attend to in the course of their everyday life, that inform them about their health.ODLs are different from signs, symptoms, and clinical indicators in that they are defined by the patient, and are not necessarily directly mapped to biomedical...
(ODLs),
and clinical data are captured and "stored" on the client computer or mobile device; then at a convenient time they are transmitted securely ("forwarded") to a clinic at another location where they are studied by relevant specialists. The opinion of the specialist is then transmitted back. Based on the requirements of the participating healthcare entities, this roundtrip could take between 1 minute to 48 hours. In the simplest form of telehealth application, basic vital signs like blood pressure, weight, pulse oximeter, and blood sugar values are monitored and trended for long term chronic care. In many specialties, such as dermatology, radiology and pathology, an immediate response is not critical, making these specialties conducive to store-and-forward technologies. Automated screening and diagnostic tele-audiology is fast becoming another specialty conducive to store-and-forward audiology.
Real-time telehealth
In real-time telehealth, a telecommunications link allows instantaneous interaction. VideoconferencingVideoconferencing
Videoconferencing is the conduct of a videoconference by a set of telecommunication technologies which allow two or more locations to interact via two-way video and audio transmissions simultaneously...
equipment is one of the most common forms of synchronous telemedicine. Peripheral devices can also be attached to computers or the video-conferencing equipment which can aid in an interactive examination. With the availability of better and cheaper communication channels, direct two-way audio and video streaming between centers through computers is leading to lower costs.
Examples of real-time clinical telehealth include:
- Tele-audiologyTele-audiologyTele-audiology is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice.This term was first used by Dr. Gregg Givens in 1999 in reference to a system being developed at East Carolina University in North Carolina, USA...
- Telecardiology
- TeledentistryTeledentistryTeledentistry is the use of information technology and telecommunications for dental care, consultation, education, and public awareness in the same manner as telehealth and telemedicine....
- Telemental HealthTelemental HealthTelemental Health is the use of telecommunications technology to provide mental health services to individuals in communities or locations that are underserviced, typically as a result of geographic isolation...
-- the use of videoconferencing technology to connect a psychiatrist with a mental health client - Teleneurology
- TelenursingTelenursingTelenursing refers to the use of telecommunications and information technology for providing nursing services in health care whenever a large physical distance exists between patient and nurse, or between any number of nurses...
- TeleradiologyTeleradiologyTeleradiology is the transmission of radiological patient images, such as x-rays, CTs, and MRIs, from one location to another for the purposes of sharing studies with other radiologists and physicians. Teleradiology is a growth technology given that imaging procedures are growing approximately 15%...
- TelerehabilitationTelerehabilitationTelerehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet. Most types of services fall into two categories: clinical assessment , and clinical therapy...
In an effort to enhance the real-time telehealth experience, Google Health
Google Health
Google Health is a personal health information centralization service by Google introduced in 2008 and announced for withdrawal in 2011...
, a personal health information centralization service, recently began establishing relationships with telehealth providers that will allow their users to sync the data shared during telehealth consultations with their online health records. To date, partnerships have been formed with the following companies: MDLiveCare
MDLiveCare
MDLiveCare is an on-demand telehealth company that provides patients with remote access via video, phone, and secure email to board certified doctors and licensed therapists....
and Hello Health.
In the UK Stoke on Trent Primary Care Trust together with mediaburst and the West Midlands Strategic Health Authority have sponsored the development of a low cost Simple Telehealth system "Florence" which primarily operates using text messaging (SMS) and a web application.
Remote patient monitoring
In remote monitoring, sensors are used to capture and transmit physiological data. For example, a tele-EEGEEG
EEG commonly refers to electroencephalography, a measurement of the electrical activity of the brain.EEG may also refer to:* Emperor Entertainment Group, a Hong Kong-based entertainment company...
device monitors the electrical activity of a patients brain
Electroencephalography
Electroencephalography is the recording of electrical activity along the scalp. EEG measures voltage fluctuations resulting from ionic current flows within the neurons of the brain...
and then transmits that data to a specialist. This could be done in either real time or the data could be stored and then forwarded.
Examples of remote monitoring include:
- Home-based nocturnal dialysisDialysisIn medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
- CardiacHeart diseaseHeart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
and multi-parameter monitoring of remote ICUs - Home telehealth
- Disease managementDisease management (health)Disease management is defined as "a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant." For people who can access health care practitioners or peer support it is the process whereby persons with...
Benefits of telehealth
Telehealth adds a new paradigm in healthcare, where the patient is monitored between physician office visits. This has been shown to significantly reduce hospitalizations and visits to the Emergency Room, while improving patient's quality of life. Telehealth also benefits patients where traditional delivery of health services are affected by distance and lack of local specialistSpecialty (medicine)
A specialty in medicine is a branch of medical science. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency to become a medical specialist.-History of medical specialization:To...
clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...
ians to deliver services.
The rate of adoption of telehealth services in any jurisdiction is frequently influenced by factors such as the adequacy and cost of existing conventional health services
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
in meeting patient needs
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
; the policies of governments and/or insurers with respect to coverage and payment for telehealth services; and medical licensing requirements that may inhibit or deter the provision of telehealth second opinions or primary consultations by physicians.
There may also be some significant carbon reductions for the NHS to be gained from developing Telehealth and therefore reducing the need to travel (often, in the case of patients, by car) as well as encouraging healthy, sustainable behaviour through monitoring and improved communications and reducing the requirements to expand sites to meet increases in Healthcare demands.
The state of the market
Projections for the growth of the telehealth market are optimistic, and much of this optimism is predicated upon the increasing demand for remote medical care. According to a recent survey, nearly three-quarters of U.S. consumers say they would use telehealth. At present, several major companies are scrambling to establish a foothold in a market that, according to market-research firm Datamonitor, is expected to grow to more than $6 billion by 2012 from 900 million in 2007.See also
- Ontario Telemedicine NetworkOntario Telemedicine NetworkThe Ontario Telemedicine Network is one of the largest telemedicine networks in the world. It uses two-way videoconferencing to provide access to care for patients in every hospital and hundreds of other health care locations across the province...
- List of video telecommunication services and product brands
- Tele-epidemiologyTele-epidemiologyTele-epidemiology is a methodological and application area of epidemiology concerned with the application of space-based systems in the study of the space and time distribution of health events or disease process in populations.In this broader sense, the term includes...
- TelemedicineTelemedicineTelemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities...
- eHealthEHealtheHealth is a relatively recent term for healthcare practice supported by electronic processes and communication, dating back to at least 1999...
- mHealthMHealthmHealth is a term used for the practice of medicine and public health, supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones and PDAs, for health services and information...
- American Telemedicine AssociationAmerican Telemedicine AssociationAmerican Telemedicine Association , established in 1993 as a non-profit organization, ATA goal is to promote access to medical care for consumers and health professionals via telecommunications technology...
- National Rural Health AssociationNational Rural Health AssociationThe National Rural Health Association is a national nonprofit professional association in the United States with more than 18,000 members. The association’s mission is to provide leadership on rural health issues, which it attempts to carry out through education, communication, and advocacy...
- Connected HealthConnected HealthConnected Health is a term used to describe a model for healthcare delivery that uses technology to provide healthcare remotely. Connected health aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their...
- Remote therapyRemote therapyRemote Therapy, sometimes called Telemental Health Applications or Internet-based Psychotherapy, is a form of psychotherapy or related psychological practice in which a trained psychotherapist meets with a client or patient via telephone, cellular phone, the internet or other electronic media in...
Further reading
- Telemedicine,Telehealth, and the Consumer Online introduction and primer to telehealth and telemedicine from the Telemedicine Information Exchange
- Norris, A. C. (2002). Essentials of Telemedicine and Telecare. West Sussex, England; New York: John Wiley & Sons, Ltd. ISBN 0-471-53151-0.
- Maheu, Marlene M.; Whitten, Pamela; & Allen, Ace (2001). E-Health, Telehealth, and Telemedicine: A Guide to Start-up and Success. San Francisco: Jossey Bass. ISBN 0-7879-4420-3.
- Olmeda, Christopher J. (2000). Information Technology in Systems of Care. Delfin Press. ISBN 978-0-9821442-0-6
- Telehealth Technical Assistance Manual - A document to assist in the planning of telehealth and telemedicine projects for rural community and migrant health centers and other health care organizations. By Samuel G. Burgess, Ph.D. October 2006
- Teleneurology and requirements of the european Medical Devices Directive (MDD) - Telemedical Systems and regulatory affairs for Europe, by Dipl. Ing. Armin Gärtner
External links
- Telehealth connectivity between Patients, Nurse Practitioners, General Practitioners, Specialists and Allied Health Professionals .Telehealth Networks.
- Telehealth for Patients, Providers, Health Plans, Employers. American Well.
- Telemedicine and Telehealth. Teladoc.
- Post discharge follow-up calls. TeleNurse First.
- Center for Telehealth and Technology DOD Defense Centers of Excellence
- Telehealth wiki
- Telemental Health Guide
- HealthLink BC
- Telehealth Ontario
- Ontario Telemedicine Network -- Making the Connection for Health
- Tasmanian government
- GP2U Telehealth Australia
- NHS Direct, the UK National Health Service information service
- NHS Stoke on Trent Simple Telehealth Project
- International Society for Telemedicine & eHealth
- Med-e-Tel - The International Educational and Networking Forum for eHealth, Telemedicine and Health ICT
- Community for Teledermatology
- Scottish Centre for Telehealth
- British Columbia Alliance on Telehealth Policy and Research
- UCLA Wireless Health Institute
- Fit for the Future, Scenarios for low-carbon healthcare in 2030
- Lifesize Case Study on Telehealth
United States oriented
- Office for the Advancement of Telehealth (established by the Health Resources and Services AdministrationHealth Resources and Services AdministrationThe Health Resources and Services Administration , is an agency of the U.S. Department of Health and Human Services located in Rockville, Maryland...
) - U.S. Department of Veterans Affairs Care Coordination/Telehealth Program
- American Telemedicine Association
- National Rural Health Association
- National Center for Telehealth & Technology
- Center for Telehealth & E-Health Law
- Telemedicine Information Exchange
- University of New Mexico Telehealth
- University of Florida Center for Telehealth