Definition

Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve, maintain, or assist patients’ health status.

  • Videoconferencing,
  • transmission of still images,
  • e-health including patient portals,
  • remote monitoring of vital signs,
  • continuing medical education, and
  • nursing call centers, are all considered part of telemedicine.
  • rapidly developing application of clinical medicine where medical information is transferred through the Internet and other networks for the purpose of consulting, and remote medical procedures or examinations.
  • Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries.
  • use of communications and information technologies for the delivery of clinical care.

Types of telemedicine

Telemedicine is practiced based on two concepts:

  • real time (synchronous) and
  • store-and-forward and Home Health(asynchronous).

Real time telemedicine

  • could be as simple as a telephone call or as complex as robotic surgery.
  • requires the presence of both parties at the same time and a communications link between them that allows a real- time interaction to take place.
  • Video-conferencing equipment is one of the most common forms of technologies used in synchronous telemedicine.
  • There are also peripheral devices which can be attached to computers or the video-conferencing equipment which can aid in an interactive examination. For instance, a tele-otoscope allows a remote physician to ‘see’ inside a patient’s ear; a tele-stethoscope allows the consulting remote physician to hear the patient’s heartbeat.
  • Medical specialties conducive to this kind of consultation include psychiatry, family practice, internal medicine, rehabilitation, cardiology, pediatrics, obstetrics, gynecology, neurology, speech-language pathology and pharmacy.

Store-and-forward telemedicine

  • involves acquiring medical data (like medical images, biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline.
  • It does not require the presence of both parties at the same time.
  • Dermatology (cf: teledermatology), radiology, and pathology are common specialties that are conducive to asynchronous telemedicine.

Home Health Telemedicine

When a patient is in the hospital and he is placed under general observation after a surgery or other medical procedure, the hospital is usually losing a valuable bed and the patient would rather not be there as well.

Home health allows the remote observation and care of a patient. Home health equipment consists of vital signs capture, video conferencing capabilities, and patient stats can be reviewed and alarms can be set from the hospital nurse’s station, depending on the specific home health device.

  • most widely associated with populations living in isolated communities and remote regions and is currently being applied in virtually all medical domains.
  • Specialties that use telemedicine often use a “tele-” prefix; for example, telemedicine as applied by radiologists is called Teleradiology. Similarly, telemedicine as applied by cardiologists is termed as telecardiology, etc. Telemedicine is also useful as a communication tool between a general practitioner and a specialist available at a remote location.
  • Monitoring a patient at home using known devices like blood pressure monitors and transferring the information to a caregiver is a fast-growing emerging service. These remote monitoring solutions have a focus on current high morbidity chronic diseases and are mainly deployed for the First World.
  • In developing countries, a new way of practicing telemedicine is emerging better known as Primary Remote Diagnostic Visits whereby a doctor uses devices to remotely examine and treat a patient. This new technology and principle of practicing medicine holds big promises to solving major health care delivery problems in for instance Southern Africa because Primary Remote Diagnostic Consultations not only monitors an already diagnosed chronic disease, but has the promise to diagnosing and managing the diseases a patient will typically visit a general practitioner for.

General Accepted Administrative Standards

Organizations

  1. Organizations providing services via telehealth shall follow the standard operating policies and procedures of the governing institution. If the telehealth operation is a sole entity or part of a solo practice, that entity or solo practice shall have policies and procedures in place to govern all administrative functions that responsibly include and address aspects of telehealth with regards to:
  1. Human resource management
    1. Privacy and confidentiality
    1. Federal, state, and other credentialing and regulatory agency requirements
    1. Fiscal management
    1. Ownership of patient records
    1. Documentation
    1. Patient rights and responsibilities
    1. Network security
    1. Telehealth equipment use
    1. Research protocols
  • Organizations providing telehealth programs shall have in place a systematic quality improvement and performance management process that complies with any organizational, regulatory, or accrediting, requirements for outcomes management.
  • Organizations and health professionals providing telehealth services shall ensure compliance with relevant legislation, regulations, and accreditation requirements for supporting patient/client decision- making and consent, including protection of patient health information.
  • Organizations shall have a mechanism in place for assuring that patients are aware of their rights and responsibilities with respect to accessing health care via telehealth technologies, including the process for communicating complaints.
  • Organizations shall integrate telehealth into the existing operational procedures for obtaining consent for treatment from patients and organizations shall provide a mechanism for additional informed consent when required for invasive procedures.
  • Organizations providing telehealth services that establish collaborative partnerships shall be aware of applicable legal and regulatory requirements for appropriate written agreements, memorandum of understanding, or contracts. Those contracts, agreements, etc., shall be based on the scope and application of the telehealth services offered, and, shall address all applicable administrative, clinical, and technical requirements.

Health Professionals

  1. Health professionals providing telehealth services shall be fully licensed and registered with their respective regulatory/licensing bodies and with respect to the site where the patient is located, administrative, legislative, and regulatory requirements.
  • Health professionals providing telehealth services shall be aware of credentialing requirements at the site where the consultant is located and the site where the patient is located, in compliance with and when required by regulatory and accrediting agencies.
  • Health professionals shall be aware of their locus of accountability and any/all requirements (including those for liability insurance) that apply when practicing telehealth in another jurisdiction.
  • Health professionals using telehealth shall be cognizant of when a provider-patient relationship has been established within the context of a telemedicine encounter between the health care provider and the patient, whether interactive or store-and-forward, and proceed accordingly with an evidence-based, best possible standard of care.
  • Health professionals providing telehealth services shall have the necessary education, training/orientation, and ongoing continuing education/professional development to ensure they possess the necessary competencies for the safe provision of quality health services in their specialty area.

Clinical Standards

  1. The organization and health professionals shall be satisfied that health professionals providing care via telehealth are aware of their own professional discipline standards and those standards shall be upheld in the telehealth encounter, considering the specific context, location and timing, and services delivered to the patient.
  • Health professionals shall be guided by professional discipline and national existing clinical practice guidelines when practicing via telehealth, and any modifications to specialty-specific clinical practice standards for the telehealth setting shall ensure that clinical requirements specific to the discipline are maintained.

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