Author: ioannis

Telehealth allows multiple, varying disciplines to merge and deliver a potentially more uniform level of care, using technology. As telehealth proliferates mainstream healthcare, it challenges notions of traditional healthcare delivery. Some populations experience better quality, access, and more personalized health care.


Health promotion

Telehealth can also increase health promotion efforts. These efforts can now be more personalised to the target population and professionals can extend their help into homes or private and safe environments in which patients of individuals can practice, ask and gain health information. Health promotion using telehealth has become increasingly popular in underdeveloped countries where there are very poor physical resources available. There has been a particular push toward mobile Health applications as many areas, even underdeveloped ones have mobile phone and smartphone coverage.

In developed countries, health promotion efforts using telehealth have been met with some success. The Australian hands-free breastfeeding Google Glass application reported promising results in 2014. This application made in collaboration with the Australian Breastfeeding Association and a tech startup called Small World Social, helped new mothers learn how to breastfeed. Breastfeeding is beneficial to infant health and maternal health and is recommended by the World Health Organisation and health organisations all over the world.


Health care quality

Theoretically, the whole health system stands to benefit from telehealth. In a UK telehealth trial done in 2011, it was reported that the cost of health could be dramatically reduced with the use of telehealth monitoring. The usual cost of in vitro fertilisation (IVF) per cycle would be around $15,000, with telehealth it was reduced to $800 per patient. In Alaska the Federal Health Care Access Network which connects 3,000 healthcare providers to communities, engaged in 160,000 telehealth consultations from 2001 and saved the state $8.5 million in travel costs for just Medicaid patients. There are indications telehealth consumes fewer resources and requires fewer people to operate it with shorter training periods to implement initiatives.

However, whether or not the standard of health care quality is increasing is quite debatable, with literature refuting such claims. Research is increasingly reporting that clinicians find the process difficult and complex to deal with. Furthermore, there are concerns around informed consent, legality issues as well as legislative issues. New technologies are making telehealth more accessible for patients and easier for health providers.

Teleneurology defines the use of mobile technology to deliver neurological care remotely, including care for stroke, movement disorders like Parkinson’s disease, Epilepsy, Dementia, and other neurological conditions. Teleneurology can improve health care access for thousands around the globe, from those living in urban locations to those in remote, rural locations. Evidence shows that individuals with Parkinson’s disease prefer personal connection with a remote specialist to their local clinician. A randomized controlled trial of “virtual house calls” or video visits with individuals diagnosed with Parkinson’s disease demonstrates patient preference for the remote specialist vs their local clinician after one year.

Teleneurology can also be more affordable and can reduce in-person visits of patients with mobility issues. A recent systematic review describes both the limitations and potential benefits of teleneurology to improve care for patients with chronic neurological conditions.

Mobile technologies, especially smartphones and wearable sensors, can provide objective, frequent assessments of neurological conditions, and neurological care will expand and migrate from hospitals and clinics to homes and mobile devices, incorporate systems of asynchronous communications and integrate clinicians with diverse skill sets.


References – further reading

Dorsey ER, Glidden AM, Holloway MR, Birbeck GL, Schwamm LH (May 2018). “Teleneurology and mobile technologies: the future of neurological care”. Nature Reviews. Neurology. 14 (5): 285–297. doi:10.1038/nrneurol.2018.31. PMID 29623949. S2CID 4620042.

 Beck CA, Beran DB, Biglan KM, Boyd CM, Dorsey ER, Schmidt PN, et al. (September 2017). “National randomized controlled trial of virtual house calls for Parkinson disease”. Neurology. 89 (11): 1152–1161. doi:10.1212/WNL.0000000000004357. PMC 5595275. PMID 28814455.

 Ben-Pazi H, Browne P, Chan P, Cubo E, Guttman M, Hassan A, et al. (April 2018). “The Promise of Telemedicine for Movement Disorders: an Interdisciplinary Approach”. Current Neurology and Neuroscience Reports. 18 (5): 26. doi:10.1007/s11910-018-0834-6. PMID 29654523. S2CID 4850577.

 Beck CA, Beran DB, Biglan KM, Boyd CM, Dorsey ER, Schmidt PN, et al. (September 2017). “National randomized controlled trial of virtual house calls for Parkinson disease”. Neurology. 89 (11): 1152–1161. doi:10.1212/WNL.0000000000004357. PMID 28814455.

Artificial intelligence in healthcare involves the use of complex algorithms and software to emulate human cognition in the analysis, interpretation, and comprehension of complicated medical and healthcare data. Specifically, AI is the ability of computer algorithms to approximate conclusions without direct human input.
What distinguishes AI technology from traditional technologies in health care is the ability to gain information, process it and give a well-defined output to the end-user. This can be done through machine learning algorithms and deep learning which can recognize patterns in behavior and create their own sense. To reduce the margin of error, AI algorithms need to be tested repeatedly. AI algorithms behave differently from humans in two ways: (1) algorithms are literal: if you set a goal, the algorithm can’t adjust itself and only understand what it has been told explicitly, (2) and some deep learning algorithms are black boxes; algorithms can predict extremely precise, but not the cause or the why.
The primary aim of health-related AI applications is to analyze connections between prevention or treatment techniques and patient outcomes. AI programs have been developed and applied to practices such as diagnosis processes, treatment protocol development, drug development, personalized medicine, and patient monitoring and care. Medical institutions such as The Mayo Clinic, Memorial Sloan Kettering Cancer Center, and the British National Health Service, have developed AI algorithms for their departments. Large technology companies such as IBM and Google, and Microsoft have also developed AI algorithms for healthcare. Additionally, hospitals are looking to AI software to support operational initiatives that increase cost saving, improve patient satisfaction, and satisfy their staffing and workforce needs. Companies are developing predictive analytics solutions that help healthcare managers improve business operations through increasing utilization, decreasing patient boarding, reducing length of stay and optimizing staffing levels.


References

Luca M, Kleinberg J, Mullainathan S (January–February 2016). “Algorithms Need Managers, Too”. Harvard Business Review. Retrieved 2018-10-08.
Coiera E (1997). Guide to medical informatics, the Internet and telemedicine. Chapman & Hall, Ltd.
Power B (19 March 2015). “Artificial Intelligence Is Almost Ready for Business”. Massachusetts General Hospital.
Bahl M, Barzilay R, Yedidia AB, Locascio NJ, Yu L, Lehman CD (March 2018). “High-Risk Breast Lesions: A Machine Learning Model to Predict Pathologic Upgrade and Reduce Unnecessary Surgical Excision”. Radiology. 286 (3): 810–818. doi:10.1148/radiol.2017170549. PMID 29039725.
Bloch-Budzier S (22 November 2016). “NHS using Google technology to treat patients”.
Lorenzetti L (5 April 2016). “Here’s How IBM Watson Health is Transforming the Health Care Industry”. Fortune.
Kent J (2018-08-08). “Providers Embrace Predictive Analytics for Clinical, Financial Benefits”. HealthITAnalytics. Retrieved 2019-01-16.
Lee K (4 January 2016). “Predictive analytics in healthcare helps improve OR utilization”. SearchHealthIT. Retrieved 2019-01-16.

Telehealth requires a strong, reliable broadband connection. As broadband infrastructure has improved, telehealth usage has become more widely feasible. Healthcare delivery can come within four distinct domains: live video (synchronous), store-and-forward (asynchronous), remote patient monitoring, and mobile health.

Store and forward

Store-and-forward telemedicine involves acquiring medical data (such as medical images, and biosignals) and transmitting them to a medical specialist at a for assessment offline. It does not require the presence of both parties at the same time. Dermatology, radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured medical record preferably in electronic form should be a component of this transfer. The ‘store-and-forward’ process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.

Remote monitoring
Telehealth Blood Pressure Monitor

Remote monitoring, also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective. Examples include home-based nocturnal dialysis and improved joint management.

Real-time interactive

Electronic consultations are possible through interactive telemedicine services that provide real-time interactions between patient and provider. Videoconferencing has been used in a wide range of clinical disciplines and settings for various purposes including management, diagnosis, counseling, and monitoring of patients.

Videotelephony

Videotelephony comprises the technologies for the reception and transmission of audio-video signals by users at different locations, for communication between people in real-time.

At the dawn of the technology, videotelephony also included image phones which would exchange still images between units every few seconds over conventional POTS-type telephone lines, essentially the same as slow scan TV systems. Currently, videotelephony is particularly useful to the deaf and speech-impaired who can use them with sign language and also with a video relay service, and well as to those with mobility issues or those who are located in distant places and are in need of telemedical or tele-educational services.

References

“TeleHealth”. The Health Resources and Services Administration. 2017-04-28.

 Shaw DK (June 2009). “Overview of telehealth and its application to cardiopulmonary physical therapy”. Cardiopulmonary Physical Therapy Journal. 20 (2): 13–8. doi:10.1097/01823246-200920020-00003. PMC 2845264. PMID 20467533.

“What is Telehealth?”. The Center for Connected Health Policy.

 Sachpazidis I (10 Jul 2008). Image and Medical Data Communication Protocols for Telemedicine and Teleradiology (dissertation) (PDF) (Thesis). Darmstadt, Germany: Department of Computer Science, Technical University of Darmstadt. Retrieved 14 Aug 2018.

 Salehahmadi Z, Hajialiasghari F (January 2013). “Telemedicine in iran: chances and challenges”. World Journal of Plastic Surgery. 2 (1): 18–25. PMC 4238336. PMID 25489500.

 Pierratos A (November 1999). “Nocturnal hemodialysis: dialysis for the new millennium”. Canadian Medical Association Journal. 161 (9): 1137. PMC 1230743. PMID 10569098.

 Koutras C, Bitsaki M, Koutras G, Nikolaou C, Heep H (17 August 2015). “Socioeconomic impact of e-Health services in major joint replacement: A scoping review”. Technology and Health Care. 23 (6): 809–17. doi:10.3233/THC-151036. PMID 26409523.

 Fatehi F, Armfield NR, Dimitrijevic M, Gray LC (October 2014). “Clinical applications of videoconferencing: a scoping review of the literature for the period 2002-2012”. Journal of Telemedicine and Telecare. 20 (7): 377–83. doi:10.1177/1357633X14552385. PMID 25399998. S2CID 39080490.

 McGraw-Hill Concise Encyclopedia of Engineering. Videotelephony, McGraw-Hill, 2002. Retrieved from the FreeDictionary.com website, January 9, 2010

Telehealth is the distribution of health-related services and information through electronic information and telecommunication technologies [1]. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions [2][3]. Telemedicine is sometimes used as a synonym or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap [4], as well as provider distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration [5]. Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy is done via digital monitoring devices, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult [1][2][5].


When face to face contact is not applicable, as, in the Covid-19 pandemic, telemedicine had become an important tool. Telehealth reduces the spread of infection while allowing the patient to continue his diagnostic-therapeutic process. Medical examination remains the cornerstone of practice, but telemedicine decreases the number of patient attendances as consultations take place on the telephone, video calls, exchanges of photographic documentation, mobile phone messages, e-mail, or other support applications for computers or mobile phones.


References

  1. “TeleHealth”. The Health Resources and Services Administration. 2017-04-28.
  2. Shaw DK (June 2009). “Overview of telehealth and its application to cardiopulmonary physical therapy”. Cardiopulmonary Physical Therapy Journal. 20 (2): 13–8. doi:10.1097/01823246-200920020-00003. PMC 2845264. PMID 20467533.
  3. Masson, M (December 2014). “Benefits of TED Talks”. Canadian Family Physician. 60 (12): 1080. PMC 4264800. PMID 25500595.
  4. Mashima PA, Doarn CR (December 2008). “Overview of telehealth activities in speech-language pathology”. Telemedicine Journal and E-Health. 14 (10): 1101–17. doi:10.1089/tmj.2008.0080. PMID 19119834.
  5. Miller EA (July 2007). “Solving the disjuncture between research and practice: telehealth trends in the 21st century”. Health Policy. 82 (2): 133–41. doi:10.1016/j.healthpol.2006.09.011. PMID 17046097.