Tag: telemedicine

Telepsychiatry, another aspect of telemedicine, also utilizes videoconferencing for patients residing in underserved areas to access psychiatric services. It offers a wide range of services to the patients and providers, such as consultation between the psychiatrists, educational clinical programs, diagnosis and assessment, medication therapy management, and routine follow-up meetings. Most telepsychiatry is undertaken in real-time (synchronous) although in recent years research at UC Davis has developed and validated the process of asynchronous telepsychiatry. Recent reviews of the literature by Hilty et al. in 2013, and by Yellowlees et al. in 2015 confirmed that telepsychiatry is as effective as in-person psychiatric consultations for diagnostic assessment, is at least as good for the treatment of disorders such as depression and post-traumatic stress disorder, and may be better than in-person treatment in some groups of patients, notably children, veterans and individuals with agoraphobia.

There are a growing number of HIPAA compliant technologies for performing telepsychiatry. Our platform at Sigma-Pi Healthcare is HIPAA compliant and is extensively used for telepsychiatry.

In April 2012, a Manchester-based Video CBT pilot project was launched to provide live video therapy sessions for those with depression, anxiety, and stress-related conditions called InstantCBT. The site supported at launch a variety of video platforms (including Skype, GChat, Yahoo, MSN as well as bespoke) and was aimed at lowering the waiting times for mental health patients.

The momentum of telemental health and telepsychiatry is growing. In June 2012 the U.S. Veterans Administration announced the expansion of the successful telemental health pilot. Their target was for 200,000 cases in 2012.

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.