1. Telehealth
Team Members:
Sukhjinder Kaur
Melissa Johnson
Oluyemisi Ibekweh
Ciji Jones
8 June 2013

2. Introduction
• Telehealth is the use of telecommunications technologies to deliver
health-related services and information that support patient care,
administrative activities, and health education. Telehealth is being
touted as a means to improve access to care, while reducing costs of
transportation and increasing /convenience to patients in obtaining
care. Access to care is an issue in regions where physician-to-patient
ratios are inadequate, or where there are not enough medical
specialists available to meet the population’s needs. As such, it has
become a key component of multifaceted strategies to improve
health service delivery in medically underserved areas in both rural
and urban settings. When patients are better able to access medical
care, they can have acute conditions treated locally, receive
treatment for medical problems before they become critical, and
receive care to better manage chronic conditions. Telehealth is
expansion of telemedicine with preventive, promotive and curative
medication widely used by members of health care community. The
American Nurses Association (1996) prefers the term telehealth as
inclusive and accurate description of services provided.

3. Definitions Of Telehealth
• "The use of communications and information technology to
deliver health services and exchange health information when
distance separates the participants." (Elford, 1998)
• “Telehealth is understood to mean the integration of
telecommunication systems into the practice of protecting
and promoting health while telemedicine is the incorporation
of these systems into curative medicine.” (WHO 1997)

4. History of Telehealth in U.S.
• Telehealth began with the use of telephone consults.
• During last five decades, U.S. government played a major role
in development and promotion of Telehealth through various
agencies.
• The most aggressive development of Telehealth in the U.S. has
been by NASA and the military.
• Telehealth is commonly used to treat prisoners, avoiding the
costs and danger of transporting prisoners.
• The U.S. may lead in the development of Telehealth, but
Australia, Canada, Norway, and Sweden are among the current
world leaders in the use of Telehealth.

5. Four Areas of Telehealth
Tele
Consultations Tele
Education
Home
Telehealth Tele
Triage
(poole,
2007)

6. Benefits of Telehealth
• Benefits - Patient
Improved access to medical specialists
Quicker , more accurate diagnosis and treatment --->
improved patient outcomes
• Benefits – Central Health Care Provider
Decreased need to travel - "see patients, not the road"
Improved screening of patients
• Benefits - Health Care Payer
Decreased overall health care costs (per patient)
Human resources are used more efficiently, "Do more
with less"
Improved patient outcomes

7. The Need for Telehealth
• Clinical shortage
• Misdistribution of providers
• Rural/urban underserved
• Aging population
• Travel, time, cost and hardship
• Delayed treatments
• Language barriers
• Clinical education programs
• Administrative meetings

8. Challenges to using Telehealth
• Regulatory barriers
• Costs for equipment, network services, and training time
• Fear of healthcare system changes
• Lack of acceptance by healthcare professionals
• Lack of acceptance by user
• Lack of reimbursement of consultative services

9. The Different Technologies
Used for Telehealth
• Telephones
• videophones
• personal computers (PCs)
• videoconferencing systems
• store and forward systems (S&F)
• specialized telemedicine workstations.

10. Basic Desktop Videoconferencing
Components for Healthcare Application
• Pc
• Pc adapter cards
• Camera
• Microphones
• Video overlay cards
• External speakers on existing PCs with broadband
switches

11. Modes of Telehealth
• Store and forward telehealth. All clinical data (vital signs, audio, video,
digital images ) are captured on client computer or mobile device stored
and transmitted securely to another location where they are then
studied by clinicians who make correlations and prescribe treatment
based on their findings. This mode is used in areas where an immediate
response is not critical to patient care, e.g. dermatology, some radiology
and pathology.
• Real time telehealth. “Here, a telecommunications link allows for
instantaneous interaction” between all involved in real-time.
Videoconferencing being one of the most common form of this method.
This mode is frequently used in cardiology, dentistry, mental health,
home health, neurology, radiology nursing and rehabilitation.
• Remote patient monitoring. In this mode, “the patient has a central
system that feeds information from sensors and monitoring equipment ,
e.g. blood pressure monitors, glucometers, scales, to an external
monitoring center” which can be done in either real-time, or store and
forward. This mode is frequently used in home health for disease
process management like Renal failure requiring home dialysis, COPD,
CHF, and Diabetes.

12. Peripheral Devices
• Otoscope: This device allows images from the ear, nose and
throat to be captured and transmitted to a distant site for
review.
• Electronic stethoscope: This device allows heart, lung and
bowel sounds to be captured and transmitted to a distant site
for review.
• General exam camera: This device can be used for multiple
purposes such as capturing gross pictures of the ear, throat
and skin.

13. Tele-health in Action
• With tele-health, providers are able to have face to face
assessment time with patients.
• They are able to use the different peripheral devices to hear
heart sounds, listen to lung sounds, and assess other areas
without actually being with the patient.

14. Telehealth Impact on Nursing

15. Impact on Nursing
• Nurses can find themselves in a variety of tele-health related jobs.
• Tele-health nurses take on more of a leadership role.
• Nurses employed from home or other settings screen calls, offering
expert healthcare advise and make necessary referrals.
• Nurses who work in telehealth must have excellent communication
skills, often the nurse becomes a life line to the patients.
• Good assessment skills and nursing judgment are essential for nurses in
telehealth related jobs.
• More and More telehealth clinics are opening across the United States.
• Tele-health clinic are often run by nurses, with remote access to
doctors.
• Another area of telehealth that utilizes nurses is home monitoring,
often the equipment is set up and reviewed with the client by
nurses. Nurses can monitor data and relay vital information to
doctors.

16. Legal and Ethical Issues
• Legal issues – safety
of clinical data,
confidentiality issues,
accountability,
malpractice
• Ethical issues –
security, privacy, and
confidentiality

17. Strategies to Ensure
Successful Teleconferences
• Select a videoconferencing system to fit your needs, such as a desktop or mobile
system or customized room.
• Locate videoconferencing facilities near where they will be used, yet in a quiet,
low-traffic area.
• Schedule sessions in advance to avoid time conflicts. Start on time.
• Establish a working knowledge of interactive conferencing features.
• Provide an agenda to keep the conference on track.
• Introduce all participants.
• Set time limits.
• Send materials needed in advance to maintain focus and involve participants.
• Summarize major points at the conclusion.
• Start by asking all participants if they have a good audio and video feed.
• Participate in a conference call as if it were a face-to-face meeting. Enunciate
clearly.
• Minimize background noise or use the mute future.
• Promote interactivity through questions and answers.
• Have technical support available to resolve any problems that might arise

18. Future of Telehealth
• In the future there maybe penalties
for not utilizing telehealth
treatment, verses inpatient
treatment.
• More consumer demand will push
to bring telehealth main stream.
• Government funding will increase.
• The development of more
telehealth clinics, will allow
individuals in rural areas access to
specialist
• Medical specialist predict that
telehealth will become a standard
of care.
• The definition of telehealth will
broaden in order to include more
aspects of care.

19. References:
• AHRQ (Agency for Healthcare Research and Quality). Retrieved from www.healthit.ahrq.org
• Digital telehealth incorporated by Dr. Rod Elford. Retrieved from www.telhealth.ca
• Elford, Dr. R (2004). Digital telehealth incorporated. Retrieved from
http://www.telehealth.ca/intrototelehealth.html
• Hebda,T.& Czar,P. (2009) Handbook of Informatics for Nurses & Healthcare Professionals.
(5th Edition). Prentice Hall.
• How Concordia Visiting Nurses Telehealth Technology Works. May 25, 2012. YouTube video.
Retrieved from http://www.youtube.com/watch?v=9vDV9zsvHOE
• Infinity Rehab (January 25, 2012). Infinity rehab advances patient care with Tele-health.
Retrieved from
http://www.infinityrehab.com/blog/2012/01/25/infinity-rehab-advances-patient-
care-with-telehealth/
• Poole, L (2007) An Overview of history and current status of telehealth in Canada. Retrieved
from www.inet-international.com
• Telehealth. Retrieved from Wikipedia.Org http://en.wikipedia.org/wiki/Telehealth
• University of Kentucky (July 4, 2011). Kentucky P20 innovation lab. Retrieved from
http://p20.education.uky.edu/labs/telehealth-lab/