Telehealth and Medicine Today

Building a Framework for a More Inclusive Healthcare System

Maria Palombini — 2023-04-29

Objective: With the explosion in the use of telehealth technologies, it is essential to address the challenges in global telehealth inequity in order to create a path to healthcare equality. To this end, this research paper focuses on investigating telehealth as it relates to the COVID-19 pandemic and its impact on healthcare inequality, telehealth inequity, and the continued vulnerabilities with increased demand in implementation.

Study Design: A set of voluntary questions were e-mailed to active members of the IEEE-SA (Institute of Electrical and Electronics Engineers Standards Association) Transforming the Telehealth Paradigm: Sustainable Connectivity, Accessibility, Privacy, and Security for all. The interview answers were analyzed via deductive thematic analysis organized into higher themes and theme-specific codes.

Setting: The country of residence varied among individuals who are the IEEE-SA Telehealth program members. These continents included: North America, South America, Africa, Asia, and Europe.

Participants: Global healthcare leaders who are active members of the IEEE-SA Transforming the Telehealth Paradigm: Sustainable Connectivity, Accessibility, Privacy, and Security for all participated. The occupations of these individuals ranged from a variety of areas within the healthcare domain, such as physicians, scientists, and public health experts.

Main outcome measure: Qualitative data obtained voluntarily from global healthcare leaders participating in the IEEE-SA Transforming the Telehealth Paradigm: Sustainable Connectivity, Accessibility, Privacy, and Security for all.

Results: The major themes that emerged from the participants' responses included: telehealth infrastructure and access, digital literacy and user interface, government regulations, and telehealth legislation.

Conclusions: Telehealth has the power to decrease healthcare disparities, thus getting closer to achieving health equity. However, there are three significant common global barriers to the implementation of telehealth: infrastructure, digital literacy, and government regulations. Because the results were based on interviewer responses, the conclusions acknowledged how the background of respondents, including career and education, influenced their experiences and, thus, the responses. Suggestions for change in reducing barriers to telehealth accessibility are detailed in this research. These suggestions were derived from respondents and focused on the global barriers to implementation. To reduce these barriers, changes in political health policy, patient health education, health provider telemedicine support, and in regulation for telemedicine are suggested. Limitations in our research project included a small sample size and the ensuing lack of representation from more geographical regions.

What the Pandemic Left Us: Regulatory Advances for Telemedicine and Telehealth in Argentina

Daniela Chueke — 2023-04-29

Among its many side effects, the COVID-19 pandemic left several positive results. This article talks about one of the main positive effects in the post-pandemic period: the adoption of telemedicine and telehealth, two related disciplines that were already present in several Latin American countries, but which in the past two years came to be a solution for delivering medical care to patients.

Factors such as social-distancing measures, the lack of knowledge about the virus at the beginning of the pandemic that led to strict protective measures being taken in hospitals and doctors’ offices, restricting face-to-face care of patients to a bare minimum, and the rapid response of governments, health care institutions, payers, and professionals, provided the conditions that telemedicine and telehealth had needed for many years to flourish and occupy the predominant place they currently have in the global health ecosystem.

All the benefits of remote patient care became clear at a time in world history that marked a turning point in the advancement of information and communication technologies for health. In this report we will look at the regulatory frameworks adopted during or since the COVID-19 pandemic from 2020 onward in Argentina.

Spanish Language Translation

http://dx.doi.org/10.30953/tmt.v8.417

Este informe describe los marcos regulatorios adoptados durante y desde la pandemia de COVID-19 a partir de 2020 en Argentina, así como el impacto de estas disciplinas y cómo se relacionan con la expansión de la telemedicina y la telesalud en el sector sanitario de la región. Entre muchos de sus efectos inesperados la pan-demia de COVID-19 dejó varios saldos positivos. Este artículo habla acerca de uno de los principales efectos positivos en la post pandemia: la adopción de la telemedicina y la telesalud, dos disciplinas relacionadas que ya estaban presentes en varios países de Latinoamérica, pero que en los últimos dos años se revelaron como la solución para hacer llegar la atención médica a los pacientes. Factores como las medidas de distanciamiento social, el desconocimiento sobre el virus al comienzo de la pandemia que obligó a tomar medidas estrictas de protección a hospitales y consultorios médicos, restringiendo la atención presencial de pacientes al mínimo indispensable y la rápida respuesta de gobiernos, instituciones sanitarias, pagadores y profesionales, posibil-itaron el impulso que desde hacía muchos años precisaba la telemedicina y la telesalud para ocupar el lugar preponderante que actualmente está ocupando en el ecosistema sanitario mundial. Todos los beneficios de la atención remota de pacientes quedaron en evidencia en un momento de la historia del mundo que representa un punto de inflexión en el avance de las tecnologías de la información y la comunicación para la salud. En este reporte veremos cuáles fueron los marcos regulatorios adoptados durante o con posterioridad a la pandemia de Covid-19 a partir de 2020 hasta la fecha en Argentina.

A Tale of Two Counties With the Same Telehealth Story: Experience with Cancer Genetics Testing During COVID-19 at a Community Hospital

Allison Jay — 2023-04-29

Introduction: With the onset of the COVID-19 pandemic in 2020, the utilization of telemedicine now offered an alternative diagnostic and treatment resource to providers in many areas of medicine including oncology and cancer genetics. This care option paired with genetic testing labs’ ability to send saliva-based DNA collection kits to patients, enabled our community hospital in Detroit to offer diagnostic testing without the patient coming to a healthcare setting for a host of reasons. Social determinants of health have been found to influence success with telehealth, and this study sought to analyze how successful telehealth cancer genetics care was throughout the Detroit Metro area. Methods: Patient demographics for in person visits six months before COVID were analyzed, and then compared with demographics of patients during the 2020-2021 pandemic period where visits were telehealth. Results: Pre-pandemic there were , 192 unique patients seen in person with the top three cities patients were from were Detroit (12.1%), Clinton Township (8.3%), and Saint Clair Shores (10.4%). During the pandemic, with telehealth as the major modality, the top three cities were Macomb (7.2%), Detroit (7%), and Clinton Township (7%). Detroit is in Wayne County, while St.Clair Shores and Clinton Township are in Macomb County. Per the US Census Bureau Macomb county has a median income of $64,641 and Wayne county has a median income of $49,359, and poverty level in Macomb county is 9.2% versus in Wayne the level is 20%. Conclusions: This paper outlines the challenges of initiating a telemedicine program in an urban community area and highlights the benefits of a concierge service in serving cancer patients who may have economic and historically poor perceived technologic abilities.

A Systematic Review Identifying Adverse Health Outcomes and Mortality Rates Associated with Telehealth

Fidelia Cascini — 2023-04-29

Background: The literature supporting telehealth management is growing accelerated by the COVID-pandemic. We hypothesize that there are risks of adverse events associated with telehealth interventions.

Methods: A review of PubMed (including MEDLINE), Embase, ISI (Web of Science), VHL/GHL, Scopus, Science Direct, and PsycINFO was conducted for all adverse events associated with telehealth from January 1, 1960 to March 1, 2021. This systematic review and meta-analyses were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: Of 5,144 citations 78 published studies met criteria for quality evaluation and underwent full text abstraction including the qualitative synthesis. Of the 78 included studies 8 were included in the quantitative synthesis resulting in 2 meta-analyses. The results of the meta-analysis suggest that monitoring patients using telehealth techniques is associated with 40% lower mortality risks among patients suffering from heart failure, compared to those who received traditional care. The results of the random-effects meta-analysis showed the pooled relative risk of mortality to be 0.60, indicating that patients that underwent telemonitoring had a lower mortality risk compared with the patients that underwent usual care. Among patients with heart implants, patients who received telemonitoring had a 35% lower mortality risk compared to patients receiving traditional care.

Conclusions: While RCTs of telehealth interventions demonstrate enhanced patient outcomes in a number of studies and pave the way to evidence-based practice, the heterogeneity of the research questions suggest an important need for more complementary studies with consistent outcome assessments.

Determining the Value-on-Investment of Provider-to-Provider Virtual Consultation for Cancer Care

David Shalowitz — 2023-04-29

BACKGROUND: Access to high-quality cancer care in the United States remains a challenge in part due to a geographic mismatch between patients with cancers and the oncologic specialists best able to serve them. There is therefore an urgent need to develop communications strategies that allow oncologists to determine which patients might benefit from referral for subspecialty cancer care, and to allow subspecialists to guide care remotely when patients are unable or unwilling to travel. Unfortunately, virtual consultation between clinicians has been understudied, and likely underutilized, in cancer care. Health systems may be hesitant to implement a virtual consultation program without data on such a program’s value.

RESEARCH DESIGN: In this article we outline a framework for calculating the value on investment (VOI) for a provider-to-provider virtual consultation framework to improve geographic access to cancer care. For each element of VOI, we suggest specific outcomes that health systems might utilize to determine the value of implementing virtual provider-to-provider consultation.

RESULTS: Elements of VOI include: direct and indirect revenue, institutional halo effect, hospital-based care, infrastructure considerations, subspecialty resource utilization, continuity of care, patient-reported outcomes, clinical trial enrollment, and program monitoring and quality improvement.

CONCLUSION: Implementation of virtual consultation between general and subspecialty oncologists offers health systems the potential for substantial value on investment, largely through improving clinical outcomes by optimizing the resources involved in patients’ cancer care.

A Prioritization Model for Emergency Telepsychiatry Service Evaluation and Selection

Jacqueline Sandling — 2023-04-29

Background: Reducing Length of Stay (LOS) is an important way for hospitals to improve emergency department (ED) costs and outcomes. Psychiatric patients represent a challenge to reducing LOS as the scarcity of psychiatric specialists leads to longer LOS. Previous literature describes the unique solutions different hospitals have employed across the US, but does not give methods for evaluating or selecting a solution that can be applied to other hospitals.

Methods: A mixed methods exploratory sequential design was retrospectively registered in order to build and subsequently test a contextually appropriate evaluation framework. First, interviews with hospital staff were conducted in a qualitative phase, the results of which were used to develop an evaluation framework as a quantitative instrument. This evaluation framework was subsequently tested using a large sample of observational ED case data from one community hospital, as well as pricing data resulting from market research on psychiatry services. This information, along with projected return on investment, was aggregated to create a holistic model for evaluating different telepsychiatry service options and selecting the one with the best fit.

Results: Our methodology identified 8 key factors that captured the overall difficulty of implementation and benefits associated with each service option. These factors were used to develop a prioritization model that identifies the one psychiatric service improving psychiatric LOS and best fitting the hospital’s overall priorities and operations.

Conclusion: The Prioritization Model created in this study was instrumental in selecting the solution for reducing LOS in a way that best meets patients’ and hospitals’ needs. This model may be applied to other hospitals in the U.S. to provide a holistic review and direct comparison of opportunities.