American Telemedicine Association Research Articles

Resource Document on Best Practices in Synchronous Videoconferencing-Based Telemental Health.

Background: This document represents an updated collaboration between the American Psychiatric Association (APA) and the American Telemedicine Association (ATA) to create a consolidated update of the previous APA and ATA official documents and resources in telemental health, to provide a single guide on clinical best practices for providing mental health services through synchronous videoconference. Methods: A joint writing committee drawn from the APA Committee on Telepsychiatry and the ATA TMH Special Interest Group (TMH SIG). was convened to draft and finalize the guidelines. This document draws directly from the 2018 APA/ATA guide and the ATA s previous guidelines, selecting from key statements/guidelines, consolidating them across documents, and then updating them where indicated. Guideline approval was provided following internal review by the APA, the ATA, the Board of Directors of the ATA, and the Joint Reference Committee of the APA. Results: The guidelines contain requirements, recommendations, and actions that are identified by text containing the keywords "shall," "should," or "may." Conclusions: Compliance with these recommendations will not guarantee accurate diagnoses or successful outcomes. The purpose of this guide is to assist providers in providing effective and safe medical care founded on expert consensus, research evidence, available resources, and patient needs.

Consensus Guidelines for Teledermatology: Scoping Review.

Consensus guidelines and recommendations play an important role in fostering quality, safety, and best practices, as they represent an expert interpretation of the biomedical literature and its application to practice. However, it is unclear whether the recent collective experience of implementing telemedicine and the concurrent growth in the evidence base for teledermatology have resulted in more robust guidance. The objective of this review was to describe the extent and nature of currently available guidance, defined as consensus guidelines and recommendations available for telemedicine in dermatology, with guidance defined as consensus or evidence-based guidelines, protocols, or recommendations. We conducted a single-reviewer scoping review of the literature to assess the extent and nature of available guidance, consensus guidelines, or recommendations related to teledermatology. We limited the review to published material in English since 2013, reflecting approximately the past 10 years. We conducted the review in November and December of the year 2022. We identified 839 potentially eligible publications, with 9 additional records identified through organizational websites. A total of 15 publications met the inclusion and exclusion criteria. The guidelines focused on varied topics and populations about dermatology and skin diseases. However, the most frequent focus was general dermatology (8/15, 53%). Approximately half of the telemedicine guidance described in the publications was specific to dermatology practice in the context of the COVID-19 pandemic. The publications were largely published in or after the year 2020 (13/15, 87%). Geographical origin spanned several different nations, including Australia, the United States, European countries, and India. We found an increase in COVID-19-specific teledermatology guidance during 2020, in addition to general teledermatology guidance during the period of the study. Primary sources of general teledermatology guidance reported in the biomedical literature are the University of Queensland's Centre for Online Health and Australasian College of Dermatologists E-Health Committee, and the American Telemedicine Association. There is strong evidence of international engagement and interest. Despite the recent increase in research reports related to telemedicine, there is a relative lack of new guidance based on COVID-19 lessons and innovations. There is a need to review recent evidence and update existing recommendations. Additionally, there is a need for guidance that addresses emerging technologies.

COVID-19 Public Health Emergency to End in May

COVID-19 Public Health Emergency to End in May

Telepathology: A Transforming Practice for the Efficient, Safe, and Best Patient Care at the Regional Veteran Affairs Medical Center

Abstract Introduction/Objective Telepathology is the practice of remote pathology using telecommunication links to enable transmission of digital pathology images for primary diagnosis, quality assurance, education, research, or second opinion diagnoses. Once properly validated and implemented, telepathology has great potential to transform the practice of pathology by increasing productivity, savings in costs, improving the quality of care, and participating in innovations to improve future care. These improvements would help ensure equity throughout all remote sites that may be served by the central regional Veteran Affairs Medical Center (VAMC), even with the long-term declining number of pathologists in the country. The validation and implementation of telepathology has been further refined by recent College of American Pathologist (CAP) and American Telemedicine Association (ATA) clinical guidelines and recommendations for the validation and implementation of telepathology, but otherwise the literature is sparse for recent telepathology validation and implementation after the promulgation of these guidelines and recommendations in the Veteran Affairs setting. Methods/Case Report An initial narrative literature review was conducted to ascertain the current clinical guidelines and practices of telepathology to ensure that practices during validation and implementation meet and exceed the standard of care. Furthermore, meetings including the appropriate stakeholders in information technology, privacy, facilities, and pathology were held. The telepathology platform from Leica Biosystems Aperio (Deer Park IL) was brought in house at the regional VAMC’s pathology department for validation and future implementation. Results (if a Case Study enter NA) Planning included following all appropriate guidelines from ATA and CAP regarding telepathology to ensure that the program met the standard of care. The arrival of the instrument was installed successfully within the pathology. Conclusion The installation of telepathology for use at a regional VAMC represents an important step to transform pathology to increase access, including even remote access, to pathology resources and subspecialty expertise throughout the Veteran Affairs Medical System.

Impacts of Telehealth on Access-to-Care for Mental Health Patients

The age of technology and smart devices has paved the way for a current and encouraging method to address mental healthcare that benefits from global connectivity: telehealth. According to the American Telemedicine Association, telehealth or telemedicine is defined as the usage of medical information from one site to another through electronic communication with the goal of improving a client’s overall health through emails, cellular phones, two-way videos, and conference calls. With the current Covid-19 pandemic, hospitals (especially those with mental health units or free-standing psychiatry facilities) are seldomly able to keep up with the influx of mental health patients without being turned away or having to wait for an extended period of time. Through telemedicine, those barriers have been lifted providing more efficient and enhanced access to care for everyone, especially those seeking mental health services. This review paper attempts to establish that despite the observations that telehealth has a positive impact on improved access to mental healthcare, it has not flourished to the extent it could have prior to the COVID-19 pandemic. We also try to provide long-term telehealth solutions, some of which are already being implemented in the current pandemic to improve the quality of mental healthcare access to a larger majority of Americans and those in other countries as well. With people being advised to stay-at-home coupled with the fear of cross-contamination in public places, people are resorting to telehealth for psychiatric visits and follow-ups. Before this pandemic, however, certain laws and rules have been a barrier to more telehealth options becoming available or feasible to the public. Telehealth is changing the conventional standard of psychiatric medicine by enhancing access to care, reducing re-admission rates, and enhancing the quality of life. Those that have tested positive for the COVID-19 virus and are quarantined at home can still meet with their mental healthcare provider periodically to discuss progress and prognosis. Research has shown that telemedicine has neutralized the impacts of delayed care, hospital admissions, and complications from psychiatric conditions globally. Telehealth has proven to provide steady benefits to patients, psychiatrists, and mental health providers through round-the-clock access remotely.

ATA2022 Annual Conference & Expo May 1–3, 2022Boston, Massachusetts

ATA2022 Annual Conference & Expo May 1–3, 2022Boston, Massachusetts

APA’s Government, Policy, and Advocacy Update (April 2022)

APA’s Government, Policy, and Advocacy Update (April 2022)

Increasing value and facilitating adoption of telehealth in the post-COVID era: An interview with chair of the American Telemedicine Association Joseph Kvedar

Increasing value and facilitating adoption of telehealth in the post-COVID era: An interview with chair of the American Telemedicine Association Joseph Kvedar

Telemental Health

Telemental Health

Audio-Only Telehealth Now Approved Permanently for Mental Health/Substance Use Services

Audio-Only Telehealth Now Approved Permanently for Mental Health/Substance Use Services

Telerehabilitation as a Tool Given on Physical Fitness and Quality of Life in Overweight and Obese College Students Amidst Covid 19 Pandemic: Single Group Pre Post Design

Background: Remote rehabilitation via advanced communications through network, online etc given in thisadvanced digital era is collectively known as telerehabilitation. American telemedicine association initiallyexplained the term of telerehabilitation based on the facilities in current advance digital world. Covid -19 pandemicenhanced the services of telerehabilitation as first line rehabilitation treatment method that need rehabilitationsservices in their domicile. Thus based on telerehabilitation has been warranted to administer in providing physicaltherapy services for subjects who have been diagnosed both positive and negative COVID.Aim & objectives of the study: To analyze the uses of exercise training through telerehabilitation applied duringCOVID-19 isolation period on overweight and obese college students on physical fitness and quality of life.Data Analysis and Results: Notable improvement in the variables of weight in kg and Body Mass Index (BMI) inobese and overweight as well as their quality of life which is measured by SF – 36 questionnaire in college studentsafter rehabilitation through telerehabilitation method where the subjects were trained with aerobic exercises,breathing exercises along with core stability exercises on physical fitness and quality of life with significance equalor less than 0.05 and confidence interval at 95%.Conclusion: statistically significant improvement in weight in kg and BMI which reflected in their physical fitnessand quality of life (SF – 36) in overweight and obese college students after the intervention of telerehabilitationconsists of aerobic exercises, breathing exercises and core stability exercises applied to them during this COVID19 Pandemic.

Telerehabilitation Policy Report: Interprofessional Policy Principles and Priorities.

The American Occupational Therapy Association, the American Physical Therapy Association, the American Speech-Language-Hearing Association and the American Telemedicine Association are collaborating to advance telehealth and ensure sustainability of virtual care services beyond the COVID-19 pandemic. These professional associations represent the interests of more than 888,000 rehabilitation services professionals. This paper summarizes the current state of telehealth policy principles and priorities for rehabilitation services. The report outlines key considerations when advocating with policymakers to avoid the “Telehealth Cliff” for audiology and therapy services and to facilitate the continued advancement of telehealth innovation and transformation by rehabilitation services professionals.

Telehealth Clinical Practice Guide for Occupational Therapy, Physical Therapy, and Speech and Language Pathology: A Saudi and Middle Eastern Guide.

Telehealth refers to the application of telecommunications technology to deliver clinical services at a distance by linking clinician to patient, caregiver, or any person(s) involved in client care for assessment, intervention, consultation, and supervision. Telehealth for occupational therapy (OT), physical therapy (PT), and speech and language pathology (SLP) have produced service delivery venues that are of great benefit during the coronavirus disease 2019 pandemic. The concept of telehealth for rehabilitation services is relatively new in the Middle East, and no specialty-specific clinical practice standards or guidelines are published to guide the rehabilitation practitioners. Therefore, a specialty-specific telehealth practice guide for rehabilitation practitioners has been developed by an expert panel in the field of rehabilitation. This guide is documented in this article. Such a guide will be beneficial when providing tele-evaluation, teleintervention/telerehabilitation, teleconsultation, and telemonitoring through communication technologies. The purpose of this guide is to enable understanding of core telehealth clinical principles and aid the provision of OT, PT, and SLP telehealth services in Saudi Arabia. Also, the guide can potentially be implemented in other Middle Eastern countries. The guide is based on key telehealth guidelines involving the American Occupational Therapy Association telehealth resources, American Physical Therapy Association, American Speech and Hearing Association, telemedicine policies in Saudi Arabia by the national health information center at the Saudi Health Council, and a blueprint for telerehabilitation guidelines that are based on the American Telemedicine Association's Core Standards for Telemedicine Operations.

Reading List: Select Healthcare Transformation Library 2.0.

Reading List: Select Healthcare Transformation Library 2.0 represents a broad-based, annotated, general reading list for students of health care innovation. The books were drawn from the 5,000-book private home library of Ronald S. Weinstein, MD, President Emeritus of the American Telemedicine Association. Weinstein is a lifelong book collector with special interests in the history of medical innovation and poetry. A Massachusetts General Hospital-trained pathologist and inductee into the US Distance Learning Association's Hall of Fame, he is known as a pioneer in telemedicine and the “father of telepathology” for his invention, patenting, and commercialization of telepathology, a subspecialty of telemedicine that is a billion-dollar worldwide industry today. This Reading List: Select Healthcare Transformation Library 2.0 consists of 41 books divided into 10 sections: (1) Human Intelligence, Behavior, and Creativity; (2) Societal Revolutions; (3) Innovation; (4) Healthcare System Transformations; (5) Education; (6) Transformational Technologies—Part 1 (AI, Automation, and Robotics); (7) Transformational Technologies—Part 2 (Telemedicine and Telehealth); (8) Digital Medicine; (9) Healthcare Transformation Implementation; and (10) COVID-19 Pandemic as an Innovation Accelerator.

Telehealth in US hospitals: State-level reimbursement policies no longer influence adoption rates

ObjectivesPrior to COVID-19, levels of adoption of telehealth were low in the U.S., though they exploded during the pandemic. Following the pandemic, it will be critical to identify the characteristics that were associated with adoption of telehealth prior to the pandemic as key drivers of adoption and outside of a public health emergency. Materials and methodsWe examined three data sources: The American Telemedicine Association’s 2019 state telehealth analysis, the American Hospital Association’s 2018 annual survey of acute care hospitals and its Information Technology Supplement. Telehealth adoption was measured through five telehealth categories. Independent variables included seven hospital characteristics and five reimbursement policies. After bivariate comparisons, we developed a multivariable model using logistic regression to assess characteristics associated with telehealth adoption. ResultsAmong 2923 US hospitals, 73% had at least one telehealth capability. More than half of these hospitals invested in telehealth consultation services and stroke care.Non-profit hospitals, affiliated hospitals, major teaching hospitals, and hospitals located in micropolitan areas (those with 10-50,000 people) were more likely to adopt telehealth.In contrast, hospitals that lacked electronic clinical documentation, were unaffiliated with a hospital system, or were investor-owned had lower odds of adopting telehealth. None of the statewide policies were associated with adoption of telehealth. ConclusionsTelehealth policy requires major revisions soon, and we suggest that these policies should be national rather than at the state level. Further steps as incentivizing rural hospitals for adopting interoperable systems and expanding RPM billing opportunities will help drive adoption, and promote equity.

Ethics in an Epidemic: Nine Issues to Consider

Abstract This article addresses nine ethical concerns facing school social workers during an epidemic and other emergency situations when they must rely on electronic communication platforms, such as Doxy.me, Skype, or Zoom. These issues of concern are use of appropriate terminology, client self-determination, technological competence, informed consent, confidentiality, boundary issues, social justice, record keeping, and professional self-care. The article combines research on the psychosocial effects of quarantine on students and their families and data about the effectiveness of telemental health. It provides legal expectations from the Family Educational Rights and Privacy Act as well as ethical guidance from the American Telemedicine Association and the National Association of Social Workers’ Code of Ethics to provide practical strategies about how to help students and their families during a time of prolonged stress. The article takes a strengths-based approach to crisis intervention by indicating both the advantages and the disadvantages of using electronic communication tools to provide continuity of care to clients.

Evaluation of Teledermatology Practice Guidelines and Recommendations for Improvement.

Background: The current coronavirus disease 2019 (COVID-19) pandemic has forced dermatology practices to rapidly adopt or expand teledermatology services. To date, teledermatology clinical practice guidelines (CPGs) have not been evaluated for quality. This may hinder the implementation and sustainability of high-quality teledermatology services. The objective of this study is to evaluate teledermatology CPGs by using a comprehensive, validated appraisal tool and provide actionable recommendations for improvement for future guideline developers. Materials and Methods: A systematic literature search was performed to identify all CPGs published in teledermatology. Identified guidelines meeting inclusion criteria were scored for guideline quality by three researchers using the Appraisal of Guidelines and Research and Evaluation tool (AGREE II). Results: Three guidelines met inclusion criteria, including guidelines published by the American Telemedicine Association, the British Association of Dermatologists, and the Australian College of Dermatologists and the University of Queensland. Each of these guidelines exhibited unique strengths and areas for improvement. Areas of strength include clear objective statements, stakeholder involvement, and clarity of presentation. Areas for improvement include rigor of guideline development, applicability, and editorial independence. Conclusions: All guidelines were determined to be of sufficient quality for adoption based on AGREE scoring. Adoption of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence appraisal framework would improve the rigor of development of each guideline. Administering and publishing questionnaires to assess financial competing interests and external review processes would shed more light on the presence and/or extent of author bias. One inherent limitation of CPG selection criteria is that large providers of teledermatology services, such as the United States Veterans Affairs, were not examined in this review. However, the results of this study provide actionable targets to improve the quality of the teledermatology CPGs examined in this study.

Telerehabilitation Guidelines in Saudi Arabia.

Rehabilitation needs are increasing globally due to population growth, aging population, high survival rates for people with disability, and severe health conditions. In the past few years, new telecommunication-based practices, including various forms of e-rehabilitation have gained attention all over the world, including the Kingdom of Saudi Arabia (KSA). Telerehabilitation is an alternative way of delivering rehabilitation services in which information and communication technologies are used to expedite communication between the health care professional and the patient at a distant location. It can be beneficial to people in rural areas, especially individuals in isolated communities. At present, the COVID-19 pandemic has forced speedy adoption of telerehabilitation due to restricted traditional in-person visits all over the world, including KSA; however, no telerehabilitation guidelines are available in the country. Since specialized rehabilitation services are limited to main cities of the country, the provision of care by reaching out the underserved areas using telemedicine technology is deemed important. These guidelines were established collaboratively by panel of various rehabilitation experts with input from other practitioners in the field and strategic stakeholders. It will facilitate rehabilitation clinicians practicing in KSA providing consultation, counseling, education, assessment, monitoring, therapy, or follow-up to a patient remotely using telemedicine communication technologies. This document includes administrative, clinical, and technical guidelines, which are aimed to standardize telerehabilitation practice across the country. The core principles are based on standards set forth by American Telemedicine Association and are guided by telemedicine policy in KSA. Additionally, ethical considerations of telerehabilitation practice pertinent to Saudi culture and health care system are elaborated as well. This document serves as a general guide for the provision of telerehabilitation services and do not describe a specialty-specific clinical practice guideline.

Pediatric teledermatology: A review of the literature.

Skin complaints are common among pediatric patients, yet as of 2020, fewer than 400 board-certified pediatric dermatologists currently practice in the United States. Pediatric teledermatology may address barriers to dermatologic care in children, assisting with distant geographic locations and long wait times. A review of the literature was conducted to synthesize important features of teledermatology for pediatric dermatologists. We summarize types of telemedicine platforms, common dermatologic conditions seen by pediatric teledermatologists, diagnostic accuracy and concordance, and guidelines from the American Academy of Dermatology and the American Telemedicine Association regarding teledermatology. This report highlights the utility of pediatric telemedicine in both the outpatient and inpatient dermatology setting to increase access to high-quality dermatologic care.

The Indian Health Service Primary Care-Based Teleophthalmology Program for Diabetic Eye Disease Surveillance and Management.

Background: Historically, fewer than half of American Indians and Alaska Natives (AI/AN) with diabetes received the annual diabetic retinopathy (DR) examination that is considered the minimum standard of care; this rate is similar to that of the general United States (U.S.) population with diabetes.Solution: The Indian Health Service-Joslin Vision Network (IHS-JVN) Teleophthalmology Program in 2000 to increase compliance with DR standards of care among AI/AN through validated, primary care-based telemedicine. The IHS-JVN provides remote diagnosis of DR severity, with a report including management recommendations that is returned to the patient's primary care provider. The program conforms with the American Telemedicine Association (ATA) Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy.Outcomes: The IHS-JVN has been expanding incrementally since the first patients were recruited in 2000; this expansion coincides with large improvements in the annual DR examination rates reported as part of local, regional, and national regulatory compliance under the Government Performance and Results Act (GPRA). Currently, with 99 clinical implementations in 23 states, IHS-JVN is the largest primary care-based ATA validation category three telemedicine program in the U.S.Summary: This article describes the program's workflow, imaging and reading technologies, diagnostic protocols, reports to providers, training, quality assurance processes, and geographical distribution. In addition to its clinical use, the program has been utilized in research on utilization of diabetic eye care, cost-effectiveness, technology development, and DR epidemiology of the AI/AN population. Potential next steps for this program are discussed.