Telehealth Network Research Articles

The Southeast Telehealth Network

The Southeast Telehealth Network

Users and Nonusers of University-Based Dermatology Services Following a Teledermatology Encounter: A Retrospective Descriptive Analysis

The aim of this study was to retrospectively describe hybrid technology teledermatology encounters performed by a statewide telehealth network. Consult outcomes were reviewed to describe the number of encounters that resulted in a visit to the university-based dermatology clinics and the features of those visits. Teledermatology encounters were reviewed to determine encounter volume and the proportion of encounters that resulted in a university-based dermatology clinic visit. Additional information collected included demographics, the reason for the visit, management recommendations, and clinical diagnoses. After identifying those consults that resulted in a dermatology clinic visit, we reviewed a random sample of teledermatology encounters that did not result in a university-based dermatology clinic visit for a descriptive comparison. A total of 1,536 teledermatology encounters were completed by the network between 2001 and 2007. Of the 1,307 encounters reviewed, 56 patients were seen in the university-based dermatology clinic after the teledermatology encounter. The need for a procedure or clinic-based intervention was a reason for the visit in 79% of these encounters. When reviewing management recommendations, 46% of the patients who required a university-based clinic visit needed a procedural intervention compared with 8% of the group that did not need a clinic visit. Medical recommendations predominated in the telemedicine-only group (71%) compared with the clinic-based visit group (36%). Our study describes the features, such as demographics and case-mix, of users and nonusers of university-based dermatology clinics after teledermatology encounters that may be important considerations for future evaluations of teledermatology consult systems.

Using Telehealth to Treat Combat-Related Traumatic Brain Injury

Using Telehealth to Treat Combat-Related Traumatic Brain Injury

Exploring Perceptions of Healthcare Professionals in the Implementation of a New Professional Role of Clinical Telehealth Coordinator Within a University Integrated Healthcare Network

As telehealth networks develop across Canada, new professional roles start to emerge. A university healthcare center part of an integrated health network has identified the need to introduce a clinical coordinator for specialized telehealth programs. However, very little is found in the current literature about the description or core competencies that such a professional should possess as well as the ways to implement this role. The objective of this study was to explore how healthcare professionals (HCPs) involved in a specialized teleoncology program perceive a new clinical telehealth coordinator (CTC) role within a university integrated healthcare network (UIHN) in a metropolitan area in Québec, Canada. A descriptive qualitative design was used and a purposive sample of nine HCPs, including physicians, nurses, and pharmacists who were members of a UIHN teleoncology committee, was recruited. The HCPs identified that the CTC was a multifaceted role. The core competencies identified by the HCPs included knowledge, expertise, and experience. Participants identified three key factors in the implementation of this role, namely, the structural support, having a common language, and making the implementation of this role relevant. The results suggest that this CTC role may be more complex than originally expected and that the diverse competencies suggest an expanded nature to this role. This has important implications for administrative strategies when addressing the key factors in the implementation of this role.

Telehealth Tools for Public Health, Emergency, or Disaster Preparedness and Response: A Summary Report

Rapid advances in telehealth development and adoption are increasing the spectrum of information and communication technologies that can be applied not only to individual patient care but more broadly to population health as well. Participants in this breakout session were asked to address, from their diverse perspectives, a series of questions relating to the current and potential uses of telehealth applications and networks for public health and emergency/disaster preparedness and response systems. Participants identified several gaps in current understanding and research emphasis. There is a clear need for more and larger outcome studies to assess the impact and cost benefit of telehealth applications in terms of improving public health at the population and community levels. In addition, more research is needed to demonstrate the ability of telehealth tools and technologies to facilitate and extend the reach of major national clinical and public health research initiatives. Perhaps most importantly, the National Institutes of Health should develop and/or strengthen strategic partnerships with other funding agencies with overlapping or complementary interests to accelerate interdisciplinary research in this rapidly evolving but relatively understudied and complex field.

NIH Conference on the Future of Telehealth: Essential Tools and Technologies for Clinical Research and Care—A Summary

Major government efforts to widen the use of health information technology and speed the translation of biomedical research discoveries into clinical practice are converging with the rapid growth of the Internet to create unprecedented opportunities to use telehealth networks to broaden access to high-quality healthcare and expand the scope and reach of clinical and translational research. Recognizing the dual potential of telehealth networks to improve health outcomes and reduce barriers to participation in research, particularly in medically underserved communities, the National Center for Research Resources (NCRR), part of the National Institutes of Health (NIH), convened a national conference at the NIH on June 25-26, 2009, titled "Future of Telehealth: Essential Tools and Technologies for Clinical Research and Care," in collaboration with experts from the Health Resources and Services Administration, the Indian Health Service, the Department of Veterans Affairs, Internet2, and the NIH National Library of Medicine, National Institute of Biomedical Imaging and Bioengineering, and National Center for Minority Health and Health Disparities. The conference brought together over 400 subject matter experts from government, academia, and industry to discuss a wide range of issues in telehealth research and development. Its primary outcome is a set of short papers reporting on recommendations from thematic breakout sessions and some overarching recommendations that can, taken together, stimulate and help guide further research through new multi-agency, interdisciplinary collaborations.

Innovation networks for improving access and quality across the healthcare ecosystem.

Partnerships between patient communities, healthcare providers, and academic researchers are key to stepping up the pace and public health impact of clinical and translational research supported by the National Institutes of Health. With emphasis shifting toward community engagement and faster translation of research advances into clinical practice, academic researchers have a vital stake in widening the use of health information technology systems and telehealth networks to support collaboration and innovation. However, limited interaction between academic institutions and healthcare providers hinders the ability to form and sustain the integrated networks that are needed to conduct meaningful community-engaged research that improves public health outcomes. Healthcare providers, especially those affiliated with smaller practices, will need sustainable infrastructure and real incentives to utilize such networks, as well as training and additional resources for ongoing technical assistance.

A pilot telerehabilitation program: delivering early intervention services to rural families.

The enTECH Telerehabilitation Program explored the use of telerehabilitation as an alternative service delivery model for early intervention therapy services. Utilizing the Kentucky Telehealth Network, two families living in rural Kentucky received occupational therapy services over a 12-week period. Following program implementation, qualitative data was collected using participant journals and interviews. Data analysis identified three thematic categories related to the program: benefits/strengths, challenges/weaknesses, and recommendations for program improvement. Results of the program evaluation indicated that telerehabilitation has the potential to cost-effectively meet the therapeutic needs of children living in rural areas where provider shortages exist. The enTECH Telerehabilitation Program serves as a model for how telerehabilitation can be used to deliver early intervention services to ameliorate health disparities and improve access to rehabilitation services.

Telehealth as Gatekeeper: Policy Implications for Geography and Scope of Services

Why, despite enthusiasm, is telehealth still a relatively minor part of healthcare delivery in many health systems? We examined two less-considered policy issues: (1) the scope of services being offered by telehealth and how this matches existing arrangements for insured services; and (2) how the ability of telehealth services to minimize barriers associated with geography is dealt with in a system organized and financed on geographical boundaries. Fifty-three semistructured interviews with key stakeholders involved in the management of 43 Canadian telehealth programs were conducted. In addition, quantitative activity data were analyzed from 33 telehealth programs. Two telehealth approaches emerged: telephone-based (N = 3), and video-conferencing-based (N = 40). Most programs reflected, rather than superceded, existing geographical boundaries; with the technology being used, the videoconferencing models imposed significant barriers to unfettered access by outlying communities because they required sites to acquire expensive technology, be affiliated with an existing telehealth network, and schedule visits in advance. In consequence, much activity was administrative and educational, rather than clinical, and often extended beyond the set of mandatory insured services. Despite high hopes that telehealth would improve access to care for rural/remote areas, gatekeeping inherent in certain telehealth systems imposes barriers to unfettered use by rural/remote areas, although it does facilitate other valued activities. Policy approaches are needed to promote a closer match between the expectations for telehealth and the realities reflected by many existing models.

The attitudes of multiprofessional teams to telehealth adoption in northern Finland health centres

A telehealth network was established between seven health centres, the local university and the university hospital in the Oulu Arc Subregion in a rural area of northern Finland. During the period 2004-2007, the videophone network was used for different types of teleconsultation (orthopaedics, psychiatry, diabetes, rehabilitation), continuing education and various patient care and administrative meetings. Qualitative research with observation and interviews with 30 professionals (physicians, nurses, psychiatric nurses, physiotherapists) was carried out in early 2007 to find out health-care professionals' attitudes toward telehealth and to see how the attitudes were connected to telehealth usage. Overall, the attitudes were more positive than negative, ranging from negative to enthusiastically positive. Diversity of attitudes occurred in relation to time, situation, profession, health centre and telehealth application. Ten different types of telehealth adopters were recognized: enthusiastic user, positive user, critical user, hesitant user, positive participant, hesitant participant, critical participant, neutral participant, negative participant and positive non-participant. Telehealth was especially well accepted in continuing education and in diabetes teleconsultations. The study showed that a negative attitude was not a definite barrier to telehealth adoption, but it did require additional attention from project workers and managers. Project staff and managers need to take into account the diverse attitudes of health professionals, because different people require different actions to adopt telehealth in their work.

Table of Contents

AbstractDelays and Diminished Income Streams Impact Iowa MH ServicesColorado Launches Telehealth Network to Connect Rural and Urban MH ProvidersStudy Highlights Barriers to Treatment for Adolescent DepressionUSPRA Battling Stigma With State LegislatorsNew Army Program Hopes to Improve Soldiers' Mental HealthBriefly NotedState NewsResourcesComing up

Ethical Considerations Regarding the Use of Technology for Older Adults: The Case of Telehealth

Life expectancy increases and ongoing growth of the population older than 65 have led to new models of aging research aimed at promoting independence and empowerment of older adults. Advances in information technology have introduced numerous ways to enhance or expand health care and support service research and development. The purpose of this article is to discuss ethical considerations associated with the use of technology with older adults in research and practice and to present a framework for such ethical parameters. Specifically, we focus on the case of telehealth and discuss examples from the Native People for Cancer Control Telehealth Network to exemplify the framework. The proposed framework includes the concepts of privacy, informed consent, equity of access, patient-provider communication, and usability. These issues constitute a roadmap for researchers, practitioners, system designers, policy makers, and administrators who aim to conduct ethical research that results in improved care and support services to older adults and increase health care access for rural and underserved populations.

Long term success of a telehealth network: a case study of the Upper Peninsula Telehealth Network

Telemedicine, the provision of healthcare via telecommunication technology, is an increasingly popular option for providing healthcare services as healthcare organisations are challenged to contain costs. Telemedicine is ideally suited to meet the special demands present in rural areas, but the fact remains that many telemedicine projects fail to achieve financial viability once grant funding has been removed. This case study investigated the long-term success of the Upper Peninsula Telehealth Network (UPTN), a project that has grown from a pilot effort to a financially sustainable network operating at 42 sites. Viewed through the theoretical lens of critical mass theory, findings suggest the two primary keys to the UPTN's success were: a strategy of slow but sustainable growth; and a sponsor that helps coordinate network activities and makes it simpler for new organisations to join the network.

Applying Telehealth in Natural and Anthropogenic Disasters

There are myriad telehealth applications for natural or anthropogenic disaster response. Telehealth technologies and methods have been demonstrated in a variety of real and simulated disasters. Telehealth is a force multiplier, providing medical and public health expertise at a distance, minimizing the logistic and safety issues associated with on-site care provision. Telehealth provides a virtual surge capacity, enabling physicians and other health professionals from around the world to assist overwhelmed local health and medical personnel with the increased demand for services postdisaster. There are several categories of telehealth applications in disaster response, including ambulatory/primary care, specialty consultation, remote monitoring, and triage, medical logistics, and transportation coordination. External expertise would be connected via existing telehealth networks in the disaster area or specially deployed telehealth systems in shelters or on-scene. This paper addresses the role of telehealth in disaster response and recommends a roadmap for its widespread use in preparing for and responding to natural and anthropogenic disasters.

Tele-homecare and telehealth care network in Taiwan

Tele-homecare and telehealth care network in Taiwan

“To Care for Him Who Shall Have Borne the Battle and for His Widow and His Orphan” (Abraham Lincoln): The Department of Veterans Affairs Polytrauma System of Care

Sigford BJ. “To care for him who shall have borne the battle and for his widow and his orphan” (Abraham Lincoln): the Department of Veterans Affairs Polytrauma System of Care.The initiation of combat in Iraq and Afghanistan has resulted in a new cohort of active-duty service members and veterans seeking rehabilitation care through the U.S. Department of Veterans Affairs (VA). Service members injured in combat most often sustain multiple injuries (polytrauma) and require a unique service delivery model to meet their needs. The VA recognized this need and responded with the development of the Polytrauma System of Care (PSC). This national system of care balances access and expertise to provide specialized life-long care to the combat injured. The PSC is comprised of: 4 specialized regional rehabilitation centers that are accredited in brain injury by the Commission on Accreditation of Rehabilitation Facilities; 21 specialized outpatient and subacute rehabilitation programs; designated polytrauma teams at smaller, more remote VA facilities; and a point of contact at all other VA facilities. In addition, the PSC has developed a proactive case-management model, a specialized telehealth network, guidelines for long-term follow-up, and services for those individuals who are unable to return home. The following commentary and articles provide additional detail on this new and unique system of care.

Enhancing Access of Combat-Wounded Veterans to Specialist Rehabilitation Services: The VA Polytrauma Telehealth Network

Darkins A, Cruise C, Armstrong M, Peters J, Finn M. Enhancing access of combat-wounded veterans to specialist rehabilitation services: the VA Polytrauma Telehealth Network.Operations Iraqi Freedom and Enduring Freedom have resulted in U.S. military personnel sustaining combat wounds of unprecedented severity and complexity that necessitate long-term rehabilitation. To meet what are often conflicting requirements in providing severely wounded veterans with timely and convenient access to specialist rehabilitation care, and to enable them to return to their local communities, the Veterans Health Administration has developed a state-of-the-art Polytrauma Telehealth Network that enhances access to such services by linking Veterans Administration rehabilitation facilities. This article describes the clinical, technical, and business process issues involved in the development of this network.

An economic evaluation of a telehealth network in British Columbia

We carried out an economic evaluation of the northernmost five sites of the British Columbia telehealth network. The videoconferencing network links health-care facilities in 12 communities with Vancouver, for clinical consultations, administrative meetings and educational sessions. The economic evaluation was based on the netcost criterion (i.e. cost of telehealth minus travel costs avoided). Cost and utilization data were obtained from client interviews and log data compiled between September 2001 and January 2003. The results showed that the subnetwork of five sites was not only cost reducing, but also cost-effective. Travel costs for administrative meetings were reduced by $724,457/annum and were greater than the annual fixed and variable costs of all the telehealth sessions ($553,740). A sensitivity analysis was conducted on six parameters: amortization period, opportunity cost of capital, operating cost of a telehealth session (by type of session), number of telehealth sessions, travel time and the opportunity cost of travel time. The study suggests that the cost-effectiveness of telehealth to remote areas will increase over time as the cost of equipment continues to fall, as network connections become cheaper and as utilization rates rise.

An analysis of business issues in a telestroke project

A telehealth network based at the Medical College of Georgia was established in 2003 to treat stroke patients in remote hospitals. In the first three years, more than 400 patients were evaluated at nine rural hospitals. A total of 65 patients (16%) were treated with tissue plasminogen activator (approximately half of them in less than 2 h). Although clinically successful, the system reached the point at which it would either further diffuse or die out. We examined the roles played by internal and external factors in the development of the system. We interviewed 25 individuals in five hospitals (the hub hospital and four rural hospitals). Important business issues were identified that would need to be addressed in order to expand the project and make it self-sustaining. The external factors were economic, legal and market issues. The internal factors were organizational, technical and educational issues. Early identification and negotiation of business issues related to project implementation are likely to be important in diffusion and sustainability.

Technology exchange for cancer health network

19598 Background: The Technology Exchange for Cancer Health Network (TECH-Net) is a collaborative, multi-state effort to implement a systematic care program to improve cancer management in the rural communities of west Tennessee, north Mississippi and east Arkansas. This Health Information Technology (HIT) project uses a two-pronged approach to total clinical decision support: (1) provide access to oncology, hematology, and other specialists through the dedicated telehealth network of the University of Tennessee's Health Science Center in conjunction with the University of Tennessee Cancer Institute; and (2) rely on a distributed electronic health record (EHR) with integrated decision support systems for online management of cancer protocols, electronic orders, and medication management. Methods: Patients with a cancer diagnosis requiring treatment for at least one year are eligible to participate. The ultimate goal for this project is to enroll 250 patients (125 rural, 125 urban) and compare quality, safety, and cost outcomes for patients receiving rural Telehealth care versus “routine” urban care. Telehealth patients see their oncologist in person at the rural sites for initial care, and see their physician via telemedicine for approximately one-half of their subsequent visits. This approach allows the clinician to make in-person clinical assessments on a regular basis while still taking advantage of the time savings associated with telemedicine. Results: 163 patients have been enrolled in the study (127 rural, 36 urban) over 18 months. Patient satisfaction has been high - 95 % of patients indicated their telemedicine visit was as good as or better than an in-person office visit. Cost analysis comparing cost savings (physician travel time) with telemedicine costs (equipment, high speed lines) indicates that the cost-benefit depends critically on distance to the rural facility and number of physician trips avoided. Initial cost data indicate that telemedicine must save at least 5 hours of physician travel time per month to break even. Conclusions: Telemedicine offers a feasible method for increasing access to oncology care in rural areas that is well-accepted by both patients and clinicians. No significant financial relationships to disclose.