Clinical Telehealth Research Articles

Asynchronous Video-Otoscopy with a Telehealth Facilitator

The study investigated whether video-otoscopic images taken by a telehealth clinic facilitator are sufficient for accurate asynchronous diagnosis by an otolaryngologist within a heterogeneous population. A within-subject comparative design was used with 61 adults recruited from patients of a primary healthcare clinic. The telehealth clinic facilitator had no formal healthcare training. On-site otoscopic examination performed by the otolaryngologist was considered the gold standard diagnosis. A single video-otoscopic image was recorded by the otolaryngologist and facilitator from each ear, and the images were uploaded to a secure server. Images were assigned random numbers by another investigator, and 6 weeks later the otolaryngologist accessed the server, rated each image, and made a diagnosis without participant demographic or medical history. A greater percentage of images acquired by the otolaryngologist (83.6%) were graded as acceptable and excellent, compared with images recorded by the facilitator (75.4%). Diagnosis could not be made from 10.0% of the video-otoscopic images recorded by the facilitator compared with 4.2% taken by the otolaryngologist. A moderate concordance was measured between asynchronous diagnosis made from video-otoscopic images acquired by the otolaryngologist and facilitator (κ=0.596). The sensitivity for video-otoscopic images acquired by the otolaryngologist and the facilitator was 0.80 and 0.91, respectively. Specificity for images acquired by the otolaryngologist and the facilitator was 0.85 and 0.89, respectively, with a diagnostic odds ratio of 41.0 using images acquired by the otolaryngologist and 46.0 using images acquired by the facilitator. A trained telehealth facilitator can provide a platform for asynchronous diagnosis of otological status using video-otoscopy in underserved primary healthcare settings.

A pilot trial of a speech pathology telehealth service for head and neck cancer patients

We explored the feasibility of providing access to specialist speech pathology services via telehealth for patients with head and neck cancer. A weekly telehealth clinic was conducted between the speech pathology departments of a tertiary hospital and a regional hospital in Queensland. Over a 5-month period, 50 telehealth sessions were conducted for 18 patients. There were 38 patient consultations, nine case discussions between clinicians and three clinical training sessions relating to the skills needed for specific client management (e.g. voice prosthesis selection). Eight sessions had multidisciplinary involvement. All cases were successfully managed via telehealth. All patients agreed that they were comfortable using telehealth and would be happy to use it again in future. Both clinicians agreed that they could competently assess patients using the telehealth system. There appeared to be financial benefits for the patient, because by receiving specialist intervention at a local facility their travel expenses were lower. There was also the opportunity for workforce training and development through online case discussion and clinical consultation.

Outcome data for the remote patient monitoring over three years of over 1000 patients in Northern Ireland with a long-term chronic illness

Over a period of four years Alere Connected Health’s (ACH) management and specialist telehealth nurses have designed, implemented and delivered a completely new and re-engineered model of community care for people with long-term conditions (LTC) that has resulted in the delivery of a full ‘end to end’ clinical telehealth managed service monitoring over the period for over 1000 patients from two NHS Trusts in Northern Ireland. ACH were commissioned to develop programmes to deliver chronic disease monitoring and from the outset it was clear that the Department of Health was looking for a ‘service delivery’ partner rather than a ‘kit provider’. This regional telehealth programme in partnership with Belfast Health and Social Care Trust and South Eastern Health and Social Care Trust managed patients with one or more long-term conditions, their main chronic conditions being COPD, CHF and Diabetes. This new model of care has now been commissioned by the NHS in Northern Ireland as a National telehealth monitoring service awarding a 6-year contract for the monitoring of several thousand people with a LTC. The ACH telehealth service is ‘technology agnostic’ and can be used with point of care devices from any manufacturer, making it easier for commissioners and users that are already familiar with a particular telehealth product or manufacturer. During the four-year programme the ACH team developed an innovative web based activity database and telehealth management system software (TMS) in order to gather additional data from and about the patients care in order to determine more accurate programme evaluation data. The data gathered involved clinical, technical and statistical information in order to determine patient utilisation, return on investment (ROI) information and programme outcomes not usually derived from most commercial telehealth ‘back-end’ web server solutions. (In the process the ACH nursing team won two National Awards for ‘Innovation and Partnering’ with the NHS.) A number of significant outcomes and goals have been achieved during the past four years about service delivery and clear evidence suggests that tele health home patient monitoring can be used as a method of reducing hospital admissions, it appears to promote patients to become better self managers of their long term condition and ultimately enjoy a better quality of life, whilst delivering cost efficiencies to the health care provider. This resulted in fewer unnecessary appointments with their GP.

141 Feasibility and Effectiveness of a Telehealth Clinic for Lung Transplant Recipients

Many lung transplant programs are challenged with the lifelong follow-up of recipients who reside at a distance from the transplant center. The Ontario Lung Transplant Telehealth Program aims to deliver post-transplant follow-up care to such patients through secure remote videoconferencing. Our objectives were to evaluate the feasibility and effectiveness of this service.

Clinical use of Skype: a review of the evidence base

Skype is a popular and free software application that allows PCs and mobile devices to be used for video communication over the Internet. We reviewed the literature to determine whether the clinical use of Skype is supported by evidence. One small (n = 7) controlled clinical trial had assessed the effect of nursing communication using Skype on elderly patients with dementia and their carers. However, we were unable to identify any large, well-designed studies which had formally evaluated the safety, clinical effectiveness, security and privacy of Skype for the routine delivery of patient care. While there were many case reports and small studies, no firm evidence either in favour of, or against the use of Skype for clinical telehealth was found. The risks and benefits of using Skype for clinical purposes are not known.

Back to the future of IT adoption and evaluation in healthcare

This is a time of expansion, hope and change in the area of Health Information Technology (HIT). In this study, we provide an in-depth perspective into the adoption and diffusion of IT in healthcare based on a review of the current literature and upon expert panel assessments of adoption and diffusion issues, achievements to date, challenges facing key e-health technologies and future possibilities. These data are synthesised in the form of a research framework showing the main three areas of e-health (Electronic Medical Records, Clinical and Administrative systems and Telehealth) on three levels (individual, organisation and system). Current adoption and diffusion challenges and future possibilities are systematically presented via this research framework to inspire practice and research with both an individual and collective view of the key health systems currently confronting the healthcare sector.

Telemedicine and Epilepsy Care - A Canada Wide Survey

Canadian provinces boast one of the most sophisticated telemedicine infrastructures in the world. Feasibility of epilepsy care through telemedicine is established, but its use by practicing neurologists is unknown. The Canadian League against Epilepsy's telemedicine task force conducted this study to understand the perceptions, barriers and usage of telemedicine in epilepsy care. Using a 14 item questionnaire we prospectively surveyed all the epileptologists across Canada with regards to current use, perceived benefits and barriers to the use of telemedicine. The survey was mailed out to 76 neurologists who had a primary interest in epilepsy. We received 39 responses (54.1%) spanning seven provinces. Majority of the responders were 50 years and over (56.4%). Although 61.5% of the physicians acknowledged a need for tele-epilepsy services, the majority (64.1%) had not used telemedicine. The most common forms of technology were videoconferencing and telephone but some physicians had also used email. Telemedicine was mainly used for clinical and educational purposes. 79.5% of physicians had access to videoconferencing equipment and 61.5% assessed that there was a need/use for clinical telehealth. The main perceived obstacles in the use of telemedicine were: lack of infrastructure support and remuneration problems followed by limitations in clinical examination. Although widely available, telemedicine is under-utilized in epilepsy care. Most of the obstacles can be easily fixed and overcome through education and simple interventions. Partnering of epilepsy centers across Canada in the development of a comprehensive national telemedicine network would create an excellent opportunity to expand epilepsy care.

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.

Evaluation of a Telehealth Clinic as a Means to Facilitate Dermatologic Consultation: Pilot Project to Assess the Efficiency and Experience of Teledermatology Used in a Primary Care Network

Primary care offices spend considerable time coordinating the specialist referral process. Patients experience long wait times for consultation and intervention. To determine if telehealth combined with interdisciplinary team-based care can reduce wait times for dermatologic consultation while making the consultation process easier for physicians. Retrospective chart reviews as well as patient, referring physician, nonreferring physician, clinic physician, nurse, and teledermatologist interviews were used to evaluate the clinic. A comparative immersion approach generated themes from field notes. Wait times, appointment times, and encounter durations were measured. Twenty-eight patients were seen (23 had previous specialist referral experience) within 1 week of referral compared to a wait period of 104 days for conventional referral. Patients requiring intervention were treated within 1 week of their initial appointment. Referring practitioners were concerned that they would lose control of patients' care. An easier referral process and faster intakes met physician expectations. Teledermatology improves the timeliness of appointments. Patients forgo face-to-face appointments if alternatives are available sooner. Physicians are concerned about their own liability if dermatologists do not assess the patient in person but will refer through teledermatology when patients are seen faster and they remain in control of the care process.

Clinical Telehealth Across the Disciplines: Lessons Learned

Videoconferencing technologies can vastly expand the reach of healthcare practitioners by providing patients (particularly those in rural/remote areas) with unprecedented access to services. While this represents a fundamental shift in the way that healthcare professionals care for their patients, very little is known about the impact of these technologies on clinical workflow practices and interprofessional collaboration. In order to better understand this, we have conducted a focused literature review, with the aim of providing policymakers, administrators, and healthcare professionals with an evidence-based foundation for decision-making. A total of 397 articles focused on videoconferencing in clinical contexts were retrieved, with 225 used to produce this literature review. Literature in the fields of medicine (including general and family practitioners and specialists in neurology, dermatology, radiology, orthopedics, rheumatology, surgery, cardiology, pediatrics, pathology, renal care, genetics, and psychiatry), nursing (including hospital-based, community-based, nursing homes, and home-based care), pharmacy, the rehabilitation sciences (including occupational and physical therapy), social work, and speech pathology were included in the review. Full utilization of the capacity of videoconferencing tools in clinical contexts requires some basic necessary technical conditions to be in place (including basic technological infrastructure, site-to-site technological compatibility, and available technical support). The available literature also elucidates key strategies for organizational readiness and technology adoption (including the development of a change management and user training plan, understanding program cost and remuneration issues, development of organizational protocols for system use, and strategies to promote interprofessional collaboration).

Pharmacists run telehealth clinic to keep veterans independent

The man had poor control over his blood glucose concentrations and a glycosylated hemoglobin (HbA1c) value of 8.6% when he first came to the attention of clinical pharmacy specialist Kristin To. With a change to 500-unit/mL insulin in concert with monitoring and dosage adjustments by the pharmacist-run diabetes telehealth clinic where To value was 6.7% works, the man’s HbA1c at the most recent check. To is one of three pharmacists who run the three-year-old diabetes telehealth clinic at the flagship medical facility in the Department of Veterans Affairs (VA) Palo Alto Health Care System in California. She said the man continues to have his glucose concentration under control. Her telephone calls to him have gone from weekly to once every couple of months. “It’s not that we’re not monitoring him anymore—we are still monitoring,” To said. “But if things look good, we don’t call him on a regular basis.” More than 30,000 veterans were participating at the end of fiscal year 2007 in what VA calls “care coordination home telehealth.”

Rural School-Based Telehealth: How to Make It Happen

When organizing new health care interventions among a rural population, a careful planning process respecting community-specific considerations should be used. The project objective centered on the successful implementation of a school-based telehealth clinic serving a rural, health-disparate population. Using an American Academy of Pediatrics Community Access to Child Health planning grant, a needs assessment of the Delta community was conducted. In synthesizing the results of this planning project, consensually addressed issues led to establishing a pilot school-based telehealth clinic within the rural county schools. Seven essential steps emerged as a set of guidelines that entities might consider in introducing a telemedicine school-based service in a rural community. The steps included assessing local and regional needs, securing community support and establishing goals, evaluating resources, configuring logistics, training staff, informing parents, and launching the clinic. Proper planning is crucial to the establishment of a rural school-based telehealth clinic.

Tele-Help Line for Caregivers (TLC)

This article presents a brief overview of the literature on the unique and diverse needs of rural caregivers and issues related to the design and implementation of caregiving interventions in rural areas. The Tele-Help Line for Caregivers (TLC), a clinical telehealth intervention currently underway for rural caregivers, is described. A case example is presented, demonstrating the benefits of a telehealth intervention for the rural caregiver. Each component of the intervention is described and preliminary outcome data are discussed. Issues related to the applicability of the intervention for a racially/ethnically diverse group of caregivers are also addressed.

An experimental study comparing the effects of combined transcutaneous acupoint electrical stimulation and electromagnetic millimeter waves for spinal pain in Hong Kong

To compare the efficacy of combined transcutaneous acupoint electrical stimulation (TAES) and electromagnetic millimeter wave (EMMW) therapy as an add-on treatment for pain relief and physical functional activity enhancement among adults with sub-acute non-specific spinal pain in either the low back or neck. A non-blinded study with data obtained before, immediate, one week and three months after intervention. The Telehealth Clinic and Community Centre, Hong Kong. Forty-seven subjects with either sub-acute neck or low back pain. Subjects were randomly allocated to either an intervention group (n=23) or a control group (n=24). These groups were then divided into subgroups according to the site of their spinal pain-neck or back. The intervention group had eight treatments over a three-week period of TAES and EMMW. Changes from baseline to the end of treatment were assessed at intervals of one week and three months on either neck or low back pain intensity [by Visual Analogue Scale (VAS)]; stiffness level; stress level; neck or low back lateral flexion and forward flexion in cm, and interference with daily activities. The baseline VAS scores for the intervention and control groups were 5.34 and 5.18 out of 10, respectively (P value=0.77). At the one week and three month assessments, there were no significant differences between the groups-VAS (P value=0.09 and 0.27, respectively). A further subgroup of chronic pain sufferers (n=31) was identified and these had significantly reduced pain intensity at the one week assessment (P value=0.04) but this was not sustained at post three months after treatment (P value=0.15). Improvements in stiffness level, stress level, and functional disability level in the intervention group were not significant. Our study shows that there was a reduction in pain intensity, stress and stiffness level immediately after the eight sessions of treatment (TAES and EMMW), though the effect is not sustained after a week. No pain relief was found with the neck pain subgroup. However, the reduction in subjective average pain intensity among the chronic pain subgroup was sustained at the post one week assessment for the intervention group but not at the post three month assessment.

Telehealth Organizational Implementation Guideline Issues

The current status of policies, guidelines and standards related to the organizational context of clinical telehealth practice were investigated. The directions these should take to meet the healthcare needs of Canadians also were outlined. An environmental scan approach was employed, consisting of a literature review, stakeholder survey questionnaire, and 12 key informant interviews. The literature review resulted in 260 sources related to organizational leadership issues, of which 176 were abstracted. The stakeholder survey questionnaire response rate was 64% (156/245), with 55% (84/154) completing the organizational context section. All (100%) key informants who were selected for interviews participated. Findings were categorized into four key organizational themes: organizational readiness, quality assurance, accountability, and continuity. Organizations need to review existing policies, standards, and guidelines in order to determine whether telehealth is covered and, if not, revise them or develop new telehealthspecific policies. Telehealth policies and procedures should be integrated with those in existence for face-to-face services.

An experimental study on the effectiveness of acupressure with aromatic lavender essential oil for sub-acute, non-specific neck pain in Hong Kong

To assess the efficacy of acupressure using an aromatic essential oil (lavender) as an add-on treatment for pain relief and enhancing physical functional activities among adults with sub-acute non-specific neck pain. Experimental study design. The Telehealth clinic and the community centre, Hong Kong. A course of 8-session manual acupressure with lavender oil over a 3 week period. Changes from baseline to the end of treatment were assessed on neck pain intensity [by Visual Analogue Scale (VAS)]; stiffness level; stress level; neck lateral flexion, forward flexion and extension in cm, and interference with daily activities. The baseline VAS score for the intervention and control groups were 5.12 and 4.91 out of 10, respectively (P = 0.72). One month after the end of treatment, compared to the control group, the manual acupressure group had 23% reduced pain intensity (P = 0.02), 23% reduced neck stiffness (P = 0.001), 39% reduced stress level (P = 0.0001), improved neck flexion (P = 0.02), neck lateral flexion (P = 0.02), and neck extension (P = 0.01). However, improvements in functional disability level were found in both the manual acupressure group (P = 0.001) and control group (P = 0.02). Our results show that eight sessions of acupressure with aromatic lavender oil were an effective method for short-term neck pain relief.

The validity and reliability of the World Health Organization Mental Disorders Checklist for use in a telehealth clinic in Hong Kong

This research aimed to test the validity and reliability of the 'World Health Organization Mental Disorders Checklist' for use in a telehealth clinic in Hong Kong. The Checklist adopted four subscales: (i) depression; (ii) anxiety; (iii) alcohol use disorders; and (vi) functioning and disablement, and was translated from English into Chinese. It was validated by a panel of five experts to confirm its content validity (content validity index = 0.98) and cultural appropriateness in Hong Kong. The reliability of the checklist was supported by the findings of a test-retest procedure (Pearson correlation = 0.66-0.88, P < 0.01), internal consistency reliability (Cronbach's alpha = 0.54-0.83), and interrater reliability (Kendall's coefficient of concordance = 0.58-1.00, P < 0.01) involving a sample of 197 subjects from one telehealth clinic in Hong Kong.

Telepsychiatric Care of American Indian Veterans with Post-Traumatic Stress Disorder: Bridging Gaps in Geography, Organizations, and Culture

This paper describes a weekly telepsychiatry clinic treating post-traumatic stress disorder (PTSD) among Northern Plains American Indian Veterans. The clinic represents a unique partnership of five different organizations, including two agencies within the Veterans Affairs Administration, a tribal veterans program, the Indian Health Service, and a university medical center. It is the first report of a telepsychiatry clinic targeting American Indians, as well as the first account of a telepsychiatry clinic focusing on PTSD treatment. A total of 50 telehealth clinic interactions occurred during the first 7 months, consisting of ongoing group psychotherapy, individual therapy, and medication management. Quality control measures exhibited a high degree of patient satisfaction and comfort with the clinic. Although the findings presented here are preliminary, this clinic represents a viable model for the delivery of telepsychiatric services. Future research is needed regarding the process and outcomes of delivering psychiatric care by this means for rural, isolated, American Indians, as well as of the treatment of PTSD via real-time, interactive videoconferencing.

Telehealth consultations in rheumatology: cost-effectiveness and user satisfaction.

We conducted a feasibility study to assess user satisfaction with and the cost-effectiveness of a rheumatology telehealth clinic in northern Alberta. Six telehealth clinics were organized between a rural health centre and the specialist rheumatology centre, which was about a 4 h drive away. Fifty-two new patients were seen. Their median age was 54 years (range 7-81 years). After the teleconsultation, no patient required a conventional face-to-face consultation. Overall, patients agreed that the teleconsultation met their needs and that the care they received was as good as conventional care. The physicians involved in the study thought the process practical and effective. The total costs of service delivery would be equal for teleconsultation and for traditional consultation at a workload of 247 consultations a year.