The Michigan Stroke Network is using telemedicine to facilitate rapid stroke treatment in emergency departments and improve patient transfers to stroke centers where they get comprehensive treatment.
Problem: Stroke is the 3rd leading cause of death and a leading cause of long-term disability, and recovery depends on prompt response with the appropriate treatment. However many hospitals do not have access to stroke specialists to make live-saving and function-saving decisions when seconds count.
Innovative Program: In 2006, The Michigan Stroke Network started using robotic technology to provide 24-hour access to stroke specialists for 31 participating hospital emergency departments. Specialists can guide the treatment as thought they were present at the patient's bedside.
How it Works: When a patient with signs of stroke arrives at a participating hospital ER, the hospital calls a toll-free number that pages the oncall stroke specialist who logs onto a laptop using a wireless Internet connection. The specialist "virtually arrives" within 9 to 12 minutes and uses a joystick to move the 5-ft robot and it's camera to observe the patient, view and assess lab results, CT scans and other diagnostic tests conducted by the ER, and make treatment recommendations. If the patient requires transfer to a stroke center, a helicopter crew (that was also alerted with the initial page) is onsite within minutes.
Ongoing Stroke Education: Ongoing education for medical professionals allows review of protocols and assessment processes to improve response time. Robots are also used to educate the public about stroke symptoms and prevention via virtual health fairs.
Results: In the first 17 months, the on-demand remote consultations have enhanced care for 173 patients at 31 participating hospitals. Patients received life-saving therapies (such as rt-PA) in more than 70% of cases.
Additional Observations: Access to stroke specialists is a significant challenge for many hospitals. The decision to start certain therapies that can save lives and restore function is dependent on specialized expertise -- if the therapy is given under the appropriate circumstances, patients have a much better recovery record. But if given in the wrong circumstances, the therapy can cause death or futher damage. These decisions are not usually made by the ER physician, but depend on highly specialized expert consultation that is most often not immediately available.
This robotic technology that allows two-way audio and visual communication between the specialist and the patient results in dramatic improvement in assuring that patients who meet the right criteria get life-saving treatment when it's needed.
For more information, see
http://www.innovations.ahrq.gov/content.aspx?id=1789
Sunday, March 15, 2009
Thursday, March 12, 2009
3-D Virtual and Simulation Technology in Medical Education and Training
Use of 3-D virtual world technology and simulation training is adding an exciting dimension to medical training. Could you attend medical school in a virtual world?
In my previous post about the debate around online medical degrees, it was noted that continuing education courses have become popular in distance education. Another aspect of technology innovations and distance learning is the emergence of 3-D and simulation training, and Duke University has a robust program called the "Center for Nursing Discovery" described below.
Using a student-centered approach, the Center for Nursing Discovery provides a variety of avenues of instructional methodology, including
simulation using high fidelity (or "lifelike") adult and pediatric mannequins,
role-playing,
self-instructions
faculty-assisted instruction
procedural task trainers to develop specific hands-on skills
standardized patients (trained actors), and
the use of innovative, state-of-the art multimedia.
Students can select various methods based on their learning styles to broaden assessment, communication, psychomotor, and cognitive skills within a safe environment.
Practice in the CND, along with their clinical experiences, will help students move towards development of their own evidence-based nursing practice, achieving the ultimate goal of becoming clinical leaders in providing excellent patient care.
Is there any reason why this technology couldn't be opened to an online learning experience, allowing student nurses to train in Pennsylvania
For more information, see http://nursing.duke.edu/modules/son_currentstudents/index.php?id=20
In my previous post about the debate around online medical degrees, it was noted that continuing education courses have become popular in distance education. Another aspect of technology innovations and distance learning is the emergence of 3-D and simulation training, and Duke University has a robust program called the "Center for Nursing Discovery" described below.
Using a student-centered approach, the Center for Nursing Discovery provides a variety of avenues of instructional methodology, including
simulation using high fidelity (or "lifelike") adult and pediatric mannequins,
role-playing,
self-instructions
faculty-assisted instruction
procedural task trainers to develop specific hands-on skills
standardized patients (trained actors), and
the use of innovative, state-of-the art multimedia.
Students can select various methods based on their learning styles to broaden assessment, communication, psychomotor, and cognitive skills within a safe environment.
Practice in the CND, along with their clinical experiences, will help students move towards development of their own evidence-based nursing practice, achieving the ultimate goal of becoming clinical leaders in providing excellent patient care.
Is there any reason why this technology couldn't be opened to an online learning experience, allowing student nurses to train in Pennsylvania
For more information, see http://nursing.duke.edu/modules/son_currentstudents/index.php?id=20
Tele-Ethics Consultations
With increased availability of advanced clinical technology, medical ethics dilemnas become more frequent. More and more, families and healthcare professionals have differing views on whether aggressive treatment should be insituted (or continued). Nursing homes are often faced with the dilemna of a non-responsive patient who doesn't have immediate family or caretakers to make end-of-life decisions.
Major medical centers have robust Medical Ethics Committees to advise and consult on these issues, comprised of experts in medicine, the law, religion, ethics and philosophy, etc. But the smaller hospital or nursing home (especially in remote areas)often doesn't have access to internal resources of this nature.
Telehealth is providing a valuable link to solve these problems, allowing small remote facilities to access Tele-Ethics consultations and education for professionals.
The Missouri Dept of Health developed a collaborative effort where rural nursing homes could access virtual ethics consultation via telephone, email and video conferencing. The Missouri Telehealth Network and the Long Term Care Ombudsman Office collaborated to facilitate communications between remote nursing homes an an academic medical center to provide consultations with a clinical ethicist.
Facilities without videoconferencing were given laptops with video cameras, and in 2006 the network provided 23 "portable ethics consultations". The technology was also used to conduct training for clinical personnel to increase their understand of and comfort with challenging bioethics situations.
This targeted nice of distance education is another example of telehealth as a cost-effective means of improving patient care outside of physical borders.
Source: Fleming & Reynolds (2007), "Virtual clinical ethics consultation for long term care facilities." Presented at American Society for Bioethics and Humanities 9th Annual Meeting, October 2007, Washington DC.
For more information on ethics and telehealth, see www.ecri.org
Major medical centers have robust Medical Ethics Committees to advise and consult on these issues, comprised of experts in medicine, the law, religion, ethics and philosophy, etc. But the smaller hospital or nursing home (especially in remote areas)often doesn't have access to internal resources of this nature.
Telehealth is providing a valuable link to solve these problems, allowing small remote facilities to access Tele-Ethics consultations and education for professionals.
The Missouri Dept of Health developed a collaborative effort where rural nursing homes could access virtual ethics consultation via telephone, email and video conferencing. The Missouri Telehealth Network and the Long Term Care Ombudsman Office collaborated to facilitate communications between remote nursing homes an an academic medical center to provide consultations with a clinical ethicist.
Facilities without videoconferencing were given laptops with video cameras, and in 2006 the network provided 23 "portable ethics consultations". The technology was also used to conduct training for clinical personnel to increase their understand of and comfort with challenging bioethics situations.
This targeted nice of distance education is another example of telehealth as a cost-effective means of improving patient care outside of physical borders.
Source: Fleming & Reynolds (2007), "Virtual clinical ethics consultation for long term care facilities." Presented at American Society for Bioethics and Humanities 9th Annual Meeting, October 2007, Washington DC.
For more information on ethics and telehealth, see www.ecri.org
Monday, March 9, 2009
Innovations in Distance Learning: Online Medical Degrees?
As the new Obama Administration ponders the massive reforms needed to save the struggling U.S. healthcare system, a key challenge is the predicted shortage of physicians.
When the first Baby Boomers turn 65, the age of Medicare eligibility, on 1/1/11, the system will be hard-pressed to find adequate numbers of physicians to support their needs.
Innovations in distance learning could provide an alternative to traditional medical schools in increasing the number of practicing doctors to meet the needs of medically underserved areas and the increasing number of patients who will clog an already struggling system.
Back in 2001, the late Dr Eugene Stead, Jr. proposed that it was “time for accredited medical schools to establish distance learning curricula that would allow experienced community-bound health professionals, such as physician assistants (PAs) and nurse practitioners (NPs), to take medical school courses from home or at work” (Stead, 2001).
Dr Stead is known as the founder of the Physician Assistant profession, having created the country’s first formal education program for Physician Assistants at Duke University in 1965. He suggested that providing online courses for these “non traditional but seasoned healthcare professionals” would accelerate the time to achieve a full medical degree, while allowing the practitioners to remain in active practice.
In 2001, Stead asked “Which medical school will be the first to take the lead, which has the courage to explore alternative pathways to becoming a physician?”
Eight years later, those questions remain unanswered in the U.S. Of the 130 accredited M.D.-granting medical schools in the U.S., none yet offers a full online medical degree. However, there are some international programs emerging to offer four-year online medical degrees: “The International Virtual Medical School - IVIMEDS - is a worldwide partnership of leading edge medical schools and institutions, setting new standards in medical education and blending high quality e-learning and face-to-face learning in the training of health care professionals” (IVIMEDS, 2009).
Online medical education in the U.S. has made some strides, with many offerings for Continuing Medical Education (CME) courses that physicians are required to complete to maintain their licenses and board certifications. Harvard Medical School offers a wide range of “multimedia enriched, comprehensive, and interactive” online CME courses that have been taken by students from 105 countries (Harvard, 2009). They cost about $20 for each course hour, and topics range from clinical to administrative and legal issues.
Dr. Stead (who died in 2005 at the age of 97) would no doubt be pleased to learn that his long-time employer, Duke University in North Carolina has incorporated distance learning degree program technologies in traditional classroom courses. Anesthesiology students there are “using computer simulations to enhance their learning and decision-making processes before applying these to patients in the operating room” (Degree Board, 2008).
Many universities are taking advantage of Duke’s good example to offer a combination of technologies designed to help their students learn as effectively as possible.
See the next post on Duke School of Nursing’s Center for Nursing Discovery for an example of a world class institution using simulations and innovative state-of-the-art multi-media in online and classroom learning.
For more information:
Degree Board (2008). Campus-Based College Degree Programs offer Online Lessons . Retrieved online on March 9, 2009 at http://tinyurl.com/arqhbn
Duke University School of Nursing (2009). Center for Nursing Discovery. Retrieved online on March 9, 2009 at http://tinyurl.com/atxbu2
Harvard (2009) Harvard Medical School Department of Continuing Education. Retrieved from the Internet on March 9, 2009 at http://cmeonline.med.harvard.edu/
IVIMEDS (2009) International Virtual Medical School. Retrieved online on March 9, 2009 at http://www.ivimeds.org/
Stead, E. (2001). “Using Distance Learning to Provide a Medical Education to Non-traditional Students,” North Carolina Medical Journal, Vol 62, Number 6, 2001 retrieved from the Internet on March 9, 2009 at http://easteadjr.org/guest.html
When the first Baby Boomers turn 65, the age of Medicare eligibility, on 1/1/11, the system will be hard-pressed to find adequate numbers of physicians to support their needs.
Innovations in distance learning could provide an alternative to traditional medical schools in increasing the number of practicing doctors to meet the needs of medically underserved areas and the increasing number of patients who will clog an already struggling system.
Back in 2001, the late Dr Eugene Stead, Jr. proposed that it was “time for accredited medical schools to establish distance learning curricula that would allow experienced community-bound health professionals, such as physician assistants (PAs) and nurse practitioners (NPs), to take medical school courses from home or at work” (Stead, 2001).
Dr Stead is known as the founder of the Physician Assistant profession, having created the country’s first formal education program for Physician Assistants at Duke University in 1965. He suggested that providing online courses for these “non traditional but seasoned healthcare professionals” would accelerate the time to achieve a full medical degree, while allowing the practitioners to remain in active practice.
In 2001, Stead asked “Which medical school will be the first to take the lead, which has the courage to explore alternative pathways to becoming a physician?”
Eight years later, those questions remain unanswered in the U.S. Of the 130 accredited M.D.-granting medical schools in the U.S., none yet offers a full online medical degree. However, there are some international programs emerging to offer four-year online medical degrees: “The International Virtual Medical School - IVIMEDS - is a worldwide partnership of leading edge medical schools and institutions, setting new standards in medical education and blending high quality e-learning and face-to-face learning in the training of health care professionals” (IVIMEDS, 2009).
Online medical education in the U.S. has made some strides, with many offerings for Continuing Medical Education (CME) courses that physicians are required to complete to maintain their licenses and board certifications. Harvard Medical School offers a wide range of “multimedia enriched, comprehensive, and interactive” online CME courses that have been taken by students from 105 countries (Harvard, 2009). They cost about $20 for each course hour, and topics range from clinical to administrative and legal issues.
Dr. Stead (who died in 2005 at the age of 97) would no doubt be pleased to learn that his long-time employer, Duke University in North Carolina has incorporated distance learning degree program technologies in traditional classroom courses. Anesthesiology students there are “using computer simulations to enhance their learning and decision-making processes before applying these to patients in the operating room” (Degree Board, 2008).
Many universities are taking advantage of Duke’s good example to offer a combination of technologies designed to help their students learn as effectively as possible.
See the next post on Duke School of Nursing’s Center for Nursing Discovery for an example of a world class institution using simulations and innovative state-of-the-art multi-media in online and classroom learning.
For more information:
Degree Board (2008). Campus-Based College Degree Programs offer Online Lessons . Retrieved online on March 9, 2009 at http://tinyurl.com/arqhbn
Duke University School of Nursing (2009). Center for Nursing Discovery. Retrieved online on March 9, 2009 at http://tinyurl.com/atxbu2
Harvard (2009) Harvard Medical School Department of Continuing Education. Retrieved from the Internet on March 9, 2009 at http://cmeonline.med.harvard.edu/
IVIMEDS (2009) International Virtual Medical School. Retrieved online on March 9, 2009 at http://www.ivimeds.org/
Stead, E. (2001). “Using Distance Learning to Provide a Medical Education to Non-traditional Students,” North Carolina Medical Journal, Vol 62, Number 6, 2001 retrieved from the Internet on March 9, 2009 at http://easteadjr.org/guest.html
Sunday, January 25, 2009
An Insider's Look at the Health Distance Learning Community
Distance Learning in the health sector is of particular interest to me, both professionally and personally.
Having worked in healthcare for 30+ years, it does not surprise me to read that experts have long thought that healthcare is something like 10-15 years behind other industries in computing. (HRSA, 1998). But the recent surge in support for a new focus on health information technology is exciting on multiple levels . The new Obama Administration has included healthcare technology as one of its major platforms, giving hope to many in the health field that access can be improved and expenses reduced .
Telemedicine, which is the use of electronic devices to deliver healthcare to patients that are geographically separated from physicians and other health professionals, is an exciting aspect of telehealth. More and more physicians are communicating with patients via email to discuss test results and answer questions, leading to better patient compliance with treatment recommendations. (Mandl, Kohane & Brandt, 1998). Some physicians in my community even offer online consultations, where several specialists (from both our community as well as other geographies) consult with patients and families about complex cases.
There are also exciting developments in PACs, picture archiving and communications systems, that allow digital images to be stored and shared among care providers. I was impressed with the use of PACs and teleradiology this past summer, when I fractured several bones while on vacation a few hours from home. The closest medical center in this rural area did not have an orthopedic service, but was able to digitally transmit my xrays to an orthopedic surgeon at my home hospital for consultation. The orthopedic specialist was able to advise the rural emergency department on interim stabilization, and saved both cost and aggravation by avoiding an overnight hospital stay. PACs allow patients to have access to highly trained medical specialists independent of geography, which is especially important for rural areas without a robust medical community.
Another exciting advance in telemedicine is the use of robotic-assisted surgery, with the DaVinci Robot. This technology is applauded as being safer and more precise than traditional scalpel surgery. Today the robot is controlled by a surgeon in the same room, but surely it’s not too far down the line to expect that a highly trained specialist might control the surgery from another location across town, in another state or even another country.
There are also great advancements in interventional procedures that allow imaging without surgery. The virtual colonoscopy, where the patient actually swallows a tiny camera device, is attractive to many patients who are nervous about the more invasive traditional procedure that is uncomfortable and embarrassing. Digitzed stethoscopes are being used to transmit heart and lung sounds to specialists at remote locations. (White, Krousel-Wood & Mather, 2001).
The early field of Telemedicine has expanded to the broader general field of “Telehealth”, defined as “the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration.” (Kumekawa, 2000).
In addition to telemedicine techniques, distance learning is used for professional education with realtime teleconferences and virtual classrooms using satellite downlinks to recreate a traditional classroom environment. The savings in travel expense and time make it possible for physicians, nurses and other health professionals to maintain their credentials and stay up to date on new techniques. This is especially valuable for rural practitioners on a domestic and global level.
The evolution of the Internet also expands access to self-study courses and other asynchronous education options focused on health topics, just as in other fields of study. A quick Google search for “Online Healthcare Master’s Degrees” produced a listing of 52 online programs where I could have gotten my Master’s Degree without being limited to prescribed classroom meetings for 4 hours a week over several years. (eLearners, 2009). I am now hoping that these programs will offer new employment opportunities for me to teach online courses in these programs, aided by my new training and anticipated Distance Education Certificate from University of West Georgia after June 2009!
Patient Education is another area where Telehealth is has the potential to change lives. According to the Pew Internet and American Life Project, some eight million people do online searches for health information in the U.S. every day. (Lohr, 2007). While patients have an almost unlimited appetite for health information, there are drawbacks to the abundance of online health offerings. Many of the physicians I work with say almost every patient visit now includes the dreaded comment about something “I saw on the Internet …”
The physicians say it wastes valuable visit time to explain that the information may not be credible, and they would rather have patients using specific sites in which the doctor has more confidence. Some of my physician colleagues prepare a list of recommended websites that they give to patients – others have pre-printed handouts with patient follow-up information on various diagnoses, reprinted from websites. A few of the physicians in my community include patient-friendly medical information sites on their practice website, and the hospital where I work includes a patient-oriented medical search engine on its own website. (DH, 2009).
While telehealth and technology solutions hold great promise in the health industry, it is not without major challenges. Upfront expense is the obvious major barrier – the short term expense to acquire equipment and train the users can be overwhelming to the smaller medical communities where telemedicine is most needed.
There are also major issues around developing standards and regulations to ensure that systems have interoperability. Developing a common vocabulary is a huge task – one nephrologist told me that while the average primary care physician might order two or three basic kidney function tests and use a couple of diagnosis codes, the nephrology community has hundreds of tests and codes to pinpoint a patient’s exact condition. An electronic medical record database that doesn’t recognize the full scope of coding might indicate an incorrect diagnosis.
Privacy issues are also huge barriers to widespread adoption of electronic medical records. Various congressional actions dating back to the mid 1990’s (such as HIPPA) seek to ensure privacy and portability of protected health information, but the debates continue over how to protect sensitive information. Many consumer groups (including AARP and the American Civil Liberties Union) are reluctant to embrace personal health records because of privacy concerns. (ACLU, 2008).
On a personal level, the various aspects of telehealth give me great hope that patients will benefit from technology advances to improve the patient experience. I have observed the healthcare system from the inside out for many years, and I see how frustrating our systems are to patients and families who are often frightened and almost always frustrated by a lack of communication and limited access to care. As a patient myself, and a family caregiver for others, the medical system is at once wonderous and baffling.
Access to patient information and other tools are key steps in motivating patients to be more accountable for their own health, and evolving social networking sites could go a long way to encourage folks to eat better, exercise more and reduce risky behaviors. Even nursing homes and senior communities are getting in on the Wii Fitness movement. In Pennsylvania, Allegheny County and state grants of $400,000 supported a new senior center equipped with Wii Fitness and other machines that are senior-friendly to encourage exercise. (Cristiano, 2009).
I believe the advances in telehealth and telemedicine will improve the quality and consistency of both care and communications. I am hopeful that the new Obama Administration will make good on its promises to facilitate better funding for health technology initiatives.
An excellent resource for more information on telehealth and telemedicine is the Telemedicine Information Exchange (http://tie.telemed.org).
Also see The Association of Telehealth Service Providers at www.atsp.org.
References
ACLU (2008). “Medical Privacy and Electronic Records”, American Civil Liberties Union, July 22, 2008. http://www.aclu.org/privacy/medical/36069res20080722.html
Cristiano, M. (2009) “Technology Enhances Senior Center’s New Fitness Area,” Monroeville Times Express, January 15, 2009.
http://www.yourmonroeville.com/timesexpress/article/technology-enhances-senior-centers-new-fitness-area
DH (2009). Doylestown Hospital website. http://doylestown.photobooks.com/?oTopID=323
eLearners (2009). Healthcare Masters Degree Programs Online. http://www.elearners.com/online-degrees/master/health-administration.htm
HRSA (1998). “HRSA Focuses Agency Resources on Telehealth.” Health Resources and Services Administration Press Office, Rockville MD. May 22, 1998.
Kumekawa, J. (2000). “Telehelath and the Internet.” Office for the Advancement of Telehealth, Health Resources and Service Administration, Health Resources and Services Administration. http://telehealth.hrsa.gov/pubs/inter.htm
Lohr, S. (2007) “Microsoft to Buy Health Information Search Engine,” The New York Times, February 27, 2007. http://www.nytimes.com/2007/02/27/technology/27soft.html
Mandl, K., Kohane, I. and Brandt, A. (1998) “Electronic patient- physician communication: Problems and promise”. Annals of Internal Medicine. 1998. 129:495–500. http://www.ochsnerjournal.org/perlserv/?request=get-document&doi=10.1043%2F1524-5012(2001)003%5B0022%3ATMHDLA%5D2.0.CO%3B2&ct=1
White, L., Krousel-Wood, M. and Mather, F. (2001). “Technology Meets Healthcare: Distance Learning and Telehealth,” The Ochsner Journal. Vol. 3, Issue 1, Winter 2001. http://www.ochsnerjournal.org/perlserv/?request=get-document&doi=10.1043%2F1524-5012(2001)003%5B0022%3ATMHDLA%5D2.0.CO%3B2&ct=1
Having worked in healthcare for 30+ years, it does not surprise me to read that experts have long thought that healthcare is something like 10-15 years behind other industries in computing. (HRSA, 1998). But the recent surge in support for a new focus on health information technology is exciting on multiple levels . The new Obama Administration has included healthcare technology as one of its major platforms, giving hope to many in the health field that access can be improved and expenses reduced .
Telemedicine, which is the use of electronic devices to deliver healthcare to patients that are geographically separated from physicians and other health professionals, is an exciting aspect of telehealth. More and more physicians are communicating with patients via email to discuss test results and answer questions, leading to better patient compliance with treatment recommendations. (Mandl, Kohane & Brandt, 1998). Some physicians in my community even offer online consultations, where several specialists (from both our community as well as other geographies) consult with patients and families about complex cases.
There are also exciting developments in PACs, picture archiving and communications systems, that allow digital images to be stored and shared among care providers. I was impressed with the use of PACs and teleradiology this past summer, when I fractured several bones while on vacation a few hours from home. The closest medical center in this rural area did not have an orthopedic service, but was able to digitally transmit my xrays to an orthopedic surgeon at my home hospital for consultation. The orthopedic specialist was able to advise the rural emergency department on interim stabilization, and saved both cost and aggravation by avoiding an overnight hospital stay. PACs allow patients to have access to highly trained medical specialists independent of geography, which is especially important for rural areas without a robust medical community.
Another exciting advance in telemedicine is the use of robotic-assisted surgery, with the DaVinci Robot. This technology is applauded as being safer and more precise than traditional scalpel surgery. Today the robot is controlled by a surgeon in the same room, but surely it’s not too far down the line to expect that a highly trained specialist might control the surgery from another location across town, in another state or even another country.
There are also great advancements in interventional procedures that allow imaging without surgery. The virtual colonoscopy, where the patient actually swallows a tiny camera device, is attractive to many patients who are nervous about the more invasive traditional procedure that is uncomfortable and embarrassing. Digitzed stethoscopes are being used to transmit heart and lung sounds to specialists at remote locations. (White, Krousel-Wood & Mather, 2001).
The early field of Telemedicine has expanded to the broader general field of “Telehealth”, defined as “the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration.” (Kumekawa, 2000).
In addition to telemedicine techniques, distance learning is used for professional education with realtime teleconferences and virtual classrooms using satellite downlinks to recreate a traditional classroom environment. The savings in travel expense and time make it possible for physicians, nurses and other health professionals to maintain their credentials and stay up to date on new techniques. This is especially valuable for rural practitioners on a domestic and global level.
The evolution of the Internet also expands access to self-study courses and other asynchronous education options focused on health topics, just as in other fields of study. A quick Google search for “Online Healthcare Master’s Degrees” produced a listing of 52 online programs where I could have gotten my Master’s Degree without being limited to prescribed classroom meetings for 4 hours a week over several years. (eLearners, 2009). I am now hoping that these programs will offer new employment opportunities for me to teach online courses in these programs, aided by my new training and anticipated Distance Education Certificate from University of West Georgia after June 2009!
Patient Education is another area where Telehealth is has the potential to change lives. According to the Pew Internet and American Life Project, some eight million people do online searches for health information in the U.S. every day. (Lohr, 2007). While patients have an almost unlimited appetite for health information, there are drawbacks to the abundance of online health offerings. Many of the physicians I work with say almost every patient visit now includes the dreaded comment about something “I saw on the Internet …”
The physicians say it wastes valuable visit time to explain that the information may not be credible, and they would rather have patients using specific sites in which the doctor has more confidence. Some of my physician colleagues prepare a list of recommended websites that they give to patients – others have pre-printed handouts with patient follow-up information on various diagnoses, reprinted from websites. A few of the physicians in my community include patient-friendly medical information sites on their practice website, and the hospital where I work includes a patient-oriented medical search engine on its own website. (DH, 2009).
While telehealth and technology solutions hold great promise in the health industry, it is not without major challenges. Upfront expense is the obvious major barrier – the short term expense to acquire equipment and train the users can be overwhelming to the smaller medical communities where telemedicine is most needed.
There are also major issues around developing standards and regulations to ensure that systems have interoperability. Developing a common vocabulary is a huge task – one nephrologist told me that while the average primary care physician might order two or three basic kidney function tests and use a couple of diagnosis codes, the nephrology community has hundreds of tests and codes to pinpoint a patient’s exact condition. An electronic medical record database that doesn’t recognize the full scope of coding might indicate an incorrect diagnosis.
Privacy issues are also huge barriers to widespread adoption of electronic medical records. Various congressional actions dating back to the mid 1990’s (such as HIPPA) seek to ensure privacy and portability of protected health information, but the debates continue over how to protect sensitive information. Many consumer groups (including AARP and the American Civil Liberties Union) are reluctant to embrace personal health records because of privacy concerns. (ACLU, 2008).
On a personal level, the various aspects of telehealth give me great hope that patients will benefit from technology advances to improve the patient experience. I have observed the healthcare system from the inside out for many years, and I see how frustrating our systems are to patients and families who are often frightened and almost always frustrated by a lack of communication and limited access to care. As a patient myself, and a family caregiver for others, the medical system is at once wonderous and baffling.
Access to patient information and other tools are key steps in motivating patients to be more accountable for their own health, and evolving social networking sites could go a long way to encourage folks to eat better, exercise more and reduce risky behaviors. Even nursing homes and senior communities are getting in on the Wii Fitness movement. In Pennsylvania, Allegheny County and state grants of $400,000 supported a new senior center equipped with Wii Fitness and other machines that are senior-friendly to encourage exercise. (Cristiano, 2009).
I believe the advances in telehealth and telemedicine will improve the quality and consistency of both care and communications. I am hopeful that the new Obama Administration will make good on its promises to facilitate better funding for health technology initiatives.
An excellent resource for more information on telehealth and telemedicine is the Telemedicine Information Exchange (http://tie.telemed.org).
Also see The Association of Telehealth Service Providers at www.atsp.org.
References
ACLU (2008). “Medical Privacy and Electronic Records”, American Civil Liberties Union, July 22, 2008. http://www.aclu.org/privacy/medical/36069res20080722.html
Cristiano, M. (2009) “Technology Enhances Senior Center’s New Fitness Area,” Monroeville Times Express, January 15, 2009.
http://www.yourmonroeville.com/timesexpress/article/technology-enhances-senior-centers-new-fitness-area
DH (2009). Doylestown Hospital website. http://doylestown.photobooks.com/?oTopID=323
eLearners (2009). Healthcare Masters Degree Programs Online. http://www.elearners.com/online-degrees/master/health-administration.htm
HRSA (1998). “HRSA Focuses Agency Resources on Telehealth.” Health Resources and Services Administration Press Office, Rockville MD. May 22, 1998.
Kumekawa, J. (2000). “Telehelath and the Internet.” Office for the Advancement of Telehealth, Health Resources and Service Administration, Health Resources and Services Administration. http://telehealth.hrsa.gov/pubs/inter.htm
Lohr, S. (2007) “Microsoft to Buy Health Information Search Engine,” The New York Times, February 27, 2007. http://www.nytimes.com/2007/02/27/technology/27soft.html
Mandl, K., Kohane, I. and Brandt, A. (1998) “Electronic patient- physician communication: Problems and promise”. Annals of Internal Medicine. 1998. 129:495–500. http://www.ochsnerjournal.org/perlserv/?request=get-document&doi=10.1043%2F1524-5012(2001)003%5B0022%3ATMHDLA%5D2.0.CO%3B2&ct=1
White, L., Krousel-Wood, M. and Mather, F. (2001). “Technology Meets Healthcare: Distance Learning and Telehealth,” The Ochsner Journal. Vol. 3, Issue 1, Winter 2001. http://www.ochsnerjournal.org/perlserv/?request=get-document&doi=10.1043%2F1524-5012(2001)003%5B0022%3ATMHDLA%5D2.0.CO%3B2&ct=1
Subscribe to:
Posts (Atom)
