Telehealth solutions: use cases and technology breakdown

04.07.2019
7 min.

Wireless technology is moving healthcare outside of clinics and hospitals.

Pamela Spence

Telehealth implies using information technology for the purpose of improving healthcare practices and healthcare education delivery. Telehealth has emerged as an important discipline of healthcare due to a multitude of factors, including aging population (which means more chronic diseases and a more frequent need to access healthcare), long waiting time for an appointment, and difficulty receiving adequate health care in rural areas.

Nowadays, telehealth industry is booming, and is estimated to reach $19.5 billion in revenue in 2025, up from $6 billion in 2016.  Healthcare providers have the opportunity to enter telehealth realm by investing in the appropriate hardware and software. This investment will pay back as providers will be able to receive more new patients and distribute their resources more efficiently among existing ones. Due to the benefits it is offering, telehealth is likely to become an indispensable pillar of healthcare in the future. 

Why telehealth deserves a closer look

For patients, telehealth offers a more convenient access to health care as they can attend virtual appointments with doctors from patients’ homes or offices. This eliminates the need to wait in front of the doctor’s office and reduces risks of germ exposure in the waiting rooms.

Such virtual appointments are also easier to fit in a busy schedule for both patients and doctors as they consume less time than on—site visits. They are less expensive, too, and can be used for following–up, thereby reducing readmission rates.

Finally, telehealth allows people to monitor their health condition more conveniently with the help of mobile apps.

For healthcare providers, telehealth offers a better coverage as it opens the opportunity to serve people outside doctors’ geographical reach. Additionally, if there is a gap in a doctor’s schedule, they can access telehealth waiting rooms and take patients registered there.

Incorporating telehealth in a hospital’s practice improves allocation of hospital beds as many patients will be treated remotely, and only the ones who really need it will be assigned a bed.

Finally, telehealth allows healthcare practitioners to conveniently get a second opinion from colleagues in the same or related medical fields.

Telehealth: 4 major use cases

Telehealth is often used as an umbrella term that implies utilization of telecommunication for healthcare purposes. This section details different applications of telehealth that are often used interchangeably by mistake.

Telemedicine

The earliest use of telemedicine can be traced to Alexander Graham Bell in 1876, when he used the telephone to call Watson after spilling acid on his trousers.

To many people, telemedicine appears as a synonym of telehealth. And both concepts are indeed very similar. However, telehealth is broader as it incorporates non—clinical practices such as health education and training. Telemedicine, on the other hand, has a mandatory clinical component to it. It is a direct communication between the patient and the healthcare provider either via phone calls or text.

Incorporating telemedicine into healthcare takes your practice to another level. For example, adopting a telemedicine—ready EHR significantly enhances communication between doctors and patients, and offers the foundation for building integration platforms with other healthcare providers such as pharmacies.   

Telehealth nursing

Telehealth nursing implies using telemedicine to deliver nursing care in remote locations. With the help of telenursing, the nurse can guide patients through non—emergency situations, for example, instruct them how to treat a minor burn or process a wound. Telenursing is surely more than just a phone call—it is the ability to provide accurate information at a time of need.

The ability to receive nursing care from home makes a huge difference for some patients. Describing her typical day, a telehealth nurse recalled how she was able to help an oncology patient who was receiving care outside the hospital. She and her husband were frantic, sending 30 emails a week to the hospital physician. With the help and guidance of the telehealth nurse, the amount of emails was reduced to one, and even that was often initiated by the physician.

Telepsychiatry

Also referred to as teletherapy, it is a process of calling or texting a psychiatrist. Even though speaking to someone on the screen feels awkward for some patients, for many it creates an enhanced feeling of safety, as reported by American Psychiatric Association. The persistent stigma attached to psychiatric disorders prevents many people from seeking help. Telepsychiatry can help here, as patients do not need to physically visit the office. Also, they are more likely to open up over the video than in person.

Nowadays, telepsychiatry software is capable of offering a multitude of features including patient—psychiatrist interactions, diagnosis, and medication management, enabling the patient to attend group therapies, and allowing the psychiatrist to get a second opinion. This is especially helpful to psychiatrists operating in rural areas.

Physical therapy

This type of healthcare includes guiding patients through various physical exercises, treatment and prevention of sport—related injuries, and ensuring that patients have completed the course of prescribed treatment. Telehealth physical therapy is most popular for neurological, orthopedic, and geriatric physical therapies. It spares patients the need to physically attend the practitioner’s office every time they need to exercise. Simultaneously, the practitioner can watch over multiple patients performing different exercises at different locations.

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Telehealth physical therapy guidance through exercises 
Source: https://ewellnesshealth.com/demo-home/

Breaking down telehealth technologies

Advancements in information technologies opens opportunities to implement telehealth solutions that seemed like science fiction not long ago.

Remote patient monitoring

Remote patient monitoring stands for utilization of telehealth solutions with the purpose of gathering patient data outside the doctor’s examination room, and transmitting this data securely to the authorized healthcare provider. Remote monitoring tools gather multiple parameters including vital signs such as blood pressure, blood oxygen level, heart rate, and electrocardiogram, or just subjective information on a patient’s well—being. Patient data is gathered via mobile phones, sensors, or simply questionnaires filled in by patients.  

“Remote patient management is … about moving more healthcare out of the traditional setting, into the house and where people live, work and play every day.”

Marcus Grindstaff, COO of Care Innovations

Many applications of remote patient monitoring are currently available on the market. One example of such application is a contact lens that measures the level of glucose from patients’ tears.

Video chatting

Video conferencing technology is familiar to most people and has been around for a while—think Skype and Facetime. However, those applications are not suited for use in telehealth settings as they do not offer required privacy and reliability.

All video conference applications used for telehealth need to be compliant with the HIPAA (Health Insurance Portability and Accountability Act) that requires transmitted personal data to be encrypted. If patients are annoyed because they are unable to use their favorite video chatting application, they should realize that practicing telehealth over an unsecure video conference application is comparable to agreeing on a surgery using a dirty scalpel. Furthermore, the selected video chatting application needs to be integrated with the electronic health record system and other healthcare applications in this healthcare institution.

A study published in Journal of Informatics in Health and Biomedicine states that around 90% of patients would prefer using video conferencing over doctor visits if the option existed. In addition to offering a consultation, healthcare provider can share medical certificates and test results, conduct virtual training, and offer support for patients with anxiety and depression. However, video conferencing is not always able to replace physical visits to the doctor’s office. A broken arm will not be set over the internet.

Ann Carle, Telehealth Clinical Coordinator at Cornerstone VNA, recalled a case where she saved a patient’s life over video chatting. Through web portal, the nurse noted that one of her patients had a low O2 saturation. She immediately connected to the patient via video conferencing and noticed that the patient was struggling to breath and turning grey in color. Unsure of how to help, the patient’s husband was panicking. The nurse reacted promptly by calling 911 and easing the anxiety of the patient and her husband.

Sensors

Sensors are rapidly finding their way into telehealth. Those tiny devices are easily embedded into a watch, garment, or even directly applied on the skin as a temporary tattoo.

Sensors play a key role in continuous collection of patient data in private settings. Sensors can collect such vitals as heart rate, cardiac rhythm, oxygen saturation, blood pressure, glucose level, respiration, etc. This data is transmitted to the authorized healthcare provider who uses it to make informed decisions about the patient’s condition and treatment.

Sensors come in several types:

  • Wearable sensors: sensors that are worn directly (such as a watch or an armband) or inserted into our clothing items. Such sensor patches can also be inserted in a bra for preemptive discovery of breast cancer. 
  • Ingestible sensors: sensors we ingest orally. Those sensors gather information about our medicine intake and our body’s response to medication. This is especially helpful for people who struggle to follow their health medication plan.
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Disposable camera pill which facilitates colonoscopy procedure
Source: https://www.marsdd.com/news/ingestibles-smart-pills-revolutionize-healthcare/

  • Sensors embedded in our bodies: one example is a pacemaker embedded in the chest to help controlling abnormal heart rhythms. 
  • Sensors embedded in our surroundings: one example of such sensors is a toilet sensor that allows healthcare providers to monitor the duration and frequency of toilet use. Another example is a matrass sensor that tracks a patient’s movements to analyze sleep patterns. 

mHealth

Advances within medical mobility resulted in a series of solutions for solving health—related problems in an innovative way. Even people who are not tech—savvy are adopting the technology in order to benefit from the convenience it provides. There is a plethora of mobile health applications on the market fulfilling these functions.

Mobile health technology can be used to cover the following applications:

  • Health and wellness monitoring: those apps allow people to monitor their condition via a mobile device. One such example is heartbeat monitoring using an Apple Watch application.
  • Remote diagnostic and treatment services: some mobile solutions are trained on performing medical diagnostics. This includes imaging and chatbots gathering patients’ symptoms and coming up with a diagnosis. Another example of mobile diagnostics is Cognoa’s childhood behavior screening assistant. This application takes as input information about the child filled in by the parents, and predicts the possibility of this child developing autism or being subject to development delays.
  • Chronic disease management: in case of chronic disease such as diabetes, patients can get overwhelmed with keeping track of their sugar intake, insulin dosage, blood pressure, weight, etc. Using a mobile app to simplify this procedure becomes a relief.
  • Patient communication: mobile apps will connect patients with doctors in a matter of minutes. The drawback is that you will need to take any doctor available at the given moment. 
  • Patient support community building: these mobile apps offer a safe platform for people to express their problems and anxieties, such as self—harm, depression, and other psychological issues which are considered taboo. 

Is it worth investing in telehealth?

Currently, telehealth is rapidly taking its place among healthcare practices. It is applied in many fields including psychiatry, physical therapy, and post—surgical recovery. Telehealth facilitates timely and affordable access to care for patients, and offers opportunities for revenue increase for providers. Applying telehealth in nursing practices allows a more efficient distribution of nurse’s time. Telepsychiatry makes it possible for patients to seek help overcoming the social stigma attached to visiting psychiatry offices. Embedding telehealth in physical therapy offers the possibility for patients to exercise under supervision outside medical facilities.

Even though telehealth is advancing, it is ridden with multiple challenges. Some of those challenges originate in regulations and policies of healthcare institutions, others in vulnerability of the technologies utilized. Some experts argue that telehealth might result in overlapped care, reduced in—person interactions, connectivity issues, and more training and equipment required. Additionally, it will be a challenge to get doctors on board because they have their own concerns about adopting telehealth solutions. However, this is an avenue worth perusing as it will eliminate long waiting time in front of the doctor’s office, and make healthcare accessible to rural communities eliminating avoidable death cases, among other benefits listed above.

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