IMPACT OF TELEMEDICINE IN THE
This article is supposed to
enlighten the reader on Telemedicine. With any new development in the
technology industry there is bound to be consequences, both positive and
healthcare sector substantially has developed over the years thanks to the convenience
brought by the current technologies advancements. Nevertheless, there are still
many difficulties that the industry has to deal with, especially when it comes
to accessibility, provision and convenience of services both for the patients
and the medical providers.
the answers the medical profession and the health sector have brought up to deal
with these issues is telemedicine. What is telemedicine? It is the remote
diagnosis and treatment of patients by means of telecommunications technology. Besides
from bringing patients and medical providers together via various modes of
communication, telemedicine also supplies a way for health care professionals
to consult with other physicians.
Earlier on, telemedicine was commonly used
to provide a connection to doctors working with a patient in one location to
specialists elsewhere. This was of great advantage to rural or hard to reach places
where specialists aren’t easily and readily accessible. Throughout the next
several decades, the equipment necessary to conduct remote visits remained
expensive and complex, so the use of the approach, while growing, was limited.
The increased use of the internet brought
with it significant changes for the telemedicine practices. The risen use of
smart devices into the global market, capable of high-quality video. More so, consequentially
the growth of today’s telemedicine is the rising mobile (smartphones) health field.
With the various mobile health applications, new mobile medical devices that
are user-friendly and patients are starting to use technology to observe and
track their health. Basic home-use medical devices that can take signs and
symptoms, and diagnose ear infections, monitor glucose levels, or measure blood
pressure, lets patients gather needed medical information for use by the doctor
to perform diagnosis, without booking a doctor’s appointment. And again, as
more patients get signup to using technology to help manage their health status,
they also will be more open to alternative ways to get attention – through
CHAPTER 2: METHODOLOGY
explored the nature and purpose of qualitative research, this article explores
data collection techniques used in qualitative research. There are a variety of
methods of data collection in qualitative research, i.e. observations, textual
or visual analysis (e.g. from books or videos) and interviews (individual or
group). However, the most common methods used, particularly in healthcare
research, are interviews and focus groups.
Qualitative research interviews
are three fundamental types of research interviews: structured, semi-structured
and unstructured. Structured interviews are, verbally administered
questionnaires, in which a list of predetermined questions are asked, with
little or no variation and with no scope for follow-up questions to responses
that warrant further elaboration.
unstructured interviews do not reflect any preconceived theories or ideas and
are performed with little or no organisation. Such an interview may simply
start with an opening question and will then progress based, primarily, upon
the initial response.
interviews consist of several key questions that help to define the areas to be
explored, but also allows the interviewer or interviewee to diverge in order to
pursue an idea or response in more detail. This interview format is used most
frequently in healthcare, as it provides participants with some guidance on
what to talk about, which many find helpful.
purpose of research interviews
of the research interview is to explore the views from various individuals on
specific matters. Qualitative methods, such as interviews, are believed to enlighten
us on social phenomena than would be obtained from purely quantitative methods,
such as questionnaires. Interviews are, therefore, most appropriate where
little is already known about the study phenomenon or where detailed insights
are required from individual participants. They are also particularly
appropriate for exploring sensitive topics, where participants may not want to
talk about such issues in a group environment.
designing an interview schedule it is imperative to ask questions that are
likely to yield as much information about the study phenomenon as possible and
also be able to address the aims and objectives of the research. In a
qualitative interview, good questions should be open-ended (i.e., require more
than a yes/no answer), neutral, sensitive and understandable. It is usually
best to start with questions that participants can answer easily and then
proceed to more difficult or sensitive topics. This can help put respondents at
ease, build up confidence and rapport and often generates rich data that
subsequently develops the interview further.
length of interviews varies depending on the topic, researcher and participant.
However, on average, healthcare interviews last 20-60 minutes. Interviews can
be performed on a one-off or, if change over time is of interest, repeated
basis, for example exploring the psychosocial impact of oral trauma on participants
and their subsequent experiences of cosmetic dental surgery.
groups share many common features with less structured interviews, but there is
more to them than merely collecting similar data from many participants at
once. A focus group is a group discussion on a particular topic organized for
research purposes. This discussion is guided, monitored and recorded by a
researcher (sometimes called a moderator or facilitator).
When focus groups are used
groups are used for generating information on collective views, and the
meanings that lie behind those views. They are also useful in generating a rich
understanding of participants’ experiences and beliefs. Suggested criteria for
using focus groups include:
As a standalone method, for research relating to
group norms, meanings and processes
In a multi-method design, to explore a topic or
collect group language or narratives to be used in later stages
To clarify, extend, qualify or challenge data collected
through other methods
To feedback results to research participants.
Preparing an interview schedule
research interviews, the interview schedule for focus groups is often no more
structured than a loose schedule of topics to be discussed. However, in
preparing an interview schedule for focus groups, two general principles
suggested by Stewart and Shamdasani are used:
Questions should move from general to more
Question order should be relative to importance
of issues in the research agenda.
can, however, be some conflict between these two principles, and tradeoffs are
often needed, although often discussions will take on a life of their own,
which will influence or determine the order in which issues are covered. Usually,
less than a dozen predetermined questions are needed and, as with research
interviews, the researcher will also probe and expand on issues according to
a focus group looks easy when done well, but requires a complex set of skills. The
moderator should facilitate group discussion, keeping it focused without
leading it. They should also be able to prevent the discussion being dominated
by one member, ensure that all participants have ample opportunity to
contribute, allow differences of opinions to be discussed fairly and, if
required, encourage reticent participants.
and focus groups remain the most common methods of data collection in
qualitative research, and are now being used with increasing frequency in
dental research, particularly to access areas not amendable to quantitative
methods and/or where depth, insight and understanding of particular phenomena
are required. The examples of dental studies that have employed these methods
also help to demonstrate the range of research contexts to which interview and
focus group research.
CHAPTER 3: LITERATURE REVIEW
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The app is a 2 way communication tools
for the patients and their doctor.
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CHAPTER 4: FINDINGS AND OBSERVATION
Telemedicine impacting patients and providers?
fast-growing field in the healthcare industry, telemedicine holds a lot of
promise in solving various challenges that health professionals and patients
are facing today. Providing a range of benefits for both patients and medical
providers, it offers:
Pros of Telemedicine
the latest telemedicine initiatives can help your practice achieve numerous
benefits. You can lower healthcare costs, drive up practice efficiency and
revenue, provide your patients better access to healthcare services, and
ultimately get happier, healthier patients who stay in your practice.
More Convenient and Accessible Patient Care
to a recent Cisco global survey, 74% of patients prefer easy access to
healthcare services over in-person interactions with providers.
Healthcare Cost Savings
analysis and monitoring services and electronic data storage significantly
reduce healthcare service costs, saving money for you, your patients, and
insurance companies. Telemedicine also reduces unnecessary non-urgent ER visits
and eliminates transportation expenses for regular checkups. Recently, the
American Hospital Association reported on a telemedicine program that saved 11%
in costs and more than tripled ROI for investors. Beyond these general
cost-savings, telehealth can help boost doctors’ revenue by turning on-call
hours into billable time, attracting new patients, reducing no-shows, and even
reducing overhead for physicians who decide to switch to a flexible
work-from-home model for part of the week.
Extended Specialist and Referring Physician
telehealth, patients in rural or remote areas benefit from quicker and more
convenient specialist access. In the U.S., for every 100,000 rural patients,
there are only 43 specialists available. These patients endure longer
appointment commutes and have trouble accessing lifesaving consultations for
specific diseases or chronic care plans.
Increased Patient Engagement
patients are committed to their own healthcare goals, it leads to lower costs
and improved health. Ernst & Young Senior Advisory Services Manager Jan
Oldenburg told Healthcare IT News that the high cost of disengaged consumers
your patients through telemedicine can help them maintain appointments and care
schedules. Increased engagement initiatives can also curb obesity rates and
tobacco use by helping you to encourage your patients’ healthy lifestyle
Better Patient Care Quality
offers patient-centered approaches, such as improved timeliness of care. This
is critical to quality patient care. Patients can address healthcare issues
quickly with real-time urgent care consultations and learn about treatment
options within minutes. A new study shows that telemedicine patients score
lower for depression, anxiety, and stress, and have 38% fewer hospital
Cons of Telemedicine
telemedicine promises to grow rapidly over the next decade and has clear
benefits, it still poses some technical and practical problems for healthcare
Technical Training and Equipment
IT staff responsibilities and purchasing equipment takes time and costs money.
Training is crucial to building an effective telemedicine program. Physicians,
practice managers, and other medical staff need to be trained on the new
systems to ensure a solid ROI. In addition, your staffing requirements may
decrease. For instance, a nurse in a rural Alaska facility can monitor up to 33
patients at once from a single location using telemedicine services.
Reduced Care Continuity
where patients are using on-demand telemedicine services that connect them with
a random healthcare provider, care continuity suffers. A patient’s primary care
provider may not have access to records from those other visits and end up with
an incomplete history for the patient. Service provider shuffling increases the
risk that a doctor won’t know a patient’s history or have notes about care
Fewer In-Person Consultations
about technology’s limitations? You’re not alone. Many doctors worry about
technical problems associated with telemedicine. Senior Healthcare Group
Consultant Arun Ravi told Becker’s Hospital Review that poor broadband
connections could lead to “possible patient mismanagement.”
physicians and patients alike still like a “personal touch,” and not all
procedures – even simple checkups – can be performed digitally. However, in
cases where patients just can’t get in to see their doctors’ in-person, and for
many cases that don’t require a physical exam, telehealth can be a good
Tricky Policies and Reimbursement Rules
laws, reimbursement policies, and privacy protection rules struggle to keep up
with this fast-growing industry. As a healthcare provider, you want to promote
best practices when approaching telemedicine. While major developments have
been made to telehealth reimbursement over the past couple years, it still
remains a common stumbling block for providers interested in telemedicine. It’s best to do a little research into the
reimbursement policy landscape in your state before you get started.
CHAPTER 5: RECOMMENDATIONS
patient assessment and review
sites chose to improve the process for assessing and reviewing telehealth users
to ensure efficient use of resources. This included collecting additional
information from referring clinicians at assessment to identify goals for use
and specify a date for review.
sites aimed to improve the processes for monitoring and triage of telehealth
patients. Each site had previously completed some standardization, and
therefore targeted specific elements of their service that were not working
efficiently, or where practice was variable. Case study findings helped to
identify which processes needing improvement.
data sharing and access
sites worked on improving data sharing and access. Acknowledging that solutions
to address the interoperability problems between monitoring software and
electronic patient record systems were not readily available, participants
considered other ways to reduce the additional workload associated with having
to access two, and sometimes three, different systems. Other work focused on
how to ensure that patient records were updated with monitoring information so
that other clinicians involved in the care of a patient could access this
awareness of telehealth
sites were keen to raise awareness of telehealth and ideas for action included
training sessions for nursing teams who were reluctant to use telehealth;
working more closely with new clinical commissioning groups; and hosting events
to promote telehealth to other clinical providers. Because of competing
priorities, this work was difficult to achieve and in two sites was discontinued
after the first cycle.
evaluation of telemedicine
sites agreed that better evaluation was required to understand more about telemedicine
outcomes. However, only two sites chose to work on this activity. Divided
opinions about the rationale for investment in telehealth created uncertainties
about which outcomes to measure and consequently, while participants agreed
that this work was important, they could not agree on how to take it forward.
financial investment for telemedicine
short-term funding of telehealth was identified as a barrier to implementation.
To secure future investment, participants focused on establishing relationships
with technology providers and local decision-makers; scoping out the potential
of new technologies that were available; and identifying the needs of users and
clinicians that could be addressed with telehealth. Only one site was able to
secure financial investment during the study timeframe, and in two sites there
were real concerns about the future of telehealth.