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Telehealth strives
for ubiquity
(June
2006 Issue)
By Nan Shnitzler
From monitoring NASA astronauts' vital signs to detecting stroke
in residents of the "smart medical home" of the future, telehealth
technology can extend the reach of health care. But it's the down-to-earth
applications and collaborations where telehealth is making a difference
today. Telehealth employs telecommunications to provide health care
that transcends time and distance. It has expanded service access
to remote, at-risk and underserved populations by allowing practitioners
to offer consultation, diagnosis, education, treatment and monitoring
services at a distance and on demand.
Telehealth's unique interdisciplinary and multimedia approach will
be key to achieving the goals of Healthy People 2010, says Thomas
W. Miller, Ph.D., A.B.P.P., a professor at the University of Connecticut
School of Allied Health.
Healthy People is a federal initiative designed to eliminate health
disparities among different population segments by improving health
care access to all Americans. Among the targets are cancer, diabetes,
kidney disease, heart disease, obesity, mental health, HIV, substance
abuse, nutrition and many more.
"Telehealth is the medium by which the next wave of addressing
these issues will occur," Miller says.
An example of telehealth in action was visiting nurses in New Haven
using video telephones to monitor patients without having to travel
house to house, Miller recounts. It was cost effective because nurses
saw more patients in less time and could reserve site visits for
acute care.
Telehealth gear can be in a patient's home or at a community-based
organization. Along those lines, in a paper in the April 2006 issue
of Telemedicine and e-Health, Miller and colleagues examine the
theoretical and clinical issues involved in applying telehealth
to the care of developmentally disabled adults living in group homes.
In the article, four of Miller's graduate students, a physical
therapist, occupational therapist, physician assistant and dietician,
describe how they could use interactive telehealth links to keep
patients independent and in familiar settings, crucial to maintaining
health. The paper offers a step-by-step guideline for determining
whether telehealth is case-applicable. The first question is whether
the patient is willing to use telehealth services.
To manage liability in telehealth delivery, therapists and patients
(or their caregivers) must be trained to understand and operate
monitoring and video equipment at both ends of the link. Training,
credentialing and questions of effectiveness and privacy are still
barriers to universal adoption and insurance compensation of telehealth
services.
"So the concepts are there and the technology is there, but it
hasn't yet reached the legislative process to support it," Miller
says.
While teaching at the University of Kentucky in Lexington, Miller
saw the Kentucky model develop into 70 telehealth sites that augment
the state health care system.
"The state legislature in Kentucky bit the bullet and supported
this particular medium to the benefit of residents," Miller says.
"It's a state by state thing."
Miller says telehealth support has to start at the grassroots with
education and prevention and then move to individualized care. The
federal program of local Area Health Education Centers, charged
with improving access to health care, is key.
In Vermont, AHEC and the Department of Health offer "nursing grand
rounds" delivered via 14 interactive television sites. Each session
is attended by an average of 70 participants who can save the time
and cost involved in traveling to continuing education. The health
education delivery system could also include cable and public television,
Miller says.
"The fact that a medical journal invited me to do this article
is visionary," Miller says. "The fact that [telehealth] is being
driven by national health policy will improve access to every human
being."
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