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Topics About 'Telehealth'.

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  1. Due to the current global pandemic, telemedicine has become more relevant than ever in primary care. This external threat is forcing providers and patients to stay apart as a broader public health initiative to maintain the spread of COVID-19. This technology allows patients to receive care without the in-person contact. Under an emergency declaration in conjunction with the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act, Medicare has temporarily broadened its access of telemedicine, delivering benefits to patients while containing community spread (Centers for Medicare & Medicaid Services, 2020). As more patients and providers adopt this healthcare delivery platform during this worldwide crisis, it has the potential to create a fundamental impact on the primary healthcare landscape. Telemedicine is widely embraced by specialty areas of medicine. Although there is an overall general increase of use of telemedicine in primary care, it is still not universally employed (Barnett et al., 2018). The volume of telemedicine claim lines has increased over 4,000 percent from March 2019 to March 2020 across the United States. While meaningful increases, wider implementation of telemedicine can improve patient outcomes, decrease chronic disease burdens, and ensure financial stability (American Medical Association, 2020). Furthermore, telemedicine has the opportunity to increase continuity of care between providers and patients as frequent follow-ups are easier to achieve. Primary care providers [PCPs] have limited access to telemedicine due to barriers put in place by Medicare and these barriers are only lifted in times of need (American Hospital Association, 2019). In March of 2020, Medicare has temporarily broadened access of telemedicine during this current public health crisis, which helps to alleviate the stress of the public health crisis on the healthcare system (Centers for Medicare and Medicaid Services, 2020). Primary Care Provider Response to Public Health Crises The literature demonstrates studies have been conducted to describe the response of PCPs to public health crises. Researchers found that PCPs experiences are crucial for improving future prepandemic planning, which is a relatively new phenomenon (Kunin et al., 2013). PCPs experienced lack of confidence dealing with new and potentially life-threatening disease. Additionally, PCPs faced other problems associated with performance of public health responsibilities including surveillance, reporting, and privacy concerns (Kunin et al., 2013). Tomizuka et al. conducted a cross-sectional study that surveyed physicians based on World Health Organization checklists and essential components of institutional preparedness (2013). The researchers describe the necessity of a business continuity plan, or a plan that provides guidance on how to provide essential practice functions, staffing modifications, and record keeping during times of a public health crisis; however, this contingency plan was not implemented, and, therefore, creating a disruption in the local healthcare system (Tomizuka et al., 2013). During public health crises, PCPs and nurses are required to implement unique clinical skills. Other researchers described how clinical decision-making skills were different on the frontlines of the public health crisis, since regular office visits were suspended to control the spread of the virus (Verhoeven et al., 2020). Many PCPs and nurses expressed concern about the continuity of regular care, communication barriers to patients, and concern that certain cases would be missed due to less information gathered over the phone (Verhoeven et al., 2020). Trends of Telemedicine Healthcare is moving from fee-for-service to a value-based approach, and telemedicine has the capability to respond to the changing landscape of delivery (American Hospital Association, 2019). Barnett et al., conducted a retrospective chart review to examine trends in telemedicine utilization within a large commercial health plan (2018). The researchers found that annual telemedicine visits among all members increased from 206 to 202,374 from 2005 to 2017, and a rapid increase in growth from primary care telemedicine in 2016 and 2017 after coverage for direct-to-consumer telemedicine expanded (Barnett et al. 2018). Patient Perception of Telemedicine Many studies have concluded that patient perception of telemedicine is overall positive. In one study, 99% of the patients reported being very satisfied with all telemedicine attributes, and the majority reported the telemedicine visit just as good as a traditional visit (Polinski et al., 2015). The researchers reported an overall high satisfaction with telemedicine experience and quality of care were important to patients. Convenience was a recurring theme of telemedicine visits (Polinski et al., 2015, Powell et al., 2017). Powell et al. examined patient experiences with video visits with their established PCPs and reported that participants even preferred video visits over in-person visits; however, some participants expressed the loss of physician-patient connection, although this was not significant (2017). Despite some patients experiencing the lack of a personal connection, most patients felt telemedicine empowered them to manage their health (Hanley et al., 2018) It has been shown that telemedicine has a necessary place during the pandemic. But the question remains ... ... once we go back to our “normal lives,” will telemedicine in primary care be here to stay?
  2. Mobile Health According to Statista, during the second quarter of 2019, there were nearly 50,000 health apps available in the iOS app store. By 2020, the mobile health market is expected to be worth 21 million dollars globally. Many consumers turn to mobile health (mHealth) for overall health and wellness. You can do things like track your meals, log chronic symptoms, keep detailed records of the amount of water intake, or keep track of your workouts. More healthcare companies and practitioners are turning to mobile health to reach patients, and some are using chatbots to increase how quickly they can connect. Health insurer Anthem is taking a shot at a new digital service where patients can pay for a text chat with a physician to review symptoms and receive treatment. However, their first interaction is with artificial intelligence (A.I.) chatbot that asks about symptoms and suggests diagnoses. The patient is then connected to a physician for follow-up that happens at the patient’s convenience for an agreed-upon fee. As more people turn to mHealth for disease management, we need to get a clear picture of the pros and cons. Kevin Campbell, MD, took an in-depth look into the good and bad of mobile health and why he thinks patients will like it and physicians won’t. Here is a look at the good and bad around using mHealth and A.I. for medical care. Understanding the Benefits Most medical care and treatments come with pros. Here is a look at the positives of using AI-based apps for healthcare treatment. Price Transparency Most care happens with little or no conversations about what it might cost the patient. However, in our current healthcare market, more patients want to know what their out-of-pocket contribution will be before they sign on the line consenting for treatment. Anthem understands this desire of patients and is meeting them halfway by giving them the cost of their chatbot visit and MD appointment upfront. Not only do patients know the cost of the visit, but they also get an appointment that fits into their schedule from the comfort of their home, office, or breakroom. Of course, price transparency doesn’t only come from apps. The Affordable Care Act requires hospitals to publish a master list of costs so that consumers can shop around for the best price. This rule was enforced on January 1 of this year but has become nothing more than a long list of expenses that mean little to most consumers. With the Anthem app, prices are clearly communicated to the patient before care so that an informed decision can be made. Increased Patient Engagement As nurses, we know that a highly engaged patient typically sees better outcomes. When dealing with complex medical issues like cardiovascular disease or diabetes, being well-versed in their symptoms, medications, and any possible side effects can keep patients healthy. App visits can also provide a level of anonymity that may allow some individuals to ask questions that they may not feel comfortable asking during a face-to-face visit. Understanding the Possible Drawbacks Just like all medical treatments, there are potential cons to using A.I. and mHealth. Here are a few of the potential dangers of chatbot visits. Legal Implications for ChatBots As Dr. Campbell points out, artificial intelligence is an excellent tool for healthcare professionals. However, seeing your physician or nurse practitioner and their office staff will always be the gold-standard for medical diagnoses and treatment. If a doctor does not have the ability to see the patient and do a physical exam, the risk of misdiagnosing the condition is significant. One question that is concerning for some experts is who would be responsible if an incorrect diagnosis is given to a patient during the chatbot conversation. Chatbots can’t be sued, but physicians, nurse practitioners, and other care providers can be held responsible for misdiagnosing a patient’s condition. Physician Burnout Could healthcare systems start expecting physicians to see patients all day and then go home and be connected to their phones? More doctors are talking about symptoms of burnout they feel from their day jobs. The American Academy of Family Physicians called burnout an epidemic in 2015, with about 46 percent of physicians reporting symptoms of the condition. Burnout can lead to low job satisfaction, anxiety, depression, and lower quality of patient care. Quick Fixes Aren’t Always a Good Thing Our society likes a good quick fix. You can find a hack for almost anything these days. However, when it comes to your health, choosing the quick fix may not be the best answer. Dr. Campbell worries that patients may chat with the bot, get a few possible diagnoses and then end the visit before ever-texting an actual human. This could lead to poor outcomes and misdiagnosis because the patient didn’t take the time to speak with the physician. The Future of MHealth and A.I. Healthcare was slow on the uptake of technology. Today, the industry has caught up and is even leading the charge in many areas of technology. So, what do you think about mHealth and chatbots? Would you use this service for yourself, and would you recommend it to your patients? Share your thoughts in the comments below.
  3. Infection prevention and control is a cornerstone of safe treatment in all practice settings. In this new era of patient care amidst COVID-19, the healthcare industry is faced with having to balance the new risks posed to providers by the pandemic with existing risks for patient infection due to age, gender, or co-morbidities. Safe, efficient use of personal protective equipment (PPE) is essential for patients, providers, and the professional community in mitigating the new risks to providers and to supporting patient care. We know what must be done to safeguard providers and patients, but we face great challenges as COVID-19 cases continue to surge in waves across the country. PPE Shortages: Many PPE items are now available in only limited supply according to the FDA’s list of medical device shortages and facilities are facing increased demand, especially as physicians in ambulatory surgical centers seek to provide non-emergent care to those requiring screening, surveillance, or therapeutic procedures. Increased Expenses: It is estimated that hospitals’ PPE cost has been $3.8 billion in the second half of 2020 (Richard Pollack, American Hospital Association [AHA], CEO). Such an unprecedented cost raises questions of how to best prioritize and distribute the necessary equipment, share the burden of cost, ensure integrity and management of supplies, and maintain education standards and training on the appropriate use of PPE. Time-Consuming Fit Testing: PPE fit testing is expensive not only from a dollar perspective but from the time required. In the case of unique procedures where outside experts are needed to attend, there may be limited room or time for proper PPE fit testing to take place. Inappropriate Use of PPE: Add to this burden the fact that some facilities are fighting back against the inappropriate use of PPE, such as N95 mask re-use, and you have a perfect storm. Having moved from a long career as a nurse practitioner and educator to a new role in infection prevention with a medical technology company, I am now using my training and education to help ensure that our company supports practitioners in the safe and effective use of our products. We are all deeply concerned by the struggles of healthcare providers in accessing the PPE needed to safely do their jobs, and out of this concern, we have looked critically at our own practice. Part of the calculus we have been forced to make as a medtech company is how to facilitate correct management of our medical devices and instruments being used during diagnostic and therapeutic procedures while trying to conserve critical PPE for healthcare providers involved in patient care. We have determined that one of the best routes to reducing PPE misuse is to avoid having to use it in the first place. And we have made this determination based on the potential we see in the use of virtual telepresence platforms to save PPE supplies by allowing support and training from outside experts to be provided remotely. Facilities can use a virtual telepresence platform to: Bring medtech representatives into procedure rooms to support physicians during diagnostic and therapeutic procedures in real-time. Enable health care students to observe cases as they learn to care for patients in unique circumstances. Invite experts into procedure spaces virtually to assist physicians without having to don additional sets of PPE for quick consults. Infection prevention was already a challenging endeavor, and COVID-19 has further pressurized the situation. With a “Communicate, Enforce and Preserve” mindset, the healthcare community will adjust, as we have adjusted to the many challenges we have faced before this one. My hope is that we will not only adjust but also adapt by making investments in technologies that can help us all better support patient care. Resources 1 Medical Device Shortages During the COVID-19 Public Health Emergency | FDA.gov Updated 9/24/20. Accessed September 19, 2020.
  4. Medical AdvancesWhether we like it or not, the future has caught up with us. Old school nurses like me who have been practicing for thirty years or more have witnessed many changes. Just a couple of examples are needleless methods of administering medications and the multitude of other safety measures initiated that decrease medical and medication errors. Electronics have improved surgical, endoscopy, and X-Ray equipment by increasing accuracy. Oh, and let’s not forget electronic charting. When electronic charting first came, we nurses often complained. The common complaint was that we felt the computer took us away from the patient. Paper charting allowed us to chart at a later time and was much less complicated. However, computer charting has decreased mistakes with hard stops and standardization of the nursing language. Each step of medical advancement has increased the quality of patient care and decreased complications. And here we are on the cusp of improving the world in medicine even more. Telehealth has been around for a bit actually, but it is getting ready to be a large part of the healthcare system. What is Telehealth?What is Telehealth? It is the use of electronic information to transmit patient information and providing healthcare services. As mentioned earlier, this method of care has been used in the United States since 1964 when they used closed-circuit television (Nelson & Staggers, 2017). It has been used in medical teaching for a long time as well, beginning with live video. BenefitsThere are many benefits to using telehealth, such as decreasing or removing travel barriers for the poor, rural, and disabled. Telehealth will provide more immediate care which can lead to earlier detection of disease or health issues. By putting the power back into the patient’s hands, they become empowered, more independent, and therefore more compliant. Telenursing allows nursing and technology to combine in order to give care to those who may have trouble accessing medical care for a myriad of reasons. As we know, rural patients have difficulty with transportation due to geographic conditions, and less access to practitioners. Medical compliance is lower in rural patients, making chronic conditions harder to manage. Veterans are another group of patients that need assistance to connect with providers. Veterans with disabilities may have trouble traveling to appointments for services that are not offered locally. There are several successful programs that use telehealth in order to better provide care. The one we will focus on is The Department of Defense. Real-time appointments are conducted via video between the patient and the provider. The patients may include active service members, retirees, or dependents. Some of the services that are provided include mental health, dermatology, pulmonary disease, and cardiology care through telehealth. For more information, here is their website. Technology allows doctors to monitor vital signs, blood sugar levels, temperature, bi-pap readings, and much more. This eliminates the need to go to the doctor's office so often in the case of chronic conditions, homebound patients, and handicapped patients. Biometric data can help to not only monitor conditions but also to diagnose issues. Loop recorders are a good example. When patients have short periods of heart arrhythmias, it is often hard to record, and therefore diagnose and treat. Loop recorders are small devices implanted in the upper chest that record heart activity. They activate and begin recording when the heart rhythm becomes abnormal. This information helps the cardiologist to diagnose the patient. The question may arise asking if telehealth is equal to a face-to-face visit. Studies have shown that telehealth is just as effective (Nelson & Staggers, 2017). Another concern when using telehealth is privacy. The same rules and laws apply to these situations that apply to any other HIPAA related issue. Another consideration is the patient’s media/computer and health literacy. These factors must be considered as medicine moves forward using telehealth. Telehealth is becoming more sophisticated and applicable with each passing year. There is much to contemplate as we move forward using telehealth in the United States. What are your thoughts on the future of healthcare using telehealth? Share your thoughts and experiences with the allnurses community. https://youtu.be/cC88besDEDc
  5. Susie2310

    Covid-19 and Telehealth

    Due to the Covid 19 problem some patients are being offered the choice of video appointments with their health care providers. However, in my experience, not all patients are able to do this, for a number of reasons, such as not possessing the relevant smart phone etc., and not all patients are able to make their computer (if they have one) work with the technologies currently available for video visits. Some patients do not want to have video appointments as a personal choice. Although telehealth is widely used in the home setting, e.g. for wireless transmission of health care data from patients' various medical devices to their medical provider, to my knowledge this usually doesn't require patients' to be technologically involved in the process more than being able to read an instruction manual in order to provide basic set up for their device. As far as I know, all the necessary equipment is provided for them by the companies that supply the medical equipment according to the patients' medical insurance. We are seeing iPads being used for family members to communicate with hospitalized patients due to Covid 19, but what happens if the patient's family member doesn't own the technology necessary for this or possess the ability to use this technology? If the answer is: "Well, then they can't communicate with the patient," I find this problematic on a number of levels. So, to me, this situation is not free of dilemmas and ethical questions/concerns. For those of us who have ourselves experienced being patients or family members in these types of situations, how do we feel and what are our experiences? What difficulties do we see?