What is E-Health?

What is E-Health?

E-health is the transfer of health resources and health care by electronic means. It encompasses three main areas:

 

•   The delivery of health information, for health professionals and health consumers, through the Internet and telecommunications.
•  Using the power of IT and e-commerce to improve public health services, e.g. through the education and training of health workers.
• The use of e-commerce and e-business practices in health systems management.

 

E-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.

The 10 e’s in “e-health”

1. Efficiency – one of the promises of e-health is to increase efficiency in health care, thereby decreasing costs. One possible way of decreasing costs would be by avoiding duplicative or unnecessary diagnostic or therapeutic interventions, through enhanced communication possibilities between health care establishments, and through patient involvement.
2. Enhancing quality of care – increasing efficiency involves not only reducing costs, but at the same time improving quality. E-health may enhance the quality of health care for example by allowing comparisons between different providers, involving consumers as additional power for quality assurance, and directing patient streams to the best quality providers.
3. Evidence based – e-health interventions should be evidence-based in a sense that their effectiveness and efficiency should not be assumed but proven by rigorous scientific evaluation. Much work still has to be done in this area.
4. Empowerment of consumers and patients – by making the knowledge bases of medicine and personal electronic records accessible to consumers over the Internet, e-health opens new avenues for patient-centered medicine, and enables evidence-based patient choice.
5. Encouragement of a new relationship between the patient and health professional, towards a true partnership, where decisions are made in a shared manner.
6. Education of physicians through online sources (continuing medical education) and consumers (health education, tailored preventive information for consumers)
7. Enabling information exchange and communication in a standardized way between health care establishments.
8. Extending the scope of health care beyond its conventional boundaries. This is meant in both a geographical sense as well as in a conceptual sense. e-health enables consumers to easily obtain health services online from global providers. These services can range from simple advice to more complex interventions or products such a pharmaceuticals.
9. Ethics – e-health involves new forms of patient-physician interaction and poses new challenges and threats to ethical issues such as online professional practice, informed consent, privacy and equity issues.
10. Equity – to make health care more equitable is one of the promises of e-health, but at the same time there is a considerable threat that e-health may deepen the gap between the “haves” and “have-nots”. People, who do not have the money, skills, and access to computers and networks, cannot use computers effectively. As a result, these patient populations (which would actually benefit the most from health information) are those who are the least likely to benefit from advances in information technology, unless political measures ensure equitable access for all. The digital divide currently runs between rural vs. urban populations, rich vs. poor, young vs. old, male vs. female people, and between neglected/rare vs. common diseases.

In addition to these 10 essential e’s, e-health should also be

• easy-to-use,
• entertaining (no-one will use something that is boring!) and
• exciting

– and it should definitely exist!

We invite other views on the definition of e-health and hope that over time the journal will be filled with articles which together elucidate the realm of e-health.

Gunther Eysenbach

Editor,

Journal of Medical Internet Research

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Acknowledgments

Based on the author’s speech delivered at UNESCO (Paris), June 2001, Conference of the International Council for Global Health Progress: Global health equity – Medical progress & quality if life in the XXIst century.

The article was partly stimulated by the question “what is ehealth?” asked by A. Risk on various mailing lists and in Health Informatics Europe http://hi-europe.co.uk/files/2001/9996.htm.

 

Source:

http://www.who.int/trade/glossary/story021/en/

http://www.jmir.org/2001/2/e20/

The Evidence Base for Telehealth in Stroke Management

6th April 2011

Susan Royer

This article on the evidence base for telehealth in stroke management was taken from the Whole Systems Demonstrator Action Research Network (WSDAN) database.

In January 2011, WSDAN News reported on a systematic review into telerehabilitation in stroke care. [1] Nine post-2000 studies were included in the review, having met certain criteria. Four of the studies were randomised controlled trials (RCTs), one was a qualitative analysis, and four used observational study designs or case series. In the majority of studies, sample sizes were relatively small – fewer than 25 participants.

The selected studies included three from the United States that related specifically to stroke patients’ caregivers. Their objectives covered a range of issues:

• Analysing caregivers’ use and acceptance of telehealth – caregivers were generally accepting of the interventions.
• Measuring the impact of ‘problem-solving telephone partnerships’ – caregivers were better prepared, and more able to utilise problem-solving skills among the intervention group compared with a control group.
• Exploring the feasibility of internet-based education and support provision, aimed at caregivers living in rural communities – caregivers were satisfied that email contact with nurses provided the necessary information for their care function.

Four studies included in the review were concerned with physical post-stroke functioning. These involved stroke patients’ use of sensors on the arm or hand combined with video-consulting, which allowed therapists to monitor patients’ exercises and offer real-time guidance and support. These therapy sessions lasted one hour and took place on five days each week. Using the Fugl-Meyer motor scale to assess motor function – the controlled use of movement – one study’s pre- and post-intervention measurements recorded improvements for the telerehabilitation group compared with the control group. [2] The same study, however, found no difference between the two groups in terms of the ABILHAND scale, which also assesses motor function.

Other research used telephone consulting or audio-videoconsulting for stroke rehabilitation. The latter found significant improvements in subscales among telerehabilitation patients who completed Short Form Health Surveys.

The systematic review concluded that, while promising results were evident across the range of interventions, more research was needed to assess the impact of stroke telerehabilitation on costs, effectiveness and utilisation.

Telehealth evidence database

The telehealth evidence database currently holds 12 entries on stroke. Two studies look at robot therapy as a means of treating paralysis. In February 2011, a Japanese-based team reported results for recent stroke sufferers who used daily robotic therapy to manipulate their arms which had been left paralysed. [3] The benefits of this treatment included an increased sense of motivation among patients towards rehabilitation, with the prospect of improvement seeming more realistic than with usual methods. The robotics’ level of accuracy was also commended, as they had the ability to administer precisely the optimum pattern of movement.

Research carried out in 2009 in the United States also recorded successful use of robotic devices attached to the ankle or wrist. [4] Patients self-treated, and improvements remained in evidence six months after the trial ended.

Researchers identified an unmet need in terms of post-stroke support for veterans and carers in the United States. [5] This 2007 study was followed up in 2009 with a small-scale trial of a care co-ordination home telehealth programme (CCHT), which involved 18 veterans and 14 carers. [6] Incidence of depression, falls and post-stroke concerns were recorded for patients, along with the level of burden experienced by carers. Ninety per cent of participants felt that access to a care co-ordinator would be useful. The study concluded that home telehealth had potential for this patient group, alongside contact with health care workers.

From the perspective of clinical professionals, telemedicine has been shown to be useful in diagnosing the treatment needs of stroke patients, particularly those living in areas less well served by vascular neurologists. A 2009 study involving a range of professionals, including neurologists and emergency medicine experts, used clinical scenarios to test the efficacy of two-way audio-video links with patients. [7] The advantage of a video connection compared with a telephone-only link is the potential for clinicians to remotely see patients and to base decisions on their visible physical condition as well as reported symptoms. With the benefit of the visual link, the study recorded high levels of decision accuracy and subsequent treatment, particularly judgements about whether or not patients were appropriate candidates for thrombolytic therapy. Video telemedicine produced correct treatment decisions in 98 per cent of cases, compared with 82 per cent for telephone-only consultations.

Conclusions

With an estimated 150,000 people suffering a stroke each year in the UK alone, it represents a widespread chronic condition. [8] Ageing populations and the increased likelihood of stroke among the over-65s point to a need for improved stroke treatment services.

By increasing the delivery of these services in the home, whether administered by a carer, a visiting health professional or guided self-treatment, pressure on inpatient facilities is relieved and stroke patients are able to remain in familiar environments which, in many cases, are more conducive to recovery than hospital settings. However, the available evidence tends not to focus on costs, effectiveness and utilisation, and these areas require greater scrutiny in order to put forward a strong argument for the continued development of telemedicine technologies to support both stroke patients and their carers.

source:http://www.kingsfund.org.uk/publications/articles/evidence-base-telehealth-stroke-management

Telemedicine

NOTE: TELEHEALTH was previously known as “telemedicine” or “e-medicine”

As the healthcare profession evolves, the continued success of your practice depends on serving your patient base in ways that are convenient and cost effective.

source: Mayo Clinic

How Telemedicine Works

NOTE: Telehealth was previously known as “telemedicine” or “e-medicine”.

source: http://youtu.be/y02nSCYl2ZE

The Evidence Base for Telehealth and Telemedicine in the Management of Obesity

26th July 2011

Susan Royer

Can a telehealth programme help in maintaining weight loss? 

Publication: This article was taken from the Whole Systems Demonstrator Action Research Network (WSDAN) database

Obesity has become an increasingly prevalent long-term condition, and is now one of the major health issues in the West. While weight loss programmes are fairly common, facilities for weight loss maintenance are less so. A quasi-experimental study carried out in the United States examined the influence of telehealth in a weight loss maintenance programme. [1] Eighty-seven individuals who had participated in the ‘Colorado Weigh’ weight loss programme were involved in the study, which sought to answer this question: could a telehealth programme, undertaken following successful completion of a behavioural weight loss course, help in maintaining weight loss?

Researchers chose a quasi-experimental rather than a randomised study design so that individuals could choose to participate in a weight loss maintenance programme that was either telehealth-based or classroom-based, or to opt out completely. All those involved met both selection criteria of having previously taken part in a weight loss programme and having achieved at least 7 per cent weight loss.

Thirty-one participants selected the telehealth programme, 31 selected the classroom or ‘traditional’ programme, and 25 chose not to be involved with formalised weight loss maintenance.

The telehealth programme comprised computer software, email, and remote advice and coaching. Participants used the technology to record their weight-related activities, and to interact with a registered dietician once a fortnight over a 24-week period. Dieticians had access to the activity logs and telephoned participants where they felt that this added contact would be useful.

Those who opted for the traditional programme attended classes every fortnight for 24 weeks. Sessions were led by a registered dietician who was available before and after the class for individual queries. Attendees were required to complete a daily, paper-based log recording calorie and fat intake and physical activity.

Given that participants had chosen their method of weight loss maintenance, researchers wanted to find out user satisfaction levels for each of the programmes, as well as their effectiveness in weight loss maintenance terms.

Weight change for the telehealth and traditional groups was similar. Over the research period, the telehealth group lost 0.6 ± 2.5kg while the traditional group lost 0.5 ± 4.3kg. Within the same timeframe, the group that did not take part in either programme gained 1.7 ± 3.0kg.

These results indicate that some form of weight loss maintenance programme is more effective in the avoidance of weight gain than no programme at all. However, the traditional programme appears to have performed broadly as effectively as the telehealth one.

User surveys of convenience and satisfaction were undertaken. These found similar satisfaction levels between the telehealth and traditional groups, but the telehealth group was rated as the more convenient of the two.

The researchers point out that participants in the telehealth group were ‘highly educated’ and had above-average access to and proficiency with the internet, which will have influenced their decision to choose the telehealth option. A randomised group would have produced different, perhaps less positive, results.

In terms of time-cost for the professionals involved, the telehealth programme initially required more time than the traditional programme. However, by the end of the study, the traditional programme had a greater time requirement.

The study concluded that a telehealth option, such as that described above, can be an effective tool in weight loss management for people who wish to avoid physically attending classes, possess the required technology and are equipped to use it.

Telehealth evidence database

The telehealth evidence database currently holds seven research summaries on obesity. These include three randomised controlled trials (RCTs), as well as other study designs.

One RCT, undertaken in Greece, used telemedicine over a six-month period to allow participants to record and transmit their own blood pressure and body weight readings. [2] One hundred and twenty-two patients aged between 18 and 70, and with a body mass index (BMI) greater than 25kg/m2, took part in the study. The control group comprised 77 patients who received standard hospital care. The remaining 45 also used electronic devices for the readings mentioned above. Outcome measures included body weight, BMI, blood pressure and quality of life.

The study recorded greater weight loss among those in the intervention group compared with the control group, alongside high levels of satisfaction with the telemedicine. Quality of life measurements were similar for both the intervention and control groups.

Another six-month RCT looked at self-reported weight for a group of obese employees. [3] Telephone coaching and ‘interactive telemonitoring’ were available to an intervention group, in addition to daily self-weighing. Both the intervention and control groups under-reported their weight, but the intervention group’s under-reporting was the less significant. This might be attributed to the telemedicine and telemonitoring employed during the study.

The potential of a person’s obesity to impact on other chronic conditions was highlighted by researchers who investigated the accuracy of home blood pressure readings. [4] The study focused on the size of sphygmomanometer cuffs used by patients and found that, for some obese individuals, the cuff circumference was too small for precise home readings to be taken. It concluded that patients need better information about appropriate cuff sizes for their arms to improve their blood pressure management.

Numerous studies have been undertaken on obesity among children and adolescents. One such study looked at the feasibility and acceptability of a telemedicine intervention for family-based paediatric obesity. [5] Seventeen families were involved, including children with a mean age of 9.9 years. The control group received a single physician visit during the study, while the intervention group took part in four one-hour videoconference sessions with health professionals over an eight-week period. Families began the sessions together, before the parents spoke separately with a psychologist over the video link. BMI measurements did not change significantly for either group. Parents recorded high satisfaction with the telemedicine, as did the health professionals involved, who had access to patients across a wide geographical area without travelling to numerous locations.

Another RCT involved 8-12-year-old children and their parents. Over one year, some parents received ‘interactive voice response counseling’. [6] Sustained BMI decreases were recorded for children whose parents regularly accessed the counselling service, compared with parents who were using other methods. Researchers concluded that the interactive facility could successfully support parents in reducing their children’s weight.

It is clear that telehealth and telemedicine can be used in the treatment of obesity, whether by facilitating patients’ and health professionals’ monitoring of the condition or by providing additional, remote guidance and support. Patient satisfaction with these methods tends to be high and, from the provider perspective, delivery savings in time and cost are achievable after initial set-up.

Source:
http://www.kingsfund.org.uk/publications/articles/evidence-base-telehealth-and-telemedicine-management-obesity

Using Telehealth to Improve Continuity of Care

By Julie Cheitlin Cherry, RN, MSN, PHN

As our global population grows older with a higher incidence of chronic conditions, we have an imperative to truly improve quality of care both within and beyond the walls of the hospital while reducing costs. Continuity of care plays a key role in patient management by ensuring that patients experience a smooth transition from the hospital back to the home, and new models of care that utilize telehealth technologies will be important to support this process and reduce rehospitalizations.

In the context of post-discharge care, telehealth technologies can enable healthcare providers to bridge care between the hospital and home, encouraging earlier interventions and thus reducing the need for rehospitalizations (Wakefield, n.d.). This advanced level of connectivity is necessary to overcome the traditional “black hole” of care that occurs in the period between initial hospital discharge and a patient’s first follow-up appointment. During this time, physician transitions, medication adjustments, and other changes to the care routine that were made in the hospital often fall by the wayside and are not adequately transitioned when the patient goes back to his or her primary provider.

However, the advanced level of care offered by telehealth technology ensures that the healthcare professional can intervene early when a change in health is noted, thereby improving the quality of care, reducing the chance for readmission, and ensuring cost-efficiency for both the hospital and the patient. By extending their reach beyond the traditional confines of the hospital walls, clinicians can offer a connection of care between the hospital and the home that results in better overall outcomes and lower costs (Schlachta-Fairchild et al., 2008). When using the newest generation of remote health management (RHM) systems, clinicians can communicate with patients on a regular basis while having access to timely actionable and accurate data from the patients in their homes.

As the role of RHM expands in post-discharge care and other healthcare services, there is great potential for future growth of this market. A recent analysis from Frost & Sullivan (2008) expects the telehealth market to reach $428.6 million in 2015, more than quadrupling from the $98.2 million it generated in 2008. Further, according to a recent survey of American government and health leaders, 90% of U.S. health leaders and 84% of global health leaders believe that the merging of information technology and healthcare will be critical for changing healthcare delivery (PR Newswire, 2010).

New Models of Care

New models of care that incorporate RHM offer numerous benefits to providers, payors, and patients alike. One key advantage of RHM is the notable improvement to patient care and safety. According to the Joint Commission 2010 National Patient Safety Goals for both hospital and home care, correct identification of patients, approved use of medications, and careful review of patient safety risks are all important ways to improve overall patient safety in hospitals and homes (Joint Commission, 2010). To meet these goals, hospitals may implement telehealth systems to help manage high-risk patients and ensure that the correct medications are being taken at the right times. As a result of the recently-passed Patient Protection and Affordable Care Act, starting in October 2012, Medicare will penalize hospitals whose readmission rates within a 30-day period are higher than expected (Kentucky Coalition, 2010); therefore, hospitals will have even more financial incentive to help transition patients home and keep them there.

Adoption of RHM also decreases costs for both hospitals and patients across a variety of chronic disease categories, especially through the reduction of rehospitalizations (Seto, 2008). Today’s healthcare landscape is seeing a renewed interest in the economic costs of rehospitalizations: according to a 2010 report by the Center for Technology and Aging, 17.6% of all Medicare hospital admissions are readmissions, a majority of which are avoidable. In total, readmissions cost $15 billion annually; however, if successfully prevented, Medicare could save $12 billion of the $15 billion in readmission costs, equaling 80% of this expenditure and decreasing costs for hospitals, payors, and patients.

Telehealth has the potential to dramatically reduce this number, minimizing unnecessary costs, and improving quality of care. According to a trial sponsored by the University of Illinois at Chicago (UIC) Institutional Review Board and the West Side Veterans Administration (WSVA) Research and Development Committee, home healthcare provided by nurse telemanagement reduced the rate of readmissions by more than 25%, resulting in savings of at least $136,000 when compared to patients who had nurse home visits without the adjunct of telehealth. The projected national cost of chronic heart failure hospital visits could be reduced from $8 billion to $4.2 billion annually, based on hospital days per patient per year with and without intervention and the cost of intervention by telehealth (Seto, 2008).

With the implementation of RHM comes the potential to accommodate a decreasing labor force as well. By limiting the time spent traveling to remote areas and the length of basic check-up appointments, telehealth technology allows for improved productivity of hospital staff, especially in the post-discharge care setting (Schlachta-Fairchild, L., 2008). Telehealth-enabled care models can help clinicians—whether hospital-based, home-based, or remotely-based—better manage the risk associated with chronic care patients, enabling them to move beyond simple data collection toward more interactive interventions. Driving educational information to the patient at the time of an identified teachable moment, providing regular reminders, and supporting virtual visits with video conferencing technology are a few ways that the new generation of telehealth technologies differs from simple vital sign collection modalities. Using these technologies, healthcare providers have greater availability and the opportunity to reach more patients and spend additional time addressing the needs of each individual.

Patient Engagement

Finally, RHM ensures that the patient has an increased involvement in the management of personal health. In a recent survey by PriceWaterhouseCoopers (2010), 97% of government and health leaders in 20 countries agreed that patients should have some responsibility for managing their health and chronic conditions, such as obesity, diabetes, and heart disease. This accountability is especially important in post-discharge care: when released from the hospital, patients and their caregivers must be engaged in managing medications and staying true to care plans. Contrary to the traditional belief that fragile elders are unable or unwilling to use technology, older people are very engaged in telehealth systems, especially those that allow them to stay more independent while aging in place in their homes.

According to a recent study, elderly patients using a video-enabled RHM device reported high satisfaction and improved perception about the quality of care that they received (Little & Meyers, 2010). Another study found that telehealth patients report a higher sense of patient satisfaction; users feel more connected to their care team, which reduces the stress of managing chronic illness and enhances the sense of control of their own health (Noel et al., 2004).

Further supporting this shift in focus, the Patient Protection and Affordable Care Act has created a groundswell of interest in new and more affordable models of care. The next phase of health reform will “reflect a concerted effort to keep people well, out of the hospital and more actively engaged in managing their own health” (Pricewaterhouse Coopers, 2010)—all areas in which RHM has a track record of improving outcomes. The current shift from quantity to quality in payment of care will also help support the growth of the telehealth industry and solutions marketplace by enabling clinicians to manage by exception and offer more personalized care to their patients.

Accountable Care Organizations (ACOs) are another hot button-issue as a result of the Patient Protection and Affordable Care Act.  Built upon the goal of rewarding high quality care and encouraging providers to work together to deliver superior results, ACOs will also need the support of telehealth to both implement and measure improved care. RHM encourages this unified structure of care by connecting the full team of healthcare providers to the patient and ensuring a high level of attention is paid to the patient’s health post-discharge. According to the law, ACOs require a coordinated care team to “define processes to promote evidence-based medicine, report on quality and cost measures, and coordinate care.” Using a RHM model is a promising solution as many telehealth systems have the capabilities to support these initiatives to help meet new requirements and track progress.

The question for many continues to be reimbursement, and a variety of organizations and companies are advocating for a system where clinicians are compensated for “virtual visits” by the Centers for Medicare and Medicaid Services and other payers (American Telemedicine Association). However, healthcare organizations do not need to wait for reimbursement, as the financial incentives for implementing telehealth are already clear. Hospitals in particular will see lower financial penalizations if they can successfully extend their care into the homes and prevent readmissions, and payers will reap the benefits of a healthier patient population with chronic disease under control.

As the number of patients with multiple chronic conditions continues to rise, so will the number of inappropriate and costly hospitalizations (Robert Wood Johnson Foundation, 2010), and our hospital-centric system simply cannot afford this influx of patients and acute incidents. With this growing market and the undeniable demographic need, RHM solutions are necessary to ensure that clinicians remain connected to their patients with up-to-date medical recommendations and proactive engagement. Our spiraling costs and commitment to patient care are forcing us to start now to change the way that patients and clinicians interact tomorrow. Telehealth solutions such as RHM have already been proven as cost-effective systems that improve quality of life for patients and clinicians alike—now is the time to start implementing them throughout post-discharge care and beyond.

ABOUT THE AUTHOR:

Julie Cherry is an advanced practice nurse with a specialty in gerontology. Her area of expertise is in chronic illness management. She has worked diligently throughout her career to influence the adoption of care models designed specifically to meet the needs of the chronically ill. Cherry is currently the director of professional services for the Digital Health Group at Intel Corporation. Previously, she helped pioneer the first home telehealth solution for remote patient monitoring and more recently was instrumental in the design and development of the Intel Health Guide system. She has published extensively, focusing on the care of the chronically ill, and has written several publications and position papers on the impact of technology for remote patient monitoring and chronic illness management. Cherry holds both a BS and an MS in nursing from San Jose State University.

Source:

http://www.psqh.com/september-october-2010/630-using-telehealth-to-improve-continuity-of-care.html
Using Telehealth to Improve Continuity of Care By Julie Cheitlin Cherry, RN, MSN, PHN

Connectivity for Better Quality of Care

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