the cedar ledge

What Is Telehealth?

Date: May 2 2022

Summary: An outline addressing what is telehealth and core components

Keywords: ##outline #telehealth #background #emergency #framework #quality #care #acute #chronic #archive

Bibliography

Not Available

Table of Contents

    1. Telehealth Background
    2. Telehealth Frameworks and Systems
    3. Telehealth Challenges
    4. Telehealth Opportunities
    5. Leading Successful Telehealth Interventions
    6. Background
    7. Telehealth Strategies or Frameworks
    8. Challenges in Telehealth
    9. Opportunities for Telehealth
    10. Success in Telehealth Interventions
  1. How To Cite
  2. References:
  3. Discussion:

Telehealth Background

TODO: Make its own note

- Telehealth Defined
- History of Telehealth
- Goals of Telehealth

Telehealth Frameworks and Systems

[NOTE](https://jacobzelko.com/05022022153220-evaluating-telehealth)
- [SPROUT Telehealth Evaluation and Measurement profile] [1]
	- Utilizes concepts from:
		- National Quality Forum
		- World Health Organization
		- Agency for Healthcare Research and Quality
	- Reorganizes concepts into 4 clear measurement domains:
		- Health outcomes
		- Health delivery
		- Experience
		- Program implementation and key performance indicators 
	- Meant to communicate value to:
		- Patients
		- Providers
		- Health systems
		- Payer
- [NATO Multinational Telemedicine System]
[NOTE](https://jacobzelko.com/05022022171845-telehealth-global-emergencies)
- American Telemedicine Association Emergency and Response framework and infrastructure checklist [2]
- [National Quality Federation]

Telehealth Challenges

TODO: Make its own note

- [Clinician Unwillingness]
- [Socialization]

Telehealth Opportunities

TODO: Make its own note

- [Chronic Conditions]
- [Acute Care]
- [Behavioral Health]

Leading Successful Telehealth Interventions

NOTE How to realize a successful telehealth intervention alongside medical professionals according to this paper:

Background

Telehealth is the remote delivery of healthcare via telecommunication tools [3] and the transferral of medical information between sites via telecommunications to improve patient health. [4] The term telehealth is often used interchangeably with the term "telemedicine" as well [4], [5]

Given this definition, one of the most obvious goals of telehealth is to improve patient health and care. [3] Although this is the obvious and most idealistic goal for telehealth, there are other subtle goals of telehealth. For example, it may be to ease the burden to provider care or to assist with triage [6] or to enable cost savings for health systems or payers. [7]

Telehealth Strategies or Frameworks

NOTE

- Utilizes concepts from:
	- National Quality Forum
	- World Health Organization
	- Agency for Healthcare Research and Quality
- Reorganizes concepts into 4 clear measurement domains:
	- Health outcomes
	- Health delivery
	- Experience
	- Program implementation and key performance indicators 
- Meant to communicate value to:
	- Patients
	- Providers
	- Health systems
	- Payer

Challenges in Telehealth

NOTE [4]

- Get in the way currently of how individuals get paid for telehealth
- CPT Editorial panel working on this circa 2015
- Federation of State Medical Boards created the Interstate Medical Licensure Compact
	- Ease multistate licensing [8]
	- Not all states involved at the time of publication
- National Quality Forum developing telehealth framework
	- Telehealth Framework To Support Measure Development 2016 - 2017
		- Developed to identify existing and potential telehealth metrics

NOTE

- Despite high funding in Australia, less than 1% of specialist consultations were telehealth-based [10]
- Clinicians must see telehealth interventions as normal [9]
- Such as lab tests
- Some physical examinations

NOTE

- Eligible for clinical facilities where shortage of health professionals (get citation)
- The digital divide [11]
	- Difference of access to telehealth based on:
		- Geography 
		- Social factors
	- Worst for the elderly
		- Only 58% of persons > 65 years old use Internet [12]

Opportunities for Telehealth

NOTE

- Activate large number of care providers at once
- Enable better triage
- Provide care services when provider locations are unavailable
- Reduce person-to-person contact of disease transmission

NOTE

- Elderly Americans 
	- ~2 million elderly that are homebound [13]
	- Medical home will be patient's home for best patient-centered care [14]
- Stroke [15]
- Pneumonia [16]

Success in Telehealth Interventions

NOTE How to realize a successful telehealth intervention alongside medical professionals according to this paper:

How To Cite

Zelko, Jacob. What Is Telehealth?. https://jacobzelko.com/05022022181455-telehealth-explained. May 2 2022.

References:

[1] Macy, Michelle L., Dana Aronson Schinasi, David McSwain, and John Chuo, “SPROUT COVID-19 Measure Framework,” Mar. 24, 2020. https://research.musc.edu/-/sm/research/resources/sctr/f/sprout-telehealth-measurement-framework-for-covid-19.ashx?la=en (accessed May 02, 2022).

[2] C. R. Doarn and R. C. Merrell, “Telemedicine and e-health in disaster response,” vol. 20. Mary Ann Liebert, Inc. 140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA, pp. 605–606, 2014.

[3] E. R. Dorsey and E. J. Topol, “State of Telehealth,” N Engl J Med, vol. 375, no. 2, pp. 154–161, Jul. 2016, doi: 10.1056/NEJMra1601705.

[4] R. Tuckson, M. Edmunds, and M. Hodgkins, “Telehealth,” New England Journal of Medicine, Oct. 2017. Accessed: Apr. 29, 2022. [Online]. Available: https://www.nejm.org/doi/pdf/10.1056/NEJMsr1503323?articleTools=true

[5] “About telemedicine. Washington, DC: American Telemedicine Association.” https://www.americantelemed.org/main/about/%20about-telemedicine/telemedicine-faqs (accessed May 02, 2022).

[6] A. C. Smith et al., “Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19),” J Telemed Telecare, vol. 26, no. 5, pp. 309–313, Jun. 2020, doi: 10.1177/1357633X20916567.

[7] J. Chuo, M. L. Macy, and S. A. Lorch, “Strategies for Evaluating Telehealth,” Pediatrics, vol. 146, no. 5, p. e20201781, Nov. 2020, doi: 10.1542/peds.2020-1781.

[8] “Understanding the Medical Licensure Compact,” Federation of State Medical Boards, 2013. Accessed: May 02, 2022. [Online]. Available: http://www.fsmb.org/policy/advocacy-policy/interstate-model-proposed-medical-lic

[9] V. A. Wade, J. A. Eliott, and J. E. Hiller, “Clinician acceptance is the key factor for sustainable telehealth services,” Qual. Health Res., vol. 24, no. 5, pp. 682–694, 2014.

[10] V. Wade, J. Soar, and L. Gray, “Uptake of telehealth services funded by Medicare in Australia,” Aust. Health Rev., vol. 38, no. 5, pp. 528–532, 2014.

[11] P. Norris et al., Digital divide: Civic engagement, information poverty, and the Internet worldwide. Cambridge university press, 2001.

[12] A. Perrin and M. Duggan, “Americans’ internet access: 2000-2015,” 2015.

[13] K. A. Ornstein et al., “Epidemiology of the homebound population in the United States,” JAMA Intern. Med., vol. 175, no. 7, pp. 1180–1186, 2015.

[14] N. Herendeen and P. Deshpande, “Telemedicine and the patient-centered medical home,” Pediatr. Ann., vol. 43, no. 2, pp. e28–e32, 2014.

[15] A. Itrat et al., “Telemedicine in prehospital stroke evaluation and thrombolysis: Taking stroke treatment to the doorstep,” JAMA Neurol., vol. 73, no. 2, pp. 162–168, 2016.

[16] W. T. Summerfelt, S. Sulo, A. Robinson, D. Chess, and K. Catanzano, “Scalable hospital at home with virtual physician visits: Pilot study,” Am J Manag Care, vol. 21, no. 10, pp. 675–84, 2015.

Discussion:

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