The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/readmissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.
The authors describe an innovative academic health center (AHC)-led program of health care delivery and clinical education for the management of complex, common, and chronic diseases in underserved areas, using hepatitis C virus (HCV) as a model. The program, based at the University of New Mexico School of Medicine, represents a paradigm shift in thinking and funding for the threefold mission of AHCs, moving from traditional fee-for-service models to public health funding of knowledge networks. This program, Project Extension for Community Health care Outcomes (ECHO), involves a partnership of academic medicine, public health offices, corrections departments, and rural community clinics dedicated to providing best practices and protocol-driven health care in rural areas. Telemedicine and Internet connections enable specialists in the program to comanage patients with complex diseases, using case-based knowledge networks and learning loops. Project ECHO partners (nurse practitioners, primary care physicians, physician assistants, and pharmacists) present HCV-positive patients during weekly two-hour telemedicine clinics using a standardized, case-based format that includes discussion of history, physical examination, test results, treatment complications, and psychiatric, medical, and substance abuse issues. In these case-based learning clinics, partners rapidly gain deep domain expertise in HCV as they collaborate with university specialists in hepatology, infectious disease, psychiatry, and substance abuse in comanaging their patients. Systematic monitoring of treatment outcomes is an integral aspect of the project. The authors believe this methodology will be generalizable to other complex and chronic conditions in a wide variety of underserved areas to improve disease outcomes, and it offers an opportunity for AHCs to enhance and expand their traditional mission of teaching, patient care, and research.
Executive SummaryThis document reflects the strongly held views and perspective of a diverse group of healthcare academicians, researchers, providers, and industry representatives from across the country who share a belief in the necessity of healthcare reform and the centrality of telemedicineor information technology-enhanced healthcare-in that reform.The need for reform stems from long-standing problems in our health system, and the central role of telemedicine derives from an ever-expanding body of research and experience that attests to its merit in addressing these problems. Despite the fact that the United States spends more on healthcare than any other country, both in absolute numbers and on a per capita basis, the health status of Americans ranks relatively low when compared with that of people in other developed nations. Moreover, the general discrepancy between expenditures and health status indicators in the United States masks significant differentials among segments of the population, based on socio-economic, geographic, cultural, ethnic, and other factors. Hence, we continue to suffer from inequities in access to healthcare, inefficiencies in the delivery of care, escalating costs, and the prevalence of adverse lifestyles that exacerbate these problems.Much attention has been devoted to the utility of the electronic health records (EHRs) as a means to improving the healthcare system. Yet, despite its potential benefits, the EHR represents only a partial solution to the problems we face. A broader focus on telemedicine (also frequently referred to as telehealth or e-health) that incorporates EHRs is a more prudent and effective approach. We believe that an exclusive concern with developing system-wide EHRs, while laudable and potentially valuable in improving one sector in healthcare delivery, would ultimately increase the cost of care without contributing to necessary changes in the rest of the system. National Telemedicine Initiatives: Essential to Healthcare Reform © MARY ANN LIEBERT, INC. • VOL. 15 NO. 6 • JULY/AUGUST 2009 TELEMEDICINE and e-HEALTH 601 NATIONAL TELEMEDICINE INITIATIVES Telemedicine technology embodies the electronic acquisition, processing, dissemination, storage, retrieval, and exchange of information for the purpose of promoting health, preventing disease, treating the sick, managing chronic illness, rehabilitating the disabled, and protecting public health and safety. Telemedicine systems consist of collaborative health networks, facilities, and organizations dedicated to these objectives. Over the past several decades, telemedicine systems have demonstrated the capacity to do the following: • Improve access to all levels (primary, secondary, and tertiary) of healthcare for a wide range of conditions-including, but not limited to, heart and cerebrovascular disease, endocrine disorders such as diabetes, cancer, psychiatric disorders, and trauma; as well as services such as radiology, pathology, and rehabilitation. • Promote patient-centered care at lower cost and in local env...
In New Mexico, a large rural state, it was anticipated that telehealth would bring significant value to health care delivery, improve local capacity for patient care, decrease the need for patient travel, diminish professional isolation, provide an avenue for enhanced professional education and information sharing, increase access to care, and ultimately improve health status. During the course of an evaluation of the University of New Mexico Center for Telehealth's rural telemedicine program, we used a grounded theory approach to assess barriers to the adoption of telemedicine and components of successful adoption. We then turned to the diffusion of innovations theory to better understand the dynamic interactions between the characteristics of telehealth and the social system in which it is applied. In doing so, we learned that the type of innovation decision involved in the adoption of telehealth appears to be particularly important in determining adoption. In this article we demonstrate that diffusion theory can be a useful framework for evaluating telehealth programs. We also suggest that the development of a predictive tool for prospective assessment would be useful, and could be applied when new telehealth programs are being planned.
There are myriad telehealth applications for natural or anthropogenic disaster response. Telehealth technologies and methods have been demonstrated in a variety of real and simulated disasters. Telehealth is a force multiplier, providing medical and public health expertise at a distance, minimizing the logistic and safety issues associated with on-site care provision. Telehealth provides a virtual surge capacity, enabling physicians and other health professionals from around the world to assist overwhelmed local health and medical personnel with the increased demand for services postdisaster. There are several categories of telehealth applications in disaster response, including ambulatory/primary care, specialty consultation, remote monitoring, and triage, medical logistics, and transportation coordination. External expertise would be connected via existing telehealth networks in the disaster area or specially deployed telehealth systems in shelters or on-scene. This paper addresses the role of telehealth in disaster response and recommends a roadmap for its widespread use in preparing for and responding to natural and anthropogenic disasters.
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