Clinical Telehealth Across the Disciplines: Lessons Learned

Abstract

Videoconferencing technologies can vastly expand the reach of healthcare practitioners by providing patients (particularly those in rural/remote areas) with unprecedented access to services. While this represents a fundamental shift in the way that healthcare professionals care for their patients, very little is known about the impact of these technologies on clinical workflow practices and interprofessional collaboration. In order to better understand this, we have conducted a focused literature review, with the aim of providing policymakers, administrators, and healthcare professionals with an evidence-based foundation for decision-making. A total of 397 articles focused on videoconferencing in clinical contexts were retrieved, with 225 used to produce this literature review. Literature in the fields of medicine (including general and family practitioners and specialists in neurology, dermatology, radiology, orthopedics, rheumatology, surgery, cardiology, pediatrics, pathology, renal care, genetics, and psychiatry), nursing (including hospital-based, community-based, nursing homes, and home-based care), pharmacy, the rehabilitation sciences (including occupational and physical therapy), social work, and speech pathology were included in the review. Full utilization of the capacity of videoconferencing tools in clinical contexts requires some basic necessary technical conditions to be in place (including basic technological infrastructure, site-to-site technological compatibility, and available technical support). The available literature also elucidates key strategies for organizational readiness and technology adoption (including the development of a change management and user training plan, understanding program cost and remuneration issues, development of organizational protocols for system use, and strategies to promote interprofessional collaboration).

The use of mobile robotic telemedicine technology in the neonatal intensive care unit

“…This form of telemedicine has been utilized primarily by large health-care systems to provide services at medically underserved or remote areas involving disciplines such as obstetrics and neonatal-perinatal medicine, 11,13,14 medicine, surgery, pharmacy, nursing and home health care. 1 The second and most common form of telemedicine provides the local physician with interpretation of imaging by a remote expert in different areas such as cardiac electrophysiology and echocardiography, [16][17][18][19][20][21]29,30 radiology 22,28 and ophthalmology. 15,31 The third and most complex form of telemedicine requires the provision of direct care or invasive interventions by a physician not physically located at the same place with the patient.…”

“…[1][2][3] As telemedicine offers bringing the expertise of specialists and subspecialists to locations where their physical presence is not possible or feasible, it has tremendous potential to improve health-care delivery and outcomes. Indeed, the benefits of the use of telemedicine in adult and pediatric intensive care have already been demonstrated.…”

Rural pharmacy in Canada: pharmacist training, workforce capacity and research partnerships

“…With the amount of experiential learning changing from 16 weeks (baccalaureate degree) to 41 weeks in the new PharmD program, Université Laval faculty, for example, are working with a rural health agency to "facilitate (practically and financially) the lodging" of their students. With widespread access to high-speed internet in most rural northern communities (16), the availability of videoconferencing, webinars and ehealth libraries can facilitate clinical care, promote lifelong learning and nurture research (33,34). By basing continuing professional education programs on the best available research evidence, universities can contribute to closing the knowledge-to-practice gap in providing optimal care in remote and rural clinical practice settings (35).…”

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement

“…Timing of application occurred after an hospital discharge or to maintain benefits such as functional independence, education, participation, physical change, early detection of relapses, adherence, airway clearance, exercise training. Among different technologies, video-conferencing can vastly increase the provision of patients ( particularly those in rural/ remote areas) with previously difficult access to services [75,76]. An on-demand tele-consult and mechanical insuflator-exsuflator device access programme avoided hospitalisations due to severe airway encumbrance for patients with ALS with significant cost savings [69].…”