EMR Benefits: Telehealth

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Telehealth

Integrating EMRs with telehealth can improve the scope of telehealth and boost its benefits. Some benefits are:

  1. It can increase the access of healthcare to remote, underserved and rural areas
  2. It can address the shortage of healthcare providers. Primary care physicians and specialist consultants can serve patients remotely
  3. It can ensure continuity of care without increasing number of hospital visits.

Examples of Telehealth Use

For example, Texas prison system successfully combined a statewide EMR system with Telemedicine system of UTMB, which resulted in improved healthcare delivery for the inmates as well as huge savings for the state. [1]

Telehealth has become very popular due to the rural patients that can start receiving specialty services at their local communities. Some of the services rural hospitals can provide are trauma, stroke and intensive care. The adoption of Telehealth also supports clinical education programs. It allows easy communication between rural clinicians and specialists. Continuing education will also be easily accessed by rural healthcare providers. [1]

In one paper Telehealthcare showed to improve blood glucose checking by individuals with diabetes and resulted in the study participants to have tighter glycemic control, this may result in more widespread adoption of such technology for diabetes management. [2]

Special Care Access Network - Extension for Community Healthcare Outcomes (SCAN-ECHO):Through VA’s SCAN-ECHO initiative, Veterans and their primary care team can videoconference to seek expertise advice from specialists within 100-500 miles away. In 2013, SCAN ECHO spread to 46 rural sites of care with more than 100 participating rural primary care physicians, nurse practitioners, and physician assistants. [3]

The U.S. Department of Veterans Affairs (VA) uses telehealth for several situations, including mental health, rehabilitation, cardiology, neurology, nutrition, etc.[4] 45% of veterans live in rural areas and telehealth allows them to get treatment without driving miles to go to a VA medical center or clinic. The VA's telehealth services are growing 22% in each year and is expected to grow. [5] VA has added TeleAudiology to its growing list of telehealth services. Hearing Aids now have blue tooth connections which enable testing, fitting, and maintenance without a patient going to an audiology clinic. [6]

Thought the use of telehealth, hospital costs can be reduced. Physicians can remote monitor patients and patients can remote consult with physicians. This allows health situations to be taken care of at home reducing the number of unnecessary admissions or readmissions to hospitals. [7]

Rural Areas and PHRs

Personal Health Records and telemedicine access for individuals living in rural areas can have several benefits. Those benefits include: improved consumer access to healthcare providers, improve the quality of care provided through electronic information exchange, and reduce healthcare costs industry-wide. The benefits listed above combat the known disadvantages for rural areas (long travel times and distances, inclement weather conditions, and physician shortages). According to the Agency for Healthcare Research and Quality (AHRQ), 20% of Americans live in rural areas in 29 states, but only 9% of physicians practice in those same areas. Patients who have access to an internet connection can take advantage of PHR. [8]

Telehealth Applications In Mental Health Services

  1. A study of mental health services conducted by New England Veterans Integrated Service Network (VISN1) in 2013 indicated that telemedicine services provide financial benefits that outweigh the cost of implementation [9] Telemedicine reduced costs in the following areas: travel time reimbursement, clinical operations, staff salaries, and staff training. Individually these savings are small, but collectively they are significant
  2. A multi-attribute analysis of VISN1 telemedicine services showed additional qualitative improvements [10]. The qualitative benefits include: increased patient satisfaction, fewer no-shows, decreases wait time, decreased unnecessary referrals, decreased hospitalizations (26.6%), and decreased days in the hospital. While these benefits are not tangible, they add to the total value of telemedicine program implementation in the area of mental health.
  3. In another study, telemedicine relieved the burden on mental health services in rural communities by reducing travel time, cost of services, and number of missed appointment [11]. Patients in rural committees also highly rated telehealth services and expressed willingness to use these services again.

Home Based Telehealth Application

Informatics for Diabetes Education And Telemedicine project (IDEATel) is the largest project “combining telemedicine with patient access to an EMR.” This four year project was established in February 2000, and cost $28-million. It was designed to “maximize Medicare patients' control of their diabetes by providing them with a computerized link to their caregivers.” Patients measured their blood sugar or blood pressure using a home telemedicine unit (HTU) which then transmitted the information securely into the Columbia University Web-based Clinical Information System (WebCIS) via the internet. [12]

In a one year study conductive in under-served areas of New York State of 1,665 Medicare recipients 55 years or older with diabetes found that management of diabetes using HTU “improved hemoglobin A1c, blood pressure and LDL cholesterol levels in older patients with diabetes mellitus at one year of follow-up, compared to usual care.” [13]

References

  1. ↑ name="Telehealth">Benefits of Telehealth / Telemedicine? http://www.setrc.us/index.php/what-is-telehealth/benefits-of-telehealth-telemedicine/
  2. ↑ Chen, L., Chuang, L.M., Chang, C.H., Wang, C.S., Wang, I.C., Chung, Y., Peng, H.Y., Chen, H.C., Hsu, Y.L., Lin, Y.S., Chen, H.J., Chang, T.C., Jiang, Y.D., Lee, H.C., Tan, C.T., Chang, H.L. & Lai, F. (2013). Evaluating Self-Management Behaviors of Diabetic Patients in a Telehealthcare Program: Longitudinal Study Over 18 Months. Journal of Medical Internet Research; 15(12):e266. http://www.jmir.org/2013/12/e266/
  3. ↑ http://www.va.gov/healthbenefits/resources/publications/IB10185_Health_Care_Overview_2014_Eng_V6_web.pdf
  4. ↑ Real-time clinic based video telehealth (n.d.). http://www.telehealth.va.gov/real-time/index.asp
  5. ↑ Lemire, P. (2014). U.S. department of veterans affairs leads the way to provide better care with telehealth. Medical Design Technology, Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com.ezproxyhost.library.tmc.edu/docview/1611569470?accountid=70
  6. ↑ TeleAudiology in VA. VHA Telehealth Quaterly, 14(1), pp. 1-10. Retrieved from http://www.telehealth.va.gov/newsletter/2015/Newsletter_Vol14Iss01.pdf
  7. ↑ http://www.handsontelehealth.com/past-issues/76-telehealth-benefits
  8. ↑ Will electronic personal health records benefit providers and patients in rural America? (2010). Telemedicine and e-Health. 16.2 (Mar. 2010): p167.. Retrieved from http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?p=HRCA&u=txshracd2509&id=GALE%7CA222408568&v=2.1&it=r&sid=summon&userGroup=txshracd2509&authCount=1
  9. ↑ Moore, M., Moreschi A., Rieger K., & Vardaro M. (2013). Return on investment analysis of the VISN1 telehealth program. Worcester Polytechnic Institute. Retrieved from: https://www.wpi.edu/Pubs/E-project/Available/E-project-121813-160755/unrestricted/MQP_Telehealth_ROI_and_Overall_Benefit_Analysis_FINAL_VERSION.pdf
  10. ↑ Moore, M., Moreschi A., Rieger K., & Vardaro M. (2013). Return on investment analysis of the VISN1 telehealth program. Worcester Polytechnic Institute. Retrieved from: https://www.wpi.edu/Pubs/E-project/Available/E-project-121813-160755/unrestricted/MQP_Telehealth_ROI_and_Overall_Benefit_Analysis_FINAL_VERSION.pdf
  11. ↑ Benavides-Vaello, S., Strode, A., & Sheeran, B. (2013). Using technology in the delivery of mental and health substance abuse treatment in rural communities: A review. Journal of Behavioral Health Services & Research, 40(1), 111-120.
  12. ↑ The Journal of American Medical Association 2001 http://jama.jamanetwork.com/article.aspx?articleid=1843694
  13. ↑ Trans Am Clin Climatol Assoc. 2007 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1863578
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