Diagnosis and Decision-Making in Telemedicine

This article provides an analysis of the skills that health professionals and patients employ in reaching diagnosis and decision-making in telemedicine consultations. As governmental priorities continue to emphasize patient involvement in the management of their disease, there is an increasing need to accurately capture the provider–patient interactions in clinical encounters. Drawing on conversation analysis of 10 video-mediated consultations in 3 National Health Service settings in England, this study examines the interaction between patients, General Practitioner (GPs), nurses, and consultants during diagnosis and decision-making, with the aim to identify the range of skills that participants use in the process and capture the interprofessional communication and patient involvement in the diagnosis and decision-making phases of telemedicine consultations. The analysis shows that teleconsultations enhance collaborative working among professionals and enable GPs and nurses to develop their skills and actively participate in diagnosis and decision-making by contributing primary care–specific knowledge to the consultation. However, interprofessional interaction may result in limited patient involvement in decisionmaking. The findings of this study can be used to inform training programs in telemedicine that focus on the development of effective skills for professionals and the provision of information to patients

Patient and Health System Experience With Implementation of an Enterprise-Wide Telehealth Scheduled Video Visit Program: Mixed-Methods Study.

BACKGROUND: Real-time video visits are increasingly used to provide care in a number of settings because they increase access and convenience of care, yet there are few reports of health system experiences. OBJECTIVE: The objective of this study is to report health system and patient experiences with implementation of a telehealth scheduled video visit program across a health system. METHODS: This is a mixed methods study including (1) a retrospective descriptive report of implementation of a telehealth scheduled visit program at one large urban academic-affiliated health system and (2) a survey of patients who participated in scheduled telehealth visits. Health system and patient-reported survey measures were aligned with the National Quality Forum telehealth measure reporting domains of access, experience, and effectiveness of care. RESULTS: This study describes implementation of a scheduled synchronous video visit program over an 18-month period. A total of 3018 scheduled video visits were completed across multiple clinical departments. Patient experiences were captured in surveys of 764 patients who participated in telehealth visits. Among survey respondents, 91.6% (728/795) reported satisfaction with the scheduled visits and 82.7% (628/759) reported perceived quality similar to an in-person visit. A total of 86.0% (652/758) responded that use of the scheduled video visit made it easier to get care. Nearly half (46.7%, 346/740) of patients estimated saving 1 to 3 hours and 40.8% (302/740) reported saving more than 3 hours of time. The net promoter score, a measure of patient satisfaction, was very high at 52. CONCLUSIONS: A large urban multihospital health system implemented an enterprise-wide scheduled telehealth video visit program across a range of clinical specialties with a positive patient experience. Patients found use of scheduled video visits made it easier to get care and the majority perceived time saved, suggesting that use of telehealth for scheduled visits can improve potential access to care across a range of clinical scenarios with favorable patient experiences

Improving physician–patient communication

This chapter looks at improving physician–patient communicatio

Teleneurology clinics for polyneuropathy: a pilot study.

INTRODUCTION:Polyneuropathy (PN) is a common condition with significant morbidity. We developed tele-polyneuropathy (tele-PN) clinics to improve access to neurology and increase guideline-concordant PN care. This article describes the mixed-methods evaluation of pilot tele-PN clinics at three community sites within the Greater Los Angeles VA Healthcare System. METHODS:For the first 25 patients (48 scheduled visits), we recorded the duration of the tele-PN visit and exam; the performance on three guideline-concordant care indicators (PN screening labs, opiate reduction, physical therapy for falls); and patient-satisfaction scores. We elicited comments about the tele-PN clinic from patients and the clinical team. We combined descriptive statistics with qualitative themes to determine the feasibility and acceptability of the tele-PN clinics. RESULTS:The average tele-PN encounter and exam times were 28.5 and 9.1 min, respectively. PN screening lab completion increased from 80 to 100%. Opiate freedom improved from 68 to 88%. Physical therapy for patients with recent falls increased from 58 to 100%. The tele-PN clinic was preferred for follow-up over in-person clinics in 86% of cases. Convenience was paramount to the clinic's success, saving an average of 231 min per patient in round-trip travel. The medical team's caring and collaborative spirit received high praise. While the clinic's efficiency was equal or superior to in-person care, the limited treatment options for PN and the small clinical exam space are areas for improvement. CONCLUSION:In this pilot, we were able to efficiently see and examine patients remotely, promote guideline-concordant PN care, and provide a high-satisfaction encounter

Electronic Consultations Between Primary and Specialty Care Clinicians: Early Insights

Outlines how e-consultation enables clinicians and specialists to communicate more easily and reduce the need for in-person referrals; experiences for patients, clinicians, and health systems; benefits such as continuity of care; and barriers to adoption

Rapid Implementation of Inpatient Telepalliative Medicine Consultations During COVID-19 Pandemic.

As coronavirus disease 2019 cases increase throughout the country and health care systems grapple with the need to decrease provider exposure and minimize personal protective equipment use while maintaining high-quality patient care, our specialty is called on to consider new methods of delivering inpatient palliative care (PC). Telepalliative medicine has been used to great effect in outpatient and home-based PC but has had fewer applications in the inpatient setting. As we plan for decreased provider availability because of quarantine and redeployment and seek to reach increasingly isolated hospitalized patients in the face of coronavirus disease 2019, the need for telepalliative medicine in the inpatient setting is now clear. We describe our rapid and ongoing implementation of telepalliative medicine consultation for our inpatient PC teams and discuss lessons learned and recommendations for programs considering similar care models

Telehealth Wound Applications: Barriers, Solutions, and Future Use by Nurse Practitioners

Telehealth applications are an emerging technology in a new era of health care system technologies. Although telehealth technologies, including a number of different applications, are used by various members of the health care team, nurse practitioners (NPs) utilize them for a variety of patient issues across healthcare settings. The Indiana University-Purdue University Fort Wayne Computer Science Department has recently developed a wound scanning application, WoundView for nurse practitioners to utilize in different healthcare settings. Such telehealth mobile applications are used in clinics, home health, rural, and remote settings where a physician may not be readily available. However, there are obstacles with the current practice of using telehealth technologies such as a dire need for evidence-based research that supports attainable solutions for these barriers. Extensive, ongoing research will allow NPs to anticipate an immense mainstream implementation of telehealth applications in the very near future

Patient Satisfaction With Digital Health Services in Hospital during COVID-19 Pandemic: A Systematic Review

Pandemi coronavirus 2019 (COVID-19) adalah masalah kesehatan masyarakat yang telah mengganggu sistem perawatan kesehatan di seluruh dunia. Digitalisasi layanan kesehatan menjadi salah satu bentuk penyesuaian untuk menghadapi pandemi. Perubahan metode pelayanan di rumah sakit dapat mempengaruhi kualitas pelayanan kesehatan dan kepuasan pasien. Tinjauan ini akan mengidentifikasi dan menganalisis kepuasan pasien terhadap layanan kesehatan digital di rumah sakit selama pandemi covid-19. Pencarian sistematis dilakukan melalui PubMed, ScienceDirect, Springer Link, dan Pencarian Manual dari publikasi tahun 2019 hingga 2022, mengikuti pedoman PRISMA. Tinjauan sistematis ini mengidentifikasi 42 studi termasuk 34 studi menemukan kepuasan pasien di rumah sakit dan 8 studi membandingkan kepuasan pasien dalam layanan kesehatan digital dan layanan kesehatan langsung. Ada 97% penelitian yang menunjukkan kepuasan pasien dalam layanan kesehatan digital. Sementara itu, masing-masing 1 studi menemukan hasil signifikan dari kepuasan pasien terhadap layanan kesehatan digital dan langsung. Dengan mengimplementasikan layanan kesehatan digital pada platform yang sesuai, aplikasi yang sesuai dengan ketersediaan sumber daya, aplikasi yang sesuai dengan kebutuhan setting klinis diharapkan dapat meningkatkan kualitas layanan kesehatan di rumah sakit

Consumer preferences for teledermoscopy screening to detect melanoma early

Introduction: ‘Store and forward’ teledermoscopy is a technology with potential advantages for melanoma screening. Any large-scale implementation of this technology is dependent on consumer acceptance. Aim: To investigate preferences for melanoma screening options compared with skin self-examination in adults considered to be at increased risk of developing skin cancer. Methods: A discrete choice experiment was completed by 35 consumers, all of whom had prior experience with the use of teledermoscopy, in Queensland, Australia. Participants made 12 choices between screening alternatives described by seven attributes including monetary cost. A mixed logit model was used to estimate the relative weights that consumers place on different aspects of screening, along with the marginal willingness to pay for teledermoscopy as opposed to screening at a clinic. Results: Overall, participants preferred screening/diagnosis by a health professional rather than skin self-examination. Key drivers of screening choice were for results to be reviewed by a dermatologist; a higher detection rate; fewer non-cancerous moles being removed in relation to every skin cancer detected; and less time spent away from usual activities. On average, participants were willing to pay AUD110 to have teledermoscopy with dermatologist review available to them as a screening option. Discussion and conclusions: Consumers preferentially value aspects of care that are more feasible with a teledermoscopy screening model, as compared with other skin cancer screening and diagnosis options. This study adds to previous literature in the area which has relied on the use of consumer satisfaction scales to assess the acceptability of teledermoscopy