Telehealth Parity Laws - Ongoing Reforms Are Expanding the Landscape of Telehealth in the Us Health Care System, but Challenges Remain.

Despite the fact that no other developed country even comes close to the United States in annual spending on health care, 20 percent of Americans still live in areas where shortages of physicians and health care specialists exist, and the United States still ranks the lowest overall among eleven industrialized countries on measures of health system efficiency, access to care, equity, and healthy lives. Many believe that the answer to issues of cost and access in the US health system lies in telehealth, which increases access to care, alleviates travel costs and burdens, and allows more convenient treatment and chronic condition monitoring.With the implementation of the Affordable Care Act (ACA), the federal government announced the move toward encouraging and including telehealth services in health care coverage. The ACA, however, only implementedtelehealth at the federal level through Medicare, in selected circumstances; the power to determine which, if any, telehealth services is covered by Medicaid still remains largely within the powers of individual states.Also, states can govern private payer telehealth reimbursement policies. This means that telehealth implementation varies from state to state in terms of what services providers will be reimbursed for delivering, as well as what sort of "parity," defined as "equivalent treatment of analogous services," is expected between in-person health services reimbursements and telehealth reimbursements. This variation affects providers' ability to implement telehealth options, thereby reducing the patients' ability to use these services and become comfortable with the telehealth processes. Consequently, telehealth faces significant obstacles in becoming an accepted and used health care option for individuals, and states and the nation as a whole cannot fully realize the cost savings of telehealth

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

A Systematic Review of Telehealth in Palliative Care: Caregiver Outcomes

Objective: Telehealth interventions have proven efficacy in healthcare, but little is known about the results of such interventions in palliative care. We conducted a systematic review to evaluate caregiver outcomes related to palliative telehealth interventions. Materials and Methods: We searched multiple databases for articles published between January 2003 and January 2015 related to telehealth in palliative care. Two hundred twenty-one articles were considered; nine of these met study inclusion criteria. Data on study design, population, interventions, methods, outcomes, conclusions, and methodological quality were extracted and evaluated by three investigators. Results: Of the nine studies, five measured caregiver quality of life, three measured caregiver anxiety, and two measured caregiver burden. All the studies measuring caregiver quality of life showed no significant difference after telehealth interventions. The caregiver anxiety score decreased after the intervention in two studies, and one study reported significantly reduced caregiver burden. Although feasibility of or caregiver satisfaction with the telehealth intervention was not the focus of this review, most studies reported such findings. Of the nine studies, the majority were rated as having moderate quality using the Cochrane Collaboration’s tool for assessing risk of bias. Conclusions: This systematic review suggests there is evidence of overall satisfaction in caregivers who undergo a telehealth intervention, but outcomes reported were often not substantial. Methodological flaws and small sample sizes negatively affected study quality. More rigorous research to test and evaluate such palliative interventions is needed

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

Telehealth methods to deliver multifactorial dietary interventions in adults with chronic disease: A systematic review protocol

Background: The long-term management of chronic diseases requires adoption of complex dietary recommendations, which can be facilitated by regular coaching to support sustained behaviour change. Telehealth interventions can overcome patient-centred barriers to accessing face-to-face programs and provide feasible delivery methods, ubiquitous and accessible regardless of geographic location. The protocol for this systematic review explains the methods that will be utilised to answer the review question of whether telehealth interventions are effective at promoting change in dietary intake and improving diet quality in people with chronic disease. Methods/design: A structured search of Medline, EMBASE, CINAHL, and PsychINFO, from their inception, will be conducted. We will consider randomised controlled trials which evaluate complex dietary interventions in adults with chronic disease. Studies must provide diet education in an intervention longer than 4 weeks in duration, and at least half of the intervention contact must be delivered via telehealth. Comparisons will be made against usual care or a non-telehealth intervention. The primary outcome of interest is dietary change with secondary outcomes relating to clinical markers pre-specified in the methodology. The process for selecting studies, extracting data, and resolving conflicts will follow a set protocol. Two authors will independently appraise the studies and extract the data, using specified methods. Meta-analyses will be conducted where appropriate, with parameters for determining statistical heterogeneity pre-specified. The GRADE tool will be used for determining the quality of evidence for analysed outcomes. Discussion: To date, there has been a considerable variability in the strategies used to deliver dietary education, and the overall effectiveness of telehealth dietary interventions for facilitating dietary change has not been reviewed systematically in adults with chronic disease. A systematic synthesis of telehealth strategies will inform the development of evidence-based telehealth programs that can be tailored to deliver dietary interventions specific to chronic disease conditions. Systematic review registration: PROSPERO CRD42015026398

Telehealth as a tool for independent self-management by people living with long term conditions

Telehealth is seen as a key component of 21st century healthcare, and studies have explored its cost effectiveness and impact on hospital admissions. Research has been carried out into how to best implement it, and the barriers to its adoption. The impact of telehealth on self-management however has been a neglected area. An evaluation of the implementation of a telehealth programme in one area in the South of England found that some patients were using the telehealth equipment provided to enhance their own self management abilities. Whilst the nurses managing the scheme felt that they had an education role they did not involve their patients in setting goals. The patients equally did not feel that were being educated by their nurses. Patients were using the monitoring equipment independently of the nurses and the scheme to support their self-management strategies. Therefore the concept of graduating from telehealth once good self-management is established needs to be rethought. Patients in this study experienced less face to face contact with their nurse, but also reported that they were happy with the changes. This suggests that for some patients the contact with the nurse may well be able to be reduced or withdrawn however removing the monitoring equipment will remove the very tools essential to continued self-management

Liver transplant recipients’ experiences and perspectives of a telehealth-delivered lifestyle programme A qualitative study

Introduction Dietary modification and exercise are encouraged to address cardiometabolic risk factors after solid organ transplantation. However, the lived experience of attempting positive lifestyle changes for liver transplant recipients is not known. The aim of this study was to explore the experiences of liver transplant recipients and their perspectives of a 12-week telehealth lifestyle programme and assess the feasibility of this innovative health service. Methods Focus groups and one-on-one interviews were conducted with participants who had completed a 12-week, group-based, telehealth-delivered diet and exercise programme and thematic qualitative analysis was used to code and theme the data. Results In total, 19 liver transplant recipients participated in the study (25-68 years, median time since transplant 4.4 years, 63% male). Overarching themes included: (a) 'broad telehealth advantages' which highlighted that telehealth reduced the perceived burdens of face-to-face care; (b) 'impact of employment' which identified employment as a competing priority and appeared to effect involvement with the programme; (c) 'adapting Mediterranean eating pattern to meet individual needs' which identified the adaptability of the Mediterranean diet supported by sessions with the dietitian; (d) 'increasing exercise confidence' which recognised that a tailored approach facilitated confidence and acceptability of the exercise component of the programme. Discussion A telehealth lifestyle programme delivered by dietitians and exercise physiologists is an acceptable alternative to face-to-face care that can meet the needs of liver transplant recipients. There is a need to further innovate and broaden the scope of routine service delivery beyond face-to-face consultations

Telehealth and information society: a critical study of emerging concepts in policy and practice

This thesis explores a number of interrelated factors that influence the development of telehealth. Telehealth refers to health-related services that can be provided in electronic form over various telecommunications networks, including applications beyond clinical settings and reaching out to communities and homes. As such this study encompass different disciplines and draws not only on the medical tradition but also on information systems, social theory and ideas of information society. The study is based on the fundamental claim that technology does not follow a pre-determinate path but is shaped by people, who in turn are constrained by historical conditions and current structures. The research takes into consideration a number of such defining structures, including the organisation of healthcare in Britain, the health policy process, strategies for the employment of information and communications technologies (ICTs), conflicting ethical traditions and their manifestations in evaluation processes, and visions of an information society. The theoretical position and research approach is informed by critical theory. Thus the work focuses on the different, often conflicting, interests of varied stakeholders. It also unveils factors constraining social aims to which telehealth could aspire, e.g. reducing social exclusion and supporting empowerment of patients and citizens. Insights into these concepts and their practical manifestations are explored through a set of linked case studies, which investigate a variety of telehealth projects and initiatives in the London Borough of Lewisham. The thesis' contribution is twofold - practical and theoretical. The practical contribution is aimed at those who work in and study telehealth, offering a new approach and focus that is not substantially found in other telehealth studies. In this the thesis makes a contribution to the ongoing debates about telehealth's potential implications for the healthcare process. The theoretical contribution is found in the thesis' re-affirmation of the applicability of critical theory to the development of ICT-based social and organisational innovations, re-conceptualised in the light of post-modern and information society theories

The relevance of telehealth across the digital divided the transfer of knowledge over distance

This paper explores the concept of Relevance as an explanatory factor to the diffusion of ITuse, or, in this paper particularly, the use of Telehealth. Relevance is the net value of performance expectancy and effort expectancy and contains both micro-relevance (i.e. here-and-now) and macro-relevance (i.e. actual goals) Following the case-study approach, two Telehealth situations were studied in Rwanda and The Netherlands. In the comparison, two more existing studies in Canada and Tanzania were included. The conclusion is that Relevance is the explanatory factor, whereas particularly micro-relevance is crucial. Without the micro-relevant occasions that initiate use, there will be no use on longer term In the cases studied the micro-relevance of knowledge-transfer was crucial. Furthermore distance determined Telehealth relevance. Practical conclusions to cases were drawn

Nurses' and community support workers' experience of telehealth: A longitudinal case study

Copyright © 2014 Sharma and Clarke; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.This article has been made available through the Brunel Open Access Publishing Fund.Background - Introduction of telehealth into the healthcare setting has been recognised as a service that might be experienced as disruptive. This paper explores how this disruption is experienced. Methods - In a longitudinal qualitative study, we conducted focus group discussions prior to and semi structured interviews post introduction of a telehealth service in Nottingham, U.K. with the community matrons, congestive heart failure nurses, chronic obstructive pulmonary disease nurses and community support workers that would be involved in order to elicit their preconceptions and reactions to the implementation. Results - Users experienced disruption due to the implementation of telehealth as threatening. Three main factors add to the experience of threat and affect the decision to use the technology: change in clinical routines and increased workload; change in interactions with patients and fundamentals of face-to-face nursing work; and change in skills required with marginalisation of clinical expertise. Conclusion - Since the introduction of telehealth can be experienced as threatening, managers and service providers should aim at minimising the disruption caused by taking the above factors on board. This can be achieved by employing simple yet effective measures such as: providing timely, appropriate and context specific training; provision of adequate technical support; and procedures that allow a balance between the use of telehealth and personal visit by nurses delivering care to their patients