Telehealth and E-Health are Changing the Scope of Health Care

Two decades ago we used to imagine what life would be like in the year 2000. Maybe we thought we would be in flying cars, zipping off to work while robots clean our houses. Although we may not be planning weekend trips to the moon yet, technology truly has changed everything. Now it is difficult for anyone to imagine what they did before e-mail. The Internet and e-mail have put people and information a click away.

For health care delivery, a new world is emerging. Patients who used to have to trek to the library to learn about a newly diagnosed disease now have access to experts and resources with just a computer and a telephone line. Patients can access information and people around the globe, not just what is listed in their phone books.

The essence of telehealth is communication and monitoring.

This utilization of computer and electronic communication is referred to as telehealth or telemedicine. The National Institute of Medicine defines telehealth as "the use of electronic information and communication technologies to provide and support health care when distance separates the participants."

Telemedicine began with one doctor phoning a specialist for consultation. Then it evolved to intensive care services where several hospitals on a network could rapidly transmit patient images and gain expert opinions. Now it can involve a patient who sees a specialist thousands of miles away via a live interactive system.

This telehealth equipment provides services such as health assessments, diagnoses, intervention, consultation, supervision and education, all through the medium of information technology.

Typically referred to as e-health, the Internet is now an important vehicle for the exchange of information between medical specialists and primary health providers as well as educational information exchanges between patients and their personal physicians.

E-health is growing so rapidly that it has its own divisions as well. E-health includes: consumer medical information; health to business billing; patient records; on-line consultations; and medical and pharmaceutical sites.

Telehealth, telemedicine, electronic medicine and e-health all are terms that can encompass a variety of health care services and equipment. There is another common denominator as well: they all bring the patient closer to information, specialists and treatment options in a more timely and efficient manner than ever before. Telehealth can reach people who could not be reached in the past. It can pour into every home and link every person.

The equipment side of telehealth includes oxygen concentrators, blood pressure monitors EKG hook-ups, picture telephones, video conferencing, telephone triage and call-in centers. And the technology continues to evolve.

These technologies can reach patients in rural areas; reduce the time and cost of patient transportation; and improve health care by connecting people to specialists all over the world. Technology opens the door to many treatment options that may not have been available in the past.

The exploding popularity of technology and advances in telecommunication have resulted in the growth of telehealth. With telehealth, health care delivery is entering unchartered territory while advancing two of the most important aspects of health care: quality of care and reduction of costs.

Services and HIDA

The Telemedicine Information Exchange (TIE) Website, tie.telemed.org, provides information about telemedicine maintained by the Telemedicine Research Center in Portland, Ore. The Website includes a database listing vendors of telemedicine products and services.

· American TeleCare Inc., Eden Prairie, Minn., develops and markets the Aviva Single Line System, a telemedicine home monitoring system with telephonic stethoscope over a single POTS line. They also feature the CareTone telephonic real-time stethoscopes with store and forward capability that function over either POTS or digital phone lines.

· InforMedix Inc., Rockville, Md., offers portable telemedicine technologies that link the patient, health care provider and customers, providing patients the information needed to manage medications and health through real time data capture on medication and compliance, health status and quality of life.

· The Medi-Monitor from InforMedix Inc. is a portable, palmtop disease management tool that reminds patients to take their medication on time; provides patients with information regarding their condition; and it reminds patients to record clinical information such as blood glucose levels, temperature, or blood pressure. It also retains a month's supply of up to five medications in individual compartments.

· The e-Nurse Group Inc., Richland, Wash., is a company that provides an Internet software application that allows individuals to capture, organize and fully manage their personal medical information and establish Internet communications with their personal doctors for sharing their medical information. E-Nurse allows a physician authorized access to the patient's medical records at any time and from anywhere in the world.

Another Web site, AmericasDoctor.com, provides research and development information regarding pharmaceutical organizations and it helps consumers with medical questions. Chats are available with physicians around the clock. www.drkoop.com is a global health care network designed to empower consumers with information and resources to be active in their own health care. Planet RX.com offers products and services such as prescriptions and medical information.

The Health Industry Distributors Association (HIDA) is holding a health care industry e-commerce forum September 10 in Orlando, Fla. HIDA will bring together a group of more than 50 executives including distributors, manufacturers and trade association representatives to discuss the issues surrounding e-commerce and facilitate the adoption of industry standards that will enable the health care supply chain to efficiently and effectively engage in electronic ordering.

This forum is expected to result in the development of a communications plan that will provide guidance for industry trading partners in creating a common language for e-commerce in health care.

"Working together with everyone in the supply chain, including manufacturers and distributors, is the only way that we can bring about change that ultimately benefits everyone," said Matt Rowan, president and CEO of HIDA.

"HIDA has always supported universal adoption of barcoding and electronic efficiencies to reduce cost," Rowan said.

The group's goals include identifying e-commerce standards for health care supply partners; defining recommended steps for distributors and manufacturers to adopt standards; and developing messages and a communication plan to build provider awareness throughout the supply chain.

E-Health

With the explosion of the Internet, e-health is taking center stage. Through the Internet and E-mail, health care will never be the same. "The Internet enables consumers to access the latest health information and empowers them to be their own health advocate in conjunction with their physician," said Peter J. Plantes, MD, medical director of LaurasHealth.com, a Website developed by VHA Inc., a national cooperative of more than 1,800 community-owned hospitals, to provide health care and medical information.

E-health is also changing the way physicians manage their documents and files. "The physician office itself is starting a transformation by Web-enabling processes such as insurance verification, referrals, claims submission and appointment scheduling," said Plantes.

"When the Internet is combined with the ability to email physicians, access test results online, schedule appointments and even provide online clinical information like insulin results, the benefits quickly multiply," Plantes said.

Atlanta-based www.Caredata.com , an online syndicator of health care content, is partnering with ZirMed.com Inc., an applications service provider, to offer real-time interactive technology enabling physicians to enter and file medical and dental claims on the Internet.

The partnership will help reduce administrative time and costs within medical practices and allow ZirMed.com to enhance the use of its web-based applications by offering its customers access to Caredata.com's appSTAT, a universal health plan credentialing application and CiteLine, a medical Web research tool.

AppSTAT makes filling out credentialing applications easier by automating the application process. By filling out the standardized form, a physician's staff is able to complete multiple credentialing applications with just a click of the mouse, allowing more time for other work duties.

"The alliance with Caredata is part of ZirMed.com's vision to expand its provider services by creating open partnerships with relevant e-health companies," said Kenneth H. Dicken, president and CEO of www.Zirmed.com. "These partnerships will provide revolutionary Web-based applications that enhance the health care professional's ability to effectively and cost efficiently manage his or her practice," Dicken said.

Benefits

Telehealth makes home health care more efficient in multiple ways, including replacing certain nursing visits with video visits, collecting vital-signs data remotely and improving medication compliance and patient education. The use of telehealth in home health care settings will provide a means of interacting in a client-centered manner, promoting client autonomy through education and improved communications.

E-health has many benefits but the most evident is the improved means of communication. With the global network of information, e-health patients can be more educated than ever before. Doctors spend only seven minutes with patients on average and as a result, many patients need somewhere else to go where they can learn more about their diagnoses.

"For physicians, this emerging technology will transform the way care is delivered. Physicians will soon have a single point of access to a complete portfolio of clinical, operational and knowledge management tools," Plantes said.

Money can be saved in physician and nursing hours and there will be a greater ability to track and categorize information.

E-health sites also provide additional benefits:

· Online medical supply sites that offer equipment at reduced prices.

· Using telemedicine to provide specialized services so patients can remain in community hospitals rather than being transferred for second opinions or services. In addition, some patients are able to remain at home due to the advances in technology.

· Maintaining electronic records in acute-care and long-term care facilities. Electronic records offer greater security than the old method of endless cabinets full of paper documents.

· Educational materials that promote prevention.

· No time constraints in contacting someone. The information is always available instantly.

· A medical safety net for foreign travelers because doctors at home can be reached through e-mail while patients travel overseas.

Concerns

With patients randomly accessing Websites and information it is understandable that health care providers are concerned with the quality or accuracy of the information that is available. @.Text:Finding accurate information on Websites is comparable to finding a quality doctor; background information should be obtained to ensure the professionalism and credentials of the source and the veracity of the information.

Currently, Websites are not regulated by the government and there are no stipulations on the information that can be posted. Most Websites are self-regulated. As a result, Websites that monitor the information and credibility of other health care sites are becoming more common.

"While we hope that the educated consumer becomes a partner in care, the unregulated quality of content on some consumer health sites creates challenges of a different hue," said Sharyn S. Lee, RN, MS, CEO and president of CEU-Online Inc.

"Patients who demand treatments, procedures and therapies that are inappropriate (for them) are now taking up an inordinate amount of clinician time," said Lee.

The American Telemedicine Association issues advisories to consumers and medical providers on the appropriate use of the Internet to obtain health care information and medical services.

Industry-related watchdog sites are common as well. The National Association of Boards of Pharmacy (NABP) developed the Verified Internet Pharmacy Practice Sites (VIPPS) seal of approval to provide consumers the means to identify reliable online pharmacies. The information on VIPPS- approved Websites is verified by NABP and follows specified guidelines.

HI-Ethics, or Health Internet Ethics, is a coalition uniting the most widely used health Internet sites supporting high ethical standards, according to the company. Member companies work to earn the trust and confidence of consumers who choose to use Internet health services for improving their health and healthcare. The goal of HI-Ethics is to establish and comply with the highest standards for privacy, security, credibility and reliability so that consumers can realize the fullest benefits of the Internet.

Highly recognized Websites such as those of the National Institutes of Health, the Food and Drug Administration and the American Cancer Society also provide reliable information to patients and their families regarding conditions and medications.

Trends and Conclusions

Unlike baby boomers, Generation X was brought up in an electronic world and they are likely to search for information on their own to augment the information from their health care provider. As patients become active participants in their own health care, they may develop their own databases to document their medical history and their personal health care. These patients can forward their medical information to physicians online for second opinions. Geography is no longer an obstacle in finding a specialist.

In addition, patients improve the efficiency of their care and may eliminate the duplication of testing that often occurs, by maintaining their own electronic health profile.

"Internet-based tools available at the point of care will help standardize care, aid in clinical decision making, save time and reduce errors," Plantes said.

The essence of telehealth is communication and monitoring. The commonality of increased technology in the home is making the acceptance of e-health easier. With the advanced methods of communicating that e-health provides, patients have greater control over their health and this sense of empowerment leads to an increase in treatment adherence and overall compliance.

With e-health leading patients to take a more active role in their health care, the likelihood of both physically and financially positive outcomes is increased.

"Savvy organizations will identify new ways to empower patients to play an active role in reducing or eliminating the progression of health problems and promote patient adherence to treatment protocols and guidelines," said Lee.

One of the biggest advantages of this evolving technology is that it is moving the focus back to the patient. Patients will be empowered with information when they are actively involved in their own health care.

"The widespread adoption of e-health tools will ultimately result in improved health outcomes for patients; improved communication and information sharing; increased time savings; decreased costs and better patient satisfaction for health care providers," Plantes said.

Telehealth and telemedicine have undoubtedly changed the delivery of health care through advances in equipment and services. The scope of telehealth's impact is staggering.

As the Internet becomes a part of more and more homes and as information on the Internet is validated by health care professionals, e-health will likely become an integral part of every health care plan.

This article appeared in the September 2000 issue of Home Health Products, Vol. 8, No. 8.

This article originally appeared in the September 2000 issue of HME Business.

HME Business Podcast