BY MARK ELIEZER ARNOCO

DEFINITION Telehealth is the use of electronic information and telecommunications technologies to support long- distance clinical health care, patient and professional health-related education, public health and health administration.

HISTORY Telehealth may seem to be a modern technology with a short history; however, the origins of telehealth date back to the early 20th century, when the first tele- electrocardiograph was developed by Willem Einthoven. Using a string galvanometer and telephone wires, he recorded the electrical cardiac signals of patients in a hospital 1.5 km away from his lab The scope and practice of care delivered remotely varies a great deal among different settings, and different terminologies have been used to describe such practice. The most frequently used terminologies are telemedicine, telehealth, eHealth and telemonitoring

Telemedicine: Has the longest history and is defined as the provision of healthcare services and education over a distance using telecommunication technology. Examples include medical image transmission and interaction via phones. Telehealth: A more encompassing term that includes the integration of telecommunication systems into the practice of promoting health, while telemedicine is more focused on curative medicine.

eHealth: Recent term that incorporates all forms of electronic healthcare delivered over the Internet, including informational, educational and commercial services. Telemonitoring: A type of telecommunication technology that uses monitoring devices (e.g., Web camera, scale).

CLINICAL USES Transmission of medical images for diagnosis (often referred to as store and forward telehealth) Groups or individuals exchanging health services or education live via videoconference (real-time telehealth) Transmission of medical datA for diagnosis or disease management (sometimes referred to as remote monitoring) Advice on prevention of diseases and promotion of good health by patient monitoring and followup. Health advice by telephone in emergent cases (referred to as teletriage)

NON-CLINICAL USES Distance education including continuing medical education, grand rounds, and patient education administrative uses including meetings among telehealth networks, supervision, and presentations research on telehealth online information and health data management healthcare system integration asset identification, listing, and patient to asset matching, and movement overall healthcare system management patient movement and remote admission

BENEFITS Patient/Public Benefits Increases access to specialty services for rural patients. Allows the patient to stay in their own community rather than traveling. Decreases the number of cancelled appointments due to weather/travel conditions. Allows for other caregivers to participate, including teachers, youth workers, or home care staff who would otherwise not be free to travel. Reduces time for investigation, diagnosis and treatment through quicker consultations. Provides for real time second opinions. Increases access to health education opportunities for the public.

Practitioner Benefits Increases the scope of services available in rural primary care facilities. Improves continuity of care. Reduces professional isolation. Improves access to health care providers for remote and rural practitioners. Provides greater access to continuing medical education. Allows for digital and video storage of consultations for teaching and offline review. Increases educational opportunities for other health care professions, such as nursing and physiotherapy. Allows family physicians, other professionals, and caregivers providing a continuum of care to the patient to be present during the consult. Physicians being present in specialist consults provides for teaching opportunities in the treatment process, leading to a greater breadth of experience.

Health Care System Benefits Reduces duplicate tests, which are often required to ensure accuracy when a patient is transferred from a rural hospital to another site. Reduces patient transfer charges when ground or air ambulance service and medical taxis are utilized to obtain services not available in their regional health authority. Reduces travel budgets for health care providers. Reduces staffing costs of health care providers who temporarily replace those who are traveling. Helps attract and maintain medical resources in rural areas. Facilitates communication between regional partners. Increases productivity despite limited resources. Reduces costs without impacting patient care.

MODELS Store-and-forward In store-and-forward telehealth, digital images, video, audio, observations of daily living (ODLs) and clinical data are captured and "stored" on the client computer or mobile device Real Time In real-time telehealth, a telecommunications link allows instantaneous interaction.

Remote Patient Monitoring In remote monitoring, the patient has a central system that feeds information from sensors and monitoring equipment, e.g. blood pressure monitors and blood glucose meters, to an external monitoring center. Remote training Telehealth also provides opportunities for health care professionals in remote locations to receive training. Electronic consultation Electronic consultation (E-Consult), a TeleHealth modality, is a mechanism that enables primary care providers (PCPs) to obtain specialists' inputs into a patient's care treatment without requiring a patient to go in for a face-to-face visit.

VALUE IN TELEHEALTH 1.) Nurses can be more alert to patients’ current needs and address these needs in a more timely manner than ever before; 2.) Patients who receive telehealth interventions can receive more comprehensive management, leading to more rapid stabilization and, ideally, learn how to become more competent in self management skills (learning self management being the most cost effective home health service interaction of all).

Increasingly, experimenters on this still very new frontier of home telehealth have begun to conclude that, from a business perspective, telehealth works best with those patients who need the most frequent contact. For example, those patients living with diabetes who routinely overeat foods high in carbohydrates, or forget to measure their blood sugars regularly every day need more interaction, instruction, and coaching to stay relatively well.

In the last 10 years telecare-ready devices have become better designed to meet today’s health needs and have become extremely affordable— enabling their use by ordinary people/patients who need health services at home. Telecommunications-ready blood pressure cuffs, glucose meters, and other peripherals average only several hundred dollars or less. Similarly, the full- scale telehealth workstation, which can accommodate most needed monitoring devices in healthcare (pulse oxymeter, weight scale, glucose meters, and so on) are available a little for the matter.

TELEHEALTH: BETTER WORK The need for patient assessment for appropriateness of home telehealth can’t be overstated if telehealth is expected to work for that patient. That is why all patients who are targeted to receive home telehealth (even the likeliest candidates who have chronic diseases and are willing to change behaviors with telehealth help) must be assessed more closely than they would be for usual home care services. Patients can’t simply agree to use telehealth to meet the challenges of changing their life-long routines.

In assessing and then preparing the home for telehealth, it is crucial that no hazards be introduced as a result of setting up a telehealth system, and any changes that are introduced to a patient’s usual setting or routine path made safe. This safeguarding activity may call for nurses duct-taping wires to the floor, using brightly colored tape on rearranged furniture, and otherwise taking all steps to avoid affecting patients’ safety by introducing home telehealth. Call it "tele-proofing" a room to ensure safety.

BIBLIOGRAPHY Kinsella, A. (n.d.). About Home Telehealth. Retrieved from National Care Planning Council: ehealth.htm Nahm, E.-S. (2007, November 19). Telehealth. Retrieved from Advance Healthcare Network For Nurses: alth-3.aspx Benefits of Telehealth (n.d.). Retrieved from Government of Sasketchwan: