Telehealth (or telemedicine) is the use of electronic communication and information technologies to provide health care when distance separates medical professionals from the patient. It also includes administrative and educational uses of the technology to support other aspects of health care such as distance education. The terms "telemedicine" and "telehealth" are used synonymously.
Telehealth technology is most commonly utilized in the fields of radiology, mental health, dermatology and cardiology.
A point-to-point connection is when two sites link up directly. One site calls another, much like a normal telephone call. A bridge is a multi-point connection (more than two sites). Since one site cannot typically call more than one other site, a conferencing bridge (or MCU) is used to perform a “conferencing” function - bringing all sites together at once. The bridge usually dials all sites and terminates the connection at specified times.
A T1 circuit is a digital telephone circuit which connects one site to another - comprising the basics of a telemedicine or telehealth network. The circuit consists of (24) 64K channels which comprise a 1.544MB connection.
A codec is a “coder/decoder” and is the basic hardware component used to “code” analog audio and video signals into digital signals. These may then be transmitted across a network connection and “decoded” back into analog images and sound at the receiving end.
A network that is comprised of a collection of point-to-point circuits, or is “closed” to users outside the network, is referred to as a “private network.” Video calls made to sites outside the private network are typically called “off-net” calls and incur a per-minute connection charge.
H.320 refers to a video call using Integrated Services Digital Network (ISDN) - typically used outside of private networks. H.323 refers to Internet Protocol (IP) and is used for the transmission of voice and video calls or traffic across networks.
QOS (Quality of Service) is an IP protocol used across networks to assure that IP-voice and video packets arrive on-time and in-sequence, thereby minimizing tiling and jittering which degrades video images and sound.
Universal Services Funding refers to the subsidy provided by the federal government and administered by the Rural Healthcare Corporation for the costs of circuits used to connect telehealth sites on a network.
Many insurance carriers in Washington state and around the country reimburse for telehealth clinical consultations. Carriers are now realizing the potential for telehealth to achieve considerable cost savings, improved turnaround time and greater access to medical care. Medicare also reimburses for most types of telehealth consultations. Medicaid reimbursement is not as consistent throughout the country, and varies greatly between states.
Most states currently require a physician to be licensed in the state where the patient is located. Some states have special arrangements, or limited licensure, for “occasional” consultations while others have broad definitions not limited to opinions or consultations. Individual state requirements should be investigated to verify restrictions before practicing telehealth across state lines.
There are two elements of resistance to the incorporation of telehealth technologies. The first is a fear of change - which is common to most everyone. This can be addressed only by increasing familiarity with the technology and systems of operation. Training materials, personal training sessions, site visits, and other services we provide can help.
Second (and more important) however, is fear of personal consequences. It’s hard to imagine that staff resistance would be substantial if they knew the introduction of the technology would make their jobs more secure, more lucrative or more enjoyable. Since resistance can be high, they must believe that the opposite will be true.
Telemedicine is part of the larger world of telehealth - the use of communications technology in health care. There is growing interest to utilize telehealth for disease management and prevention. Home health care and long-term care are both shaping up as areas which benefit from telemedicine. Emergency telemedicine is becomming more common on airline flights and cruises, and it is part of many military operations.
The future of TeleHealth depends less on technology than on politics. Funding of health care is tied to government programs, telecommunications law and insurance reimbursement. The consumer is a key player in the future of telehealth. The more people that understand what telemedicine is, see it as having value, and insist that they have access to it, governments, employers and insurance companies will make it feasible. Public awareness is essential.
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