Telehealth involves delivering health-care through digital communication. Here are some of the services included by telehealth:
- Medical care
- Patient Education
- Health information services
- Psychiatric services
Telehealth is a broad term that includes a number of health-care related facilities. For specific medical care, the term “telemedicine” is usually used.
Telemedicine is when patients are diagnosed and treated remotely, through some form of digital communication. It is commonly used when a patient cannot come in for a physical appointment, either because they are too ill or because it is not geographically possible.
Telemedicine is also useful for simple visits that may not require an in-person consultation. For example, if someone is exhibiting mild and non-urgent symptoms, telemedicine provides the comfort and safety of speaking to a doctor without requiring the patient to disrupt their day. One company that has experience working with nursing homes in Connecticut doing virtual visits is VirtualWalkinCenter.com.
Here are some of the technologies commonly used in telemedicine:
Many people avoid going to the doctor because they are unable to travel or do not have easy access to a car or public transportation. Video conferencing solves that problem. Through this method, patients can communicate with their health providers from the comfort of their homes. Here are some of the people who may benefit from telemedicine:
- People in impoverished or rural locations
- Nurses in the facility needing order approval
- Patients who are failing in health
- Avoiding sending patients to the emergency room that could be treated in the facility
- People too weak to move and would have a hard time being transported to a doctor’s office.
- Including family in the care of the patient via three-way video appointments.
A big part of telemedicine is mobile apps. One of the key advantages of these apps is that they are easily accessible. Most Americans own a cell-phone; rather than having to drive or take public transportation to their doctor’s office, they can simply take out their phone for a consultation.
There are several mobile health apps used for telemedicine. Here are some of the features these apps have:
- Track health milestones
- Share information and communicate with providers
- Manage chronic diseases
- Track health initiatives such as weight loss
Remote Patient Monitoring (RPM)
Remote Patient Monitoring involves collecting patient health data through electronic devices, such as a smartphone, computer, or wearable device. A doctor or health provider will then evaluate this data.
With RPM, a patient may be able to enjoy the comforts of their home and still be monitored by professionals rather than having to stay in a hospital room. Here are some of the things RPM can monitor:
- Oxygen levels
- Blood pressure
- Respiratory rates
This is often used in the assisted living facilities and residential settings. However, there has been an expansion to nursing homes. These remoting monitoring services are an adjunct to nursing. It helps monitor vitals when the nurse isn’t around to monitor the patient. The resident could even use the device to start a telehealth visit with their provider when needed.
Pros & Cons of Telemedicine
Telemedicine isn’t for everyone; like any type of healthcare system, it comes with its own advantages and disadvantages. Certain types of people will benefit from telemedicine more than others. Here are some of the pros and cons involved.
Pros of Telemedicine:
- No need for transportation or travel
- Increases access to health-care
- Can receive monitoring outside of hospital setting
- Ability to consult a provider from anywhere
- Easier access to the care of a medical provider
- Minimizes time loss
- Can receive care if too weak to move
- Limits spread of illness
Cons of Telemedicine:
- Susceptible to technological problems
- Cannot cover all diagnoses
- Not ideal for emergency situations
- Takes the time of staff in the facility
Telemedicine cannot be used in all situations. Some diagnoses do require an in-person consultation. However, there are several scenarios in which telemedicine can provide care to people who would otherwise not receive it, as well as scenarios in which telemedicine is superior to in-person medicine.
The 2020 coronavirus outbreak has demonstrated the usefulness of telemedicine. Here are some statistics revolving around telehealth:
- 50% of people used telemedicine to consult a new doctor
- 75% of people used telemedicine to consult their own doctor
- Over 90% of people would use telemedicine for medication management
- Over 90% of people would use telemedicine for appointment reminders
- 83% of people plan to regularly use telemedicine
It is clear that one of the key perks of telemedicine is that it limits the spread of illness. This technology can be applied to nursing homes to produce the same effect: prevent outbreaks.
Telemedicine in Nursing Homes
To best illustrate how telemedicine would help limit outbreaks in nursing homes, consider two scenarios. In scenario A, a nursing resident is due for an in-person consultation. In scenario B, a nursing resident decides to use telemedicine for their appointment. The table below demonstrates how these situations could play out:
|Scenario A||Scenario B|
|The patient goes to a hospital||The patient logs onto the mobile app or computer application|
|The patient picks up pathogens in the infectious hospital setting||The patient remains in the comfort of their clean room|
|The patient brings these pathogens back to the nursing home, infecting both themselves and others||The patient remains healthy as well as staff and residents.|
Telemedicine can also be useful when a nursing resident develops mild symptoms. In these cases, it is important to consult a provider to ensure nothing is seriously wrong. However, physically going to the doctor’s office could result in the resident catching something even more serious, and then bringing it back to the nursing home.
Telemedicine is useful for more than just preventing outbreaks. Sometimes, residents may feel too unwell to get up and go to the doctor’s office. On the flip side, if they develop mild symptoms they may decide that the trip is simply not worth it. Easy access to telemedicine ensures that these patients can still receive quality care.
There are companies that provide advanced practice nurse practitioners to nursing homes. Some companies, such as InHouse Care LLC in Connecticut, provide in-facility support as well as telehealth visits to the nursing homes and assisted living facilities they cover. When you have the group that provides care in the nursing home also providing the telehealth visits, there will be better continuity of care for the patients.
It is important to remember that telemedicine cannot be used in every situation. If someone is severely ill, they should be seen in person when possible. However, with the right support from nurses, even patients with severe dementia can be completed.
The nurse can act as the eyes and ears for the medical provider. Usually, the vital signs are completed and the nurse listens to the heart and lungs before calling the medical provider.
Telehealth in the Real World
Telehealth coverage varies by state and insurance provider. The majority of states mandate that physicians practicing are licensed, and several states offer Medicaid reimbursement to an extent.
Large commercial payers typically cover telemedicine, but may or may not reimburse a patient for a telemedicine service depending on the policy. You can see more about the varying laws behind telemedicine here.
Telemedicine in Connecticut
In early 2020, officials in Connecticut approved a bill to expand telehealth freedoms. Here are some of the things the bill covers:
- Coverage by Medicaid and private insurers
- Expands list of care providers able to use telehealth
- Allows providers to use telehealth from any location
In addition to medical doctors, the bill mandates coverage for dentists, midwives, behavior analysts, therapists, and more.
Although the expansion is only guaranteed in 2021, many people are hopeful that these mandates will continue beyond that. The benefits telemedicine can have in nursing homes makes it essential, especially in a state like Connecticut.
Telemedicine could also encourage nursing home residents to receive the care they might otherwise neglect. For example, residents may decide that the effort and risk of leaving the nursing home to go to therapy may not be worth it. Telemedicine makes it easy to receive all types of care; thus, continued coverage would be ideal.
Telemedicine is a modern movement that prevents an alternative to what most people are used to and comfortable with: an in-person consultation. If you have any concerns about telemedicine, you’re not alone. Here are some frequent issues that come up with the topic of telemedicine.
Low Quality of Care
One major concern people have is that telemedicine does not offer a high standard of care. It is important to remember that telemedicine is not right for all cases; some cases do require an in-person visit.
A proper doctor will be able to recognize whether or not a case can be efficiently handled through telemedicine. If it cannot, then they will not schedule a virtual appointment for you.
In cases where telemedicine is used, there is nothing to suggest that it is less effective than in-person care. Conversely, telemedicine can improve results because it facilitates the process of making appointments and managing medication.
Lack of Privacy
Cyber-security is no joke; people deal with hackers every day. Thus, it is fair to be concerned about telemedicine presenting a privacy problem.
Here are some key steps to take to ensure your privacy:
- Do not share your password with anyone
- Only log in through the official site
- Watch out for spam emails and messages
Another concern patients have is that the mobile app or telehealthcare system itself may violate their privacy by broadcasting sessions or sharing information. Telehealth systems are specifically geared to protect personal information and nothing is shared without consent. Telehealth systems follow HIPAA regulations.
During the Covid 19 pandemics, the government allowed the use of third-party apps such as facetime, google DUO, and WhatsApp to increase the ease of use.
Like a regular in-person consultation, telemedicine appointments are covered by health insurance. Thus, scheduling an appointment through a telehealth system will not present any additional costs.
The cost of the medical visit will be similar to an in-person visit with deductibles when applicable.
In fact, it may save you money by eliminating the need for chair car transport or ambulance for transportation. It also saves time and money for hiring an aide to sit with the patient in a doctor’s office or traveling.
Facilities interested in using telemedicine do need a smartphone, computer, or some sort of digital communications device. Fortunately, most staff members in the home already own these.
The Importance of Staying Safe
By reducing the frequency at which residents leave the facility to go to the doctor, telemedicine/virtual visits can reduce the chance of an outbreak in the facility.
During Covid 19 pandemic, most patients sent to the provider are placed on precautions for a time period. This requires the increased use of personal protective equipment for the staff. The patient also feels isolated during this quarantine period.
The use of telehealth for medical and psychiatric visits is expanding for nursing homes and assisted living facilities. It is another alternative in treatment that can be safely utilized by the nursing home. However, it doesn’t replace the need for in-facility medical support and services. The use of third-party companies the provide services to the facilities usually leads to fragmented care. This is why using the current company that is providing services is usually the best route to take when care for patients.