Healthcare Management Information Systems Telemedicine

Healthcare Management Information Systems

Telemedicine

Telemedicine can be traced far back in the 1960 when the National Aeronautics and Space Administration (NASA) provided health care to it astronauts Bashshur & Armstrong, 1976.

The medical service was provided to the astronauts from a medical van that was linked to medical specialists equipped with a two way microwave telemedicine and audio transmission. The service was meant to telemeter astronaut's physiological response while on their space mission in their space suits

In 1967 a medical station was established in Massachusetts general hospital to cater for airport employees and deliver emergency medical attention and care to commuters. The diagnosis and evaluation of treatments was undertaken by selected nurses overseen by physicians Williams, May C.R., & Esmail a., 2002()

Further developments in the field of telemedicine were made to guarantee efficiency and accuracy in diagnosis. The need for remote video led NASA to conduct a survey establishing the minimal television system required for diagnosis. The study conducted marks the video conferencing which was used to provide video images through diagnosis and treatment.

Application of telemedicine in recent time has developed to be part of emergency preparedness and disaster response. Incidences of natural calamities have received attention from specialist even when physical presence in duly unavailable. In the current millennium it is appreciated that telemedicine has contributed to rural areas across the state providing much needed support the health institutions are physically incapacitated to provide.

Telemedicine

Telemedicine according to Mort, May, and Williams (2003)

, telemedicine involves monitoring, treatment and diagnosis where patients and doctors are detached by space and time. Medication is through information technologies. In this aspect Telemedicine has capability to improve on efficiency and cost of treatment where the patient doctors and hospital management benefit. With Telemedicine, a vision of a global hospital is prospected where geographical barriers are broken. Cartwright (2000)

, argues that Telemedicine will most likely bring forth a new pattern of global village and thus a new global paternalism will consequently emerge.

Telemedicine is argued to be affording clinical practice to explore more possibilities other than just increased access to health care. Cartwright (2000)

, observed that with Telemedicine there will be prominent increases in access to quality healthcare that is affordable and most importantly efficient in terms of delivery and a healing. The effectiveness observed by Cartwright, is discussed by Williams et al. (2001)

, with specific reference to delivery efficiency. Edwards, Hall, and Shaw (2005)

, explored the policy implication and management aspects that telemedicine improved.

Application and Use of Telemedicine

Telemedicine encompasses care giving methods in a virtual health care institution. It entails the interplay of clinical and information technology applications that capture medical information to investigate, diagnose, consult and treat. The application of the procedure uses secure internet web-based connections and a help desk for end users Cartwright, 2000()

The technology utilizes the use of a standard telephone connection, personal computers, internet connections, still images and video outputs for virtual communication, robotics an satellite transmission. In addition to this it is noted by Bar-Yam (2006)

that smart phones have enabled enhancing care provision by facilitating fast and clear access to digital image and correspondence between the patient and physician.

Telemedicine applications are in most case real time-based which enable healthcare providers to observe patients and test the likely results there by render clinical assessments with no constraints of distance or geographical barriers Bar-Yam, 2006()

Concerns arising from the use of Telemedicine

With the continued growth and embrace of telemedicine services a variety of issues are coming up. As an integral part of many health institution telemedicine is setting in matters concerning administration, delivery of payments and privacy.

Licensing

It is appreciated that as telemedicine is breaking geographical barriers issues touching on licensing are coming up. It practically impossible for medical practitioners to obtain licenses in each and every state that telemedicine will offer them an avenue to operate. As Williams et al. (2002)

, puts it, it practically for health practitioners to take exams in different states and regions and travel for interviews all in the name of obtaining licenses to practice. The cost involved in this procedure given the stretched avenue provided by telemedicine makes it virtually impossible. The concern in this case is the possibility of adapting international procedural standards that will accommodate the operations of telemedicine.

The first challenges -- which are interrelated in many respects -- that legally hinder the development of telemedicine include issues related to interstate licensing, legal liabilities, and institutional credentialing of physicians Roback & Herzog, 2003.

Unfortunately, many of these legal matters are still unanswered and unresolved within both the U.S. health care and judicial systems. For example, in interstate medical transactions where mechanical devices are used for surgery or radiology, if there is a mechanical failure or glitch that results in harming the patient, deciding on who is responsible for that accident is debatable and can be a major headache for legal authorities. Another key issue implicit in this scenario is that these practitioners who are treating and communicating with the patient are operating out of different states.

Because laws regarding telemedicine and health care certification are unique in each state, legal liability, malpractice, and jurisdiction become serious matters of concern for the judicial, legal, and medical systems Turner, 2003.

For instance, in the event that an inexperienced physician located in Arizona is physically operating on a patient and is engaged in a live telemedicine communication with a specialist in New York whose guidance and direction botch the surgery and result in the patient's death, the prosecutors and legal officials in Arizona would find difficulty in placing blame and litigation on the party in New York. An issue like this one is a typical scenario in which telemedicine presents some legal and licensing issues. However, as telemedicine and its associated technology evolve, feasible solutions (i.e., legal policies and amendments) to these problems should be discovered and made available.

Patient Information Confidentiality

Privacy of information is queried to the extent that the information transferred through the technology media is only used for treatment purposes only. Chance for such information licking will be termed as a breach of rule governing safeguard of patient information. Whether Telemedicine technology and associated media are protective of the interests and privacy of a patient is a concern.

A handicap in evolution of telemedicine touches on issues concerning patient privacy. According to Mort et al. (2003)

, because many individuals (i.e., technicians, nurses, etc.) are generally involved in telemedicine communication, exposure of confidential records to all parties concerned becomes a threat to the privacy of that patient. Additionally, even though medical doctors accept the obligation of maintaining their patients' privacy rights, the other assisting parties involved in the telemedicine communication may not be held to the same standard Turner, 2003.

As a result of this risk to patients' privacy rights, telemedicine has struggled to gain acceptance from the legal and medical communities Bar-Yam, 2006.

However, again, as time progresses and this issue is tackled by the medical and legal communities alike, solutions should be found to eliminate privacy risks to patients. Furthermore, these solutions should generate increased acceptance of telemedicine practices by all parties concerned and, likewise, should alleviate the fear and frequency of breaches to patient privacy laws.

Health Insurance Companies Resistance

The most significant challenge according to Turner (2003)

that telemedicine faces in gaining adoption is the difficulty of receiving reimbursement for services from insurance companies that oppose unconventional consultations, such as the ones absent of face-to-face contact. For instance, according to Brookfield and Smith (2006)

, the U.S. Health Care Financing Administration, a national organization in charge of major health insurance companies, stipulates that reimbursement for medical services is usually available only when direct physical communication (i.e., a face-to-face appointment) is held. However, this stipulation is not universal and required of all states. There are some states that do not demand this immediate presence in medical consultations, such as California, Texas, and Oklahoma. Plus, these states even go as far as permitting such telemedicine services as appropriate substitutes for face-to-face appointments if recommended by the attending practitioners, Turner, 2003()

Payments

How payments and reimbursements are undertaken is not clear. As far as payments is concerned, there are geographical barriers Edwards et al., 2005.

Concern comes as to whether the methods of payments should be similar to those practiced where physical contact is made. Then again which are the ideal standard measures that can apply globally? To the extent of management what portion of the fee should go to the institution and the physician? These concerns are arising due to lack of a conceptualized manner to plan and amalgamate the global economies.

Determination of benefits and cost associated with Telemedicine especially in the case that it a developing innovation is not certain. The cost and benefits associated with Telemedicine has not been conceptualized in its full sense. The technology investment cost and the resultants benefits to an institution, the patient and the medical field are not fully understood. Therefore in the economic sense many institutions have been viewed to lay back.

Knowledge and Expertise in Telemedicine

Another challenge has to do with the limited knowledge and expertise in telemedicine as well as the need for enhanced and modified telemedicine systems. In this sense, little knowledge currently exists among medical practitioners on how to effectively and practically use various forms of telemedicine. This knowledge gap on insight into telemedicine, in effect, hinders the creativity to explore more efficient and effective modalities of telemedicine applications. As a result, teaching medical practitioners to learn and adopt this new way of accomplishing health services, through telemedicine, has become a significant hurdle to implementation Turner, 2003.

Special competence is also required before implementation of telemedicine can be allowed and render success to those concerned. In this regard, a unique term, telecompetence, was created to describe the required skills and credentials practitioners must have in order to carry out this kind of specialized work Turner, 2003.

Telecompetence is a must in order to be a health communication expert regarding telemedicine. In particular, according to Turner (2003)

, there is a three-stage process involved in such health communication aptitude. As such, telecompetence consists of;

1. planning and establishing,

2. learning and use, and

3. Formalizing routines.

Unfortunately, achieving this level of competence could be considered a major adversary to telemedicine implementation, because considerable training and finances are not always available resources to enable this kind of campaign. To this end, in some medical settings where resources are limited, telemedicine may not be a feasible or affordable option.

According to Edwards et al., 2005()

telemedicine has its limitation compared traditional, face-to-face diagnosis. Face-to-face diagnosis offers an added advantage where interactions can be combined with physical comparisons. In the case where physical contact is said to provide a perfect avenue for diagnosis telemedicine can then be termed as inadequate. The inadequacy is worsened by the physician's competencies and experience. Experienced physician can be able to make complete and accurate diagnosis using limited information which makes telemedicine appropriate. In reality however, the experience of physician is limited in term of regions of operation and the number of years in practice Mort et al., 2003.

This brings out the ineffectiveness of wholesomely relaying on telemedicine.

The quality of technology used by Physicians and patients greatly contributes to the diagnosis and thus effectiveness of telemedicine. In the world technology is not standardized thus, in as much as telemedicine is breaking geographical boundaries, its overall application in global perspective is limited Bar-Yam, 2006()

Accountability of medical practitioners in the telemedicine is limited owing to its admissibility in certain region and lack of broad guidelines. The argument brought out by Brookfield and Smith (2006)

, is that individual physician will set their guiding principle according to the best interpretation laws concerning malpractice. Observed from this issue is that a set of guidelines touching on practicing telemedicine is required in order to avoid inadequate diagnosis and treatments.

Solution

Training to Medical Practitioners

The continued growth of telemedicine needs to be harnessed and incorporated in the management of hospital information systems. For result in the provision of healthcare using telemedicine, there is the need to consider training to physicians and attending nurses. This will increase efficiency as telemedicine is offered by allowing for coordination of actions and expectation as well and diagnosis. Physicians need to be trained through refreshers courses to equip them with diagnosis information and reading digital data.

Training to medical practitioners may enlist feelings of inadequacy among the staff and also reduce motivation among those who are not offered the training. To the hospital, it will seem be a venture whose needs are not conceptualized.

Licensing and practicing

Licensing and practicing telemedicine should be considered as a new development, and new measures to govern it are required. The authorities need to come up with regulatory measures that are linked to Telemedicine as opposed to the existing guides. The need to incorporate countries and regions in the creation the rules and licensing procedure is emphasized owing to the fact that telemedicine has no boundaries.

Coming up with rules, regulation and licensing boards for telemedicine will entail a bureaucratic process which may lead to stagnated growth of the developments made. The ideal measure would be to have states incorporate their own measures, rules and regulation governing the practice of telemedicine and then tries later standardize theme to fit the standards of the world. This process may take a while but, it is much better.

Payments and Reimbursements

In some instances need arise for a physician to offer healthcare to patient with consideration for their payments. The Telemedicine development have not been able to incorporate direct payment to Physicians rather they get reimbursements it is evidenced that the growth in practice may not be sustainable if a payment system is not considered. There is the need to consider online payment methods which greatly contributes to the field's growth.

Recommendations

In the present day and age, we know that a considerable portion of world society relies mostly on technology and electronics for communications, memory storage, military operations, and medical procedures. With the advent and advancement of telemedicine -- especially via the Internet -- our medical and health care systems have taken a near complete redirection in how health communication is channeled and exchanged. Humans on all sides of the health care system are now becoming digitized, virtual, and cyber Turner, 2003.

Brookfield and Smith (2006)

, adds that activities by humans to embrace technology has increased in a substantial telemedicine and its modernization.

It is interesting that the subtractive communicative effects of telemedicine have often been overlooked in health communication. In addition, Turner (2003)

argued that few studies have been conducted on the communicative and interpersonal implications of telemedicine. Thus, we believe that it is important to address this issue.