Telemedicine In Today’s Healthcare Arena

Jason M. Kramer, RN PHRN

ObjectivesObjectives• Define telemedicine• Define the types of telemedicine• Describe current telemedicine

practices• Define the hardware used in

telemedicine• Define the software used in

telemedicine• Evaluate the usability of

software

Objectives

• Define Information Systems

• Discuss Advantages of Telemedicine

• Discuss Disadvantages of Telemedicine

• Discuss Ethical and Legal Issues of Telemedicine

Objectives

• Discuss Informatics Competencies

• Discuss Functions and Responsibilities of Informatics Nurses

What is Telemedicine

• Telemedicine

– To communicate with patients outside of the hospital/clinic.

– For health care providers to communicate with health care providers.

– To monitor patients while they are at home.

Definition of Telemedicine

• “The use of medical information exchanged from one site to another via electronic communication to improve patients’ health status.”

(American Telemedicine Association, n.d., Telemedicine Defined Section ¶ 1)

Types of Telemedicine

• Real Time – Synchronous

• Store and Forward – Asynchronous

Current Telemedicine Practices

• Radiology – Accessing and Reading Films from a remote site.

• Cardiology – Interrogation of Pacemakers and AICD’s in a patients home by telephone.

• Uploading of vital signs from home to a remote monitoring center

• Diabetes – Linking of Glucometers with Insulin Pumps and Physician offices.

• EMS – Video conferencing with Physicians from the field.

Hardware in Telemedicine

• Personal Computer

• Communication Link

• Digital or Video Camera

• Printer/Scanner

• Video Conferencing System

(EDT, n.d.)

“Medtronic” Hardware Information

• Personal Computer

• Insulin Pump

• Glucometer

• Continuous Glucose Monitor

(Untitled Photograph, n.d.)

Telemedicine Software

• CareLink Software

• CapSure Software

• AMD Software Solutions

“Medtronic” Software Information

• “CareLink” software for Medtronic Insulin Pumps– Effects of Insulin– Charting– Patterns

(Untitled Photo, n.d.)

Usability of “Medtronic” Software

• Insulin Pump Software

• Computer Software - Carelink

Information Systems

• An information system is a collection of methods, practices, algorithms and methodologies that transforms data into information and knowledge desired by, and useful for, individual and group users in organizations and other entities.

• (“Learn more about”, n.d. What is an Information System ¶ 1)

Information Systems

• Information that is collected and stored– Lists of customers/patients– Vital Signs– Physician documentation

• The entire electronic health record system

Medtronic Information System

• Type of System– Special Purpose/Clinical

• Users– Patients– Physicians– Nurse Practitioners and Physician assistants

• Use– Diagnose– Document

Medtronic Information System

• Configuration– Local Area Network– Mainframe

• Data Standards– Health Care Informatics Standards Planning Committee

Advantages of Telemedicine

• Improved Access

• Cost Effectiveness

• Patient Demand

Disadvantages of Telemedicine

• Legal Issues

• Liability

• Reimbursement

• Physicians/Patients

Legal/Ethical Issues of Telemedicine

• Interstate vs. Intrastate

• Licensure

• Accreditation

Legal/Ethical Issues of Telemedicine (cont.)

• Reimbursement

• Professional Liability Insurance

• Privacy Issues

Informatics Competencies

• Beginning Nurse

– To Communicate with other systems

• Access Data

• Upload and Download

– Use Computerized Monitoring System

Informatics Competencies

• Experienced Nurse

– Apply Monitoring System Appropriately

– Perform Basic Trouble Shooting

Functions/Responsibilities of Informatics Nurse Specialist (INS)

• Informatics Nurse Specialists– Devising strategies for installing

applications/systems – Applying installation tools during implementation – Managing the installation process – Developing testing, implementation, conversion,

and backup plans – Assisting in the resolution of basic software

problems

• (Starren, Tsai, Bakken, Aidala & Morin, 2005)

Functions/Responsibilities of Informatics Nurse Specialist (INS)

– Performing complex troubleshooting in applications

– Producing short- and long-term training plans – Producing training manuals and operating

manuals– Delivering user training programs – Evaluating user training programs

• (Starren, Tsai, Bakken, Aidala & Morin, 2005)

Summary

• What is Telemedicine

• Real time –Synchronous

• Store and Forward – Asynchronous

• Usage

• Components

• Informatics Systems

Summary (Cont.)

• Advantages

• Disadvantages

• Informatics Competencies

• Functions and Responsibilities of the Informatics Nurse Specialist

Bibliography• American Telemedicine Association. (2010). 

Telemedicine Defined. Retrieved September 11, 2010, from http://www.americantelemed.org/i4a/pages/index.cfm?pageid=3333

• Busey, J.C., & Michael, P. (2008, August). Telehealth—opportunities and pitfalls . Journal of the American Dietetic Association, 108(8), Retrieved from http://www.sciencedirect.com.ezaccess.libraries.psu.edu/science?_ob=ArticleURL&_udi=B758G-4T25TH5-6&_user=209810&_coverDate=08%2F31%2F2008&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000014439&_version=1&_urlVersion=0&_userid=209810&md5=eeeac2f643fcf966299a06d441c983be&searchtype=a

Bibliography (Cont.)

• CareLink Personal Therapy Management Software. (n.d.). Insulin Pumps, CGM (Continuous Glucose Monitoring), Minilink Transmitter, Paradigm Revel, Diabetes Glucose sensors and meters | Medtronic Diabetes | Formerly Minimed. Retrieved October 5, 2010, from http://www.minimed.com/products/software/index.html

• Encounter Management Software Tools | AMD Global Telemedicine. (n.d.). Telemedicine Equipment & Telehealth Technology - AMD Global Telemedicine. Retrieved October 5, 2010, from http://amdtelemedicine.com/telemedicine-equipment/encounter-management-software/index.html

Bibliography (Cont.)

• Grady, D. (1999, October 22). Doctor at south pole received medical help via video. The New York Times, Retrieved from http://www.nytimes.com/1999/10/22/us/doctor-at-south-pole-received-medical-help-via-video.html

• HEALTH DATA STANDARDS: THE PLAYERS. (n.d.). UW Faculty Web Server. Retrieved October 28, 2010, from http://faculty.washington.edu/ocarroll/infrmatc/database/data/players.htm

Bibliography (Cont.)

• Learn More About Information Systems (IS). (n.d.). UMBC An Honors University in Maryland. What is an Information System. Retrieved November 11, 2010, from http://www.is.umbc.edu/about_us/aboutIS.asp

• Medical Imaging Telemedicine Telehealth Store and Forward. (n.d.). Global Telemedicine Telehealth Medical Imaging Technology . Retrieved October 5, 2010, from http://www.globalmedia.com/telemedicine/capsure.html

Bibliography (Cont.)

• Starren, J., Tsai, C., Bakken, S., Aidala, A., & Morin, P. (2005, August 5). The role of nurses in installing telehealth technology in the home. Retrieved from http://www.medscape.com/viewarticle/508913

• Telemedicine. (n.d.). Dr. Sachin Kale, MD. (Pathology), Aurangabad, Maharashtra, India.. Retrieved October 5, 2010, from http://sachinkale1.tripod.com/telemedicine.htm

Bibliography (Cont.)

• What is Telemedicine. (n.d.). Center for Rural Health, University of North Dakota School of Medicine and Health Sciences. Retrieved November 16, 2010, from ruralhealth.und.edu/pdf/whatistele.pdf

• What is Telemedicine and Telehealth?. (n.d.). American Telemedicine Association. Retrieved November 16, 2010, from www.americantelemed.org/files/public/abouttelemedicine/What_Is_Telemedicine.pdf

Photographic Bibliography

• EDT (Credit given), Tempus IC System [Photograph] retrieved October 5, 2010 from http://www.esa.int/SPECIALS/Technology/SEM6OOMO7EG_1.html#subhead2

• Untitled Photograph of Medtronic Insulin Pump and Hardware. Retrieved October 5, 2010 from http://www.minimed.com/products/

• Untitled Photograph of Medtronic CareLink USB wireless upload device. Retrieved October 5, 2010 from https://www.medtronicdiabetes.com/store/products/details/PS-ALL/MMT-7305NA#