What is telehealth?
The NZ Telehealth Forum defines telehealth as ‘health care delivered using digital technology where participants may be separated by time and/or distance’. This definition is broad, so it is helpful to consider the main types of telehealth.
This definition is broad, so it is helpful to understand each element as follows:
1. Health care delivered
Telehealth focusses on maintaining or improving the health of a specific patient. At times a patient may not be directly involved in telehealth interactions, but if those involved are discussing the care of any particular patient, then it can accurately be described as telehealth. When a group of specialists discuss treatment options for a patient during a multi-disciplinary team meeting via digital technology, then this is a form of telehealth.
If there is a focus on the system, administration or logistics of delivering a health service, this would not be described as telehealth. While a video meeting discussing clinical team rostering uses similar digital technology, a specific patient is not receiving care, so it would not be called telehealth.
2. Using digital technology
Telephone and video are cornerstone telehealth technologies, but the range of digital technologies used to support telehealth continues to grow. Some of the technologies used are:
- Video devices
- Mobile, tablet, computers and peripherals
- Sensors, monitors
- Smartphones, wearables and implants
- Text/SMS, chat and phone messaging
- Secure email and messaging systems
- Web and mobile apps
- Chat bots and artificial intelligence (AI)
3. Where participants may be separated by time and/or distance
Telehealth usually has patients and providers at their core, a much wider group of participants may be included in telehealth. Some examples include:
- Whānau/family, friends and carers
- Kaiwhina/health navigators
- Whānau Ora co-ordinators
- School, church or community support.
- Primary and community providers
- Clinician accessing specialist advice
- Allied health specialist
- Aged care provider
- NGO providers.
- For patients: Faster access to care and shorter wait times. Remote patients can remain close to home, making consultations more convenient and reducing travel
- Te Whatu Ora - Health NZ: Fairer health system because of better access to care. More educational options for Te Whatu Ora - Health NZ district's staff via specialist video training
- Specialists/consultants: Less time spent travelling for consultations. Greater control over scheduling. Closer working relationship between specialists and primary care
- Aged care workers/nurses: Reduced need to transfer older patients. Increases nurses' knowledge through more exposure to specialist consultations
- General practitioners: GPs who serve rural health facilities need to travel less frequently. Store and forward allows for accessible referrals and second opinions
- Allied health workers: Rehabilitation and physiotherapy can take place via videoconference, meaning less time and budget spent on travel.
Types of telehealth
There are four broad types of telehealth as follows:
- Real-time telehealth: Real-time telehealth is the nearest substitute to the usual in-person communication, the most common forms are telephone and video interactions. This type of telehealth improves access and increases efficiency by eliminating unnecessary travel and lengthy wait times for patients or providers.
- Store and forward telehealth: Store and forward telehealth applications and equipment collect and electronically send clinical information to another location for evaluation. Generally, store and forward describes episodic care; the most common examples are radiology and dermatology imaging sent for expert review. The benefit of this asynchronous telehealth is expert diagnosis can be conducted at a different location and/or time.
- Remote patient monitoring: Remote patient monitoring, also known as telemonitoring, remotely collects and sends patient data to be interpreted and used in a person’s ongoing health care. The data collected is usually related to physiology, such as blood pressure, but it can also be self-reported symptoms or activity levels. Alarm systems, fall detection, adherence to treatment and environmental monitoring are also forms of telemonitoring. This type of telehealth means the patient can stay in their home and still be monitored by the team providing their care.
- mHealth: mHealth uses mobile technology such as smartphones and wearable devices to achieve improved health goals. Apps are generally a core element in mHealth solutions. Often apps collect relevant biometric data from smartwatches, wearables and sensors. mHealth has a wide variety of applications, including delivery of health information, health services and healthy lifestyle support programmes.
- Hybrid: Some forms of telehealth such as text, messaging and chat bridge some of these types of telehealth.
If you are introducing telehealth, there are a number of technical and administrative aspects you will need to understand. This can be a little daunting – remember we are here to help!
Key elements of telehealth
The type of data you use might be standalone video or audio, combined video and audio, text (eg, blood pressure, weight and symptoms), continuous monitoring streams, alarm signals or specialised recordings (eg, ECG and EEG).
Data transfer: Data transfer can take place in real-time (synchronous) where the patient is usually present or on a ‘store and forward’ basis (asynchronous) where the patient is not usually present.
Who is involved: Clinicians and patients, and patients’ family and whānau are the main parties usually involved in a telehealth consultation. It is possible for a number of people to take part in videoconferences. For example, a consultant might be with a medical student at one site, while a patient, members of their whānau and a rural nurse specialist are at another site.
The type of consultation: A number of different types of consultations can take place using telehealth. These include:
- initial specialist assessment
- follow-up appointments
- discharge planning meetings
- multidisciplinary team meetings
- acute assessments
- ward round
- triage assessments
- therapy/treatment appointments
Scheduling the consultation: Planned consultations are usually scheduled ahead of time, with locations and equipment booked by both parties. Facilities likely to need to have urgent consultations, such as emergency departments, can quickly make the appropriate equipment available.