Telehealth is defined by the National Health IT Board as "the use of information and communication technologies to deliver healthcare when patients and care providers are not in the same physical location".
Telehealth is a broad term that can also include activities not directly relating to patients, such as providing education or training sessions and video conferencing for meetings.
Telehealth in the New Zealand context
There are three key areas within the broader telehealth space that are currently being developed: telemedicine, telemonitoring and mHealth (mobile health).
- Telemedicine is "the use of telecommunication and information technologies in order to provide clinical health care at a distance". Within New Zealand the most common types of telemedicine are Video conferencing and Store and forward. You can read more about each of these at NZ Telehealth Resource Centre.
- Telemonitoring refers to "remotely collecting and sending patient data so that it can be interpreted and then contribute to the patient's ongoing management". One of the big advantages of telemonitoring is enabling patients to be at home or their usual place of residence, such as an aged care facility, while their healthcare team can monitor vitals such as blood pressure, heart rate or activity levels. It can also be used for alarm systems, such as fall detection and treatment adherence. Telemetry takes this a step further and refers to collecting and sending data, such as heart rhythm monitoring, in real time.
- mHealth (also known as mobile health) describes "the use of mobile communications technologies in medical and public health practice, including the delivery of health information, health services and healthy lifestyle support programmes" (NZ Telehealth Resource Centre). A number of devices can be used to deliver mHealth, ranging from smartphones to tablets and mobile sensors. Mobile communications technology enables additional functionality to be used, such as text messaging (SMS), mobile apps, mobile web browsing, video calling, MMS/pxt, QR code scanning and GPS location. The portability and popularity of mobile devices is obviously a major advantage and newer technologies will keep appearing as technology advances.
Key elements of telehealth
Data type: 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 it involves: 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 video conferences. 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.
Benefits of telehealth
- For patients: Faster access to care and shorter wait times. Remote patients can remain close to home, making consultations more convenient and reducing travel.
- DHBs: Fairer health system because of better access to care. More educational options for DHB 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. Increased 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 video conference, meaning less time and budget spent on travel.