Classification Model for Telehealth
Process Models for Telerehab (Systems Perspective)
- Different goals require different solutions (participants,
forms of tele-encounter)
- Many different processes are viable (see list below)
| List of telehealth process terms (based on Winters, 1999): |
Teleconsultation -- A medical/legal term that suggests communication across distance in which there is an expert consultant who provides a service. |
Teleconferencing -- The process of two or more people interacting across a distance, supported via telecommunications. |
Telematics -- The study of intelligent, effective strategies for transporting and utilizing health-related information and/or healthcare services |
Tele-education -- The process of education/training at a distance. (Education represents one of the key professional activities of a visiting home health nurse.) |
Telemonitoring (interactive) -- The process of monitoring health status at a distance. Involves interactive conferencing, and perhaps the transmission of data (e.g., vital sign recordings). |
Telemonitoring (unobtrusive) -- The process of unobtrusive sensing of personal health status, or of the environment. |
Telesupport – The process of interactive support, e.g. via a tele-nurse. Depending on the protocol, the "patient" and/or the provider of support may initiate the call. |
Tele-evaluation -- Systematic professional evaluation at a distance, e.g. by a physician, therapist, nurse, rehabilitation engineer, or other health professional. |
Teleassessment -- Systematic assessment of health status by a healthcare professional, often more broad-based that an evaluation. Normally would need to be interactive. |
Telediagnosis -- The process of performing diagnosis at a distance. |
Telecompliance -- The process of providing support, encouragement and education at a distance, so as to enhance compliance with health maintenance (e.g., taking medication) or home self-therapy (e.g., a prescribed exercise program). |
Teletherapy -- The process of actual therapeutic intervention at a distance. For instance, physical/occupational or psychological/psychiatric therapy. Ideally, there would be built-in objective telemonitoring/teleassessment that related to performance and outcomes measures. |
Teleplay – Use of interactive, exploratory "games" with built-in therapeutic and/or monitoring capabilities, and with interface parameters that can be adjusted depending on the client's progress. |
Telecoaching – The process of trained supervisor providing proactive support, training and assessment related to helping a client improve performance and abilities. |
- Hub-spoke community telemedicine (or teleconsultation), between conference rooms at different hospitals or clinics, typically to give a practitioner, and possibly a patient, access to specialized expertise,
- Telehomecare, between a consumer (and perhaps caregiver) in a home and a practitioner at a remote site, typically a telenurse who also serves as the case manager,
- Minmally obtrusive telemonitoring, where information is obtained, perhaps stored, and transmitted to a central site where it is monitored,
- Home teletherapy, where therapeutic interventions in the home are either administered remotely or telecoached and telesupported from a distant location.
Community Telemedicine (Medical Teleconsultation) Model:
- Infrastructure: Proactively
planned rooms for group videoconferencing
via H.320 (occationally H.323), electronic record-sharing
- Typical room has a large conference table,
special lighting, multiple
cameras (and often monitors), sound system. Communication is by audiovisual conferencing, sometimes augmented
by an image from a document camera
(e.g., medical image) or computer application (e.g.,
Powerpoint).
- Forms of Tele-Encounter: Typically used for tele-consutations,
i.e. access to specialized expertise via "hub-spoke" model.
- "Hubs" typically on the grounds of major
medical centers"Spokes" typically near the town center
of a rural community. Typically there are clincians on both sides of a call,
sometimes with patient also present. Desired outcome of tele-encounter: successful consultation
(e.g., diagnosis, plan of care, outcomes assessment)
- Technology Usability & Access:
- usability: often high (for those without disabilities); communication culture changes when multimodal interface is available, for better or worse.
- access: low-to-moderate (must get to and use
a specialized room)
- Local Example:
- Zablocki
VA in Milwaukee ("hub") with Iron Mountain VA ("spoke")
for rehab "televisit" for
areas such as prosthetic prescription or follow-up.
TeleHomecare Model:
- Infrastructure: Typically
a "practitioner site" (e.g., nurse) and a "patient
site" (that may also include
a caregiver)
- Often H.324 videophones are used (or IP). The practitioner site often includes a computer
workstation (e.g., for inspection of data, records). The practitioner site is simpler, including
a monitor (small
screen or their own TV) and a
controller
(like "remote" or
phone keypad).
- Forms of Tele-Encounter: Similar in aims and scope
to a "home visit," with typical tasks including:
- interactive tele-support/education & general
monitoring via interview/observation (using videophone)
- cooperative telemonitoring/teleassessment
(e.g., often including sensor-based health
status indicators
such as
scopes, vital
signs)
- Technology Usability & Access:
- Technology usability: interface is simple to
use, but poorer quality video and audio, and limited
access to health technologiesAccess: potentially very high (key questions on
protocol that
first ned to be addressed: Scheduled or self-initiated
calls? Who initiates? Who has access to whom?)
- Local Example:
- VA telehomecare, with videophones
sent home with certain SCI clients.
Telemonitoring:
- Infrastructure: Mixture
of sensor-based technologies and videoconferencing.
- Forms of Tele-Encounter: As
unobtrusive as possible, may involve sensing of physiologic
and/or task performance measures (possibly with one-way
video).
- Technology Usability & Access:
- usability: if well planned (e.g., simple, targeted
interface), potentially high
- access: if well planned (e.g., wireless/wearable),
potentially high
- Local Example: Aspects
of our ongoing ITA project (discussed later in class)
Teletherapy:
- Infrastructure: Two-way
information transfer between telepractitioner & client
terminals model.
- Forms of Tele-Encounter: Psych,
speech-language, occupational therapy, physical therapy,
medications; tele-coaching (e.g., nurse?)
- Technology Usability & Access:
- usability: depends on application, could be challenging
- access: potentially very high (vs current situation)
- Local Example: VA aspects
of psych? Plans for UniTherapy project.
Of course, a single session may switch between several process
models.
Next: Scientific Modeling Framework
Reading materials (all from Winters et al., Emerging and Accessible
Telecommunications, Information and Healthcare Technologies, RESNA
Press, 2002): Chapter 11 (Winters), Chapter 12 (Shapcott), Chapter
13 (Tran et al), pages as assigned in class.
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