Posts Tagged ‘Telehealth’

Licensure Portability for occupational and physical therapists in Telerehabilitation in the USA

What are the models of PT and OT licensure portability in the USA

1. Mutual Recognition Compacts — This model is similar to being able to use a driver’s license issued in one’s own state in other states that have a legal agreement with this state.

2. Expedited License— This is a uniform application and credential verification that is stored and sent to the state that the license is required for.

3. Limited License— this will grant a license to an OT or PT in each state that will be limited in scope to the practice of telehealth across state lines.

4. National License— The OT and PT profession will be administered at the national level and based on a universal standard.

5. Federal Pre-emption— the federal government will grant licensure for inter-state practice of telerehabilitation.


Telehealth Comes of Age

What do the following have in common?

Rural areas, medical insurance companies, 200,000 patients, cardiac patients, mental health patients, neurological telehealthdisease patients, suicide prevention and oncology follow-up care. An unlikely group of terms? Not if you consider that all of these derive a benefit or support from TELEHEALTH. In this age of high technology many medical procedures and benefits can be accomplished remotely and with as much expertise as with a face to face encounter with a professional.

Today, telehealth   is fast taking its place as a major aspect of healthcare and is understood more than ever before.

According to Jonathan Linkous, CEO of the American Telemedicine Association (ATA),  telemedicine is growing by leaps and bounds, and is due to double its current use in upcoming years.

More and more people and agencies of all kinds are joining the telehealth bandwagon.”

Telehealth used to be prevalent in rural areas mostly, where it is vital for care. However now, it is used in all parts of the country, Linkous said.

It has also attracted the interest of insurance payers. ”In the next few years,  major healthcare payers will be making interesting announcements” about telehealth, he said.

According to Linkous, tele monitoring is used by 200,000 patients nationwide. It is used to monitor one million cardiac patients a year alone, and provides 400,000 virtual visits  to mental health patients, via Skype.

The majority of patients being treated for neurological diseases are currently connected to a telesystem outside of a hospital. Nearly every major neurologic healthcare organization is using the system.

The Department of Veterans Affairs has recently begun to use telehealth to focus on mental healthcare. Beginning in July, the VA has used instant messaging in a suicide prevention program to help keep 6,000 vets online until assistance can arrive. The VA is also using telemedicine on oncology follow-up care.
When a physical therapy solution is needed and the patient lives too far from a rehabilitation facility or is back home after substantial recovery from a stroke or other limb disabling disease or surgery the TUTOR system is equipped with telerehabilitation to allow the patient to receive therapist monitored exercises.
The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are physical therapy products that consist of ergonomically designed gloves and braces with sensors connected to dedicated software. This software contains challenging games whereby the patient can use his own power to move a disabled limb or joint. The therapist then designs a specific exercise program for that patient based on his abilities.
The TUTOR system is currently in use in leading U.S. and European hospitals and clinics and is fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for further information.



Online Health, E-Health, E-Medicine,Tele-Medicine, Tele-Health, Tele-Rehabilitation

Once the age of computers arrived it was a foregone conclusion that its applications would soon incorporate online health services.
E-Health was introduced  as a further development of the idea of telemedicine.  It began to be used by many academic 
institutions, professional bodies, and funding organizations . The prefix ‘tele’ derives from the Greek for ‘at a distance’. Nowadays, eHealth is understood as the “use of information and communication technologies locally and at a distance” that combines and integrates health information and communication technologies.  Telemedicine is a new interdisciplinary approach to practice medicine with enormous potential and new perspectives for development. Ethical and medicolegal concerns, human and cultural factors, and reimburstment for 
services are still  issues of telemedicine that need to be fine tuned. 

During the last decade of the 20th century, e-commerce exploded giving new ways to conduct business and financial transactions through the Internet. Various e-terms began to appear and proliferate in combination to Internet development.  E-Health was introduced as a 
consequence of e-applications, and as a further development of the idea of telemedicine. What do those terms mean? Many previous articles have dealt with the question of how telemedicine and eHealth can  or should be defined. The aim of this article is to discuss the understanding of  telemedicine and eHealth definitions already developed in the literature, which have been published to date, and compare them to clinically oriented definitions already established. 
 There is  hope that a better understanding of the meaning and perspectives of telemedicine and eHealth will improve communication and 
cooperation of many medicine and technology specialists. 

The definition of eHealth is based on a wide variety of meanings combining informatics technology 
and health and wellness, where the concept of wellness refers to public health and health promotion. It also relates to health services delivery (e.g., health care,  health industry products). E-Health represents a new concept of health care. Technology is incorporated into the definition. Additionally, internet and internet related technologies belong to that technology. Finally, eHealth combines and integrates health, information and communication technologies. 
The idea of eHealth presents a unique opportunity for the development of public health. The World Health Organization and other subsidiaries of the United Nations have drawn up strategies for eHealth that include the use of it for public-health purposes and health-care delivery. The main ideas of the strategy focus on “eHealth for all by 2015 ”. 

 The term eHealth is currently used by many medical professionals, academic institutions, and representatives of technology in medicine. Despite the lack of a clear and precise definition it has become a widely accepted neologism. The widespread use of this term suggests the need of electronic health among the many individuals and organizations. 

Telemedicine has worldwide implications. The target of eHealth is wide and concentrates on improving and increasing the cost-effectiveness of  health care at large and to solve problems related to access, care, cost, quality, and portability of health care services locally, regionally, and worldwide . Telemedicine seems to focus on the 
same target, but is restricted to relations between patient and physician . The ultimate benefits of implemented telemedicine go directly or indirectly to a patient. The term eHealth encompasses a set of disparate concepts, including health, technology, and commerce. It has raised the promise that information and communication technologies will improve medicine and the health care system. 
The term telehealth was developed to substitute for the term telemedicine . In the early years of the twenty first century more fashionable terms such as “online health” and “e-health” appeared due to internet expansion. Some authors suggest new terms as approximate synonyms. 
 It is reported that “telemedicine encompasses all of the health care, education, information and administrative services that can be transmitted over distances by telecommunications technologies”. 

Nowadays, eHealth is understood as the “use of information and communication technologies locally and at a distance”. The technology is viewed both as a tool to embodiment of eHealth itself to expand, or to enhance human activities, but not substitute for them. 

One of the benefits of telemedicine can be that it allows the patient to receive more immediate care.  That may be expressed by utilizing digitalized products and systems. The impact on health systems may become more efficient by improving access to care, especially in remote areas, for people with disabilities and for the elderly. That creates new opportunities for faster and more comprehensive epidemiological surveillance and for better patient care. A global approach to handling data flows should be able to promote standardization and low-cost services. That opens the new platform for international participation and collaboration on information and communication technologies with other providers which can in turn 
remove barriers for health data flow. 
The main lines of the strategy for the telemedicine societies are to integrate eHealth applications into health systems and develop norms, standards, guidelines, information and training materials. 
National centers and networks of excellence will mobilize collaboration for determining evidence based eHealth. 

E-Health for citizens, patients and health professionals should meet quality, safety and ethical standards. The value of eHealth is to improve the quality and the economy of the present  health systems. However, many eHealth and telemedicine applications  are currently unregulated   or insufficiently regulated.

Any adverse, negative, harmful, or disadvantageous effects are rarely mentioned while describing eHealth or telemedicine .


The whole range of medical activities including diagnosis, treatment and prevention of disease, continuing education of health-care providers and consumers, and 
research  and evaluation is encompassed. Grigsby and Sanders  pointed out that   telemedicine is defined as “the use of electronic information and communications technologies to provide and support health care when distance separates the participants” or the specialty which “encompasses all of the health care, education, information and administrative services that can be transmitted over distances by telecommunications technologies. 

Telemedicine subjects include the interaction between the medical service receiver and the expert 
(i.e. real-time or prerecorded). Neither health care provider nor medical service receiver is moved, but only information is transmitted (e.g. text, audio, video). 

Telemedicine practice is now performed in industrialized countries, but there is an increasing interest in the use of telemedicine in developing countries. 

One of the most promising aspects of all the ehealth applications is telerehabilitation. This is manifested through the use of the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been in use now for several years in some of the leading rehabilitation facilities in the U.S. and Europe. These physical therapy products provide intensive exercise programs with augmented feedback for patients who have had a stroke, Parkinson’s disease, brain or spinal cord injuries, CP, MS, Brachial Plexus injuries and other upper and lower surgeries that have affected the movement of various limbs. When the patient is discharged from acute care or lives too far from a rehabilitation facility he can access this physical therapy solution right in his home through the use of telerehabilitation. The physical or occupational therapist at the other end will evaluate and quantify the patient’s impairments and customize an exercise program for him. Certified by the FDA and CE the TUTOR system is appropriate for adults as well as children from the age of 4 or 5. See WWW.MEDITOUCH.CO.IL for more information.

American Telemedicine Association (ATA) asks Medicare to pay for telehealth services given by physical therapists, occupational therapists, and speech-language pathologists.

Centers for Medicare and Medicaid Services - M...

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In a letter sent to Dr. Donald M. Berwick Administrator for the Centers for Medicare and Medicaid Services (CMS) the American Telemedicine Association wants Medicare to waive the restrictions on telehealth payments so that telehealth services . This will mean that tele-medicine and telerehabilitation can be treated like any other form of care. As Administrator, Dr. Berwick oversees the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP). Together, these programs provide care to nearly one in three Americans.
An important change will be the removal of Medicare restrictions on paying physical therapists, occupational therapists, and speech-language pathologists for telehealth services. The ATA contends that lifting this and the location-based prohibition would open up home-based telerehabilitation, which the group called “an important service for beneficiaries from whom going to therapy is a major barrier.”