The there are still many difficulties that the

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Last updated: September 27, 2019

The healthcare sector has substantiallydeveloped over the years thanks to the ease and convenience brought by the currenttechnologies advancements. Nevertheless, there are still many difficulties thatthe industry has to deal with, especially when it comes to accessibility, provisionand convenience of services both for the patients and the medical providers.One of the solutions the medicalprofession and the healthcare industry have brought up to deal with theseissues is telemedicine.

What is telemedicine? It is the remote diagnosis andtreatment of patients by means of telecommunications technology. Aside fromconnecting patients and medical providers, telemedicine also provides a way forhealth care professionals to consult with other physicians. Telemedicine is the use oftelecommunications technology such as phones and computers to provide clinicalservices to patients over long distance communication. Through phone calls,emails, mobile apps, and even video chat, health care professionals are able todiagnose and treat patients without the need for long travels or in-personhospital visits.In the early days, telemedicine wasused mostly to connect doctors working with a patient in one location tospecialists somewhere else. This was of great benefit to rural or hard to reachpopulations where specialists aren’t readily available. Throughout the next severaldecades, the equipment necessary to conduct remote visits remained expensiveand complex, so the use of the approach, while growing, was limited.

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The rise of the internet age broughtwith it profound changes for the practice of telemedicine. The proliferation ofsmart devices, capable of high-quality video transmission, opened up thepossibility of delivering remote healthcare to patients in their homes,workplaces or assisted living facilities as an alternative to in-person visitsfor both primary and specialty care.Impacting the rise of telemedicinetoday is the growing mobile health field. With the wide variety of mobilehealth apps and new mobile medical devices that are consumer-friendly, patientsare starting to use technology to monitor and track their health. Simplehome-use medical devices that can take vitals and diagnose ear infections,monitor glucose levels, or measure blood pressure let patients gather neededmedical information for a doctor’s diagnosis, without going into the doctor’soffice.

And again, as more patients get proactive about using technology tomanage their health, they also will be more open to alternative ways to getcare – through telemedicine!CHAPTER 2: METHODOLOGYINTRODUCTIONHaving explored the nature andpurpose of qualitative research, this article explores data collection techniquesused in qualitative research. There are a variety of methods of data collectionin qualitative research, i.e. observations, textual or visual analysis (e.g.from books or videos) and interviews (individual or group).

However, the mostcommon methods used, particularly in healthcare research, are interviews andfocus groups.Qualitativeresearch interviewsThere are three fundamentaltypes of research interviews: structured, semi-structured and unstructured.Structured interviews are, verbally administered questionnaires, in which alist of predetermined questions are asked, with little or no variation and withno scope for follow-up questions to responses that warrant further elaboration.Conversely, unstructuredinterviews do not reflect any preconceived theories or ideas and are performed withlittle or no organisation. Such an interview may simply start with an openingquestion and will then progress based, primarily, upon the initial response. Semi-structured interviewsconsist of several key questions that help to define the areas to be explored,but also allows the interviewer or interviewee to diverge in order to pursue anidea or response in more detail.

This interview format is used most frequentlyin healthcare, as it provides participants with some guidance on what to talkabout, which many find helpful. The purpose of researchinterviewsThe aim of the researchinterview is to explore the views from various individuals on specific matters.Qualitative methods, such as interviews, are believed to enlighten us on socialphenomena than would be obtained from purely quantitative methods, such as questionnaires.Interviews are, therefore, most appropriate where little is already known aboutthe study phenomenon or where detailed insights are required from individualparticipants. They are also particularly appropriate for exploring sensitivetopics, where participants may not want to talk about such issues in a groupenvironment.The interviewWhen designing an interviewschedule it is imperative to ask questions that are likely to yield as muchinformation about the study phenomenon as possible and also be able to addressthe aims and objectives of the research. In a qualitative interview, goodquestions should be open-ended (i.

e., require more than a yes/no answer),neutral, sensitive and understandable. It is usually best to start withquestions that participants can answer easily and then proceed to moredifficult or sensitive topics. This can help put respondents at ease, build upconfidence and rapport and often generates rich data that subsequently developsthe interview further.The length of interviews variesdepending on the topic, researcher and participant.

However, on average,healthcare interviews last 20-60 minutes. Interviews can be performed on aone-off or, if change over time is of interest, repeated basis, for exampleexploring the psychosocial impact of oral trauma on participants and theirsubsequent experiences of cosmetic dental surgery.FocusgroupsFocus groups share many commonfeatures with less structured interviews, but there is more to them than merelycollecting similar data from many participants at once. A focus group is agroup discussion on a particular topic organized for research purposes. Thisdiscussion is guided, monitored and recorded by a researcher (sometimes calleda moderator or facilitator).

Whenfocus groups are usedFocus groups are used forgenerating information on collective views, and the meanings that lie behindthose views. They are also useful in generating a rich understanding ofparticipants’ experiences and beliefs. Suggested criteria for using focusgroups include:·        As a standalone method, for research relating togroup norms, meanings and processes·        In a multi-method design, to explore a topic orcollect group language or narratives to be used in later stages·        To clarify, extend, qualify or challenge data collectedthrough other methods·        To feedback results to research participants.Preparingan interview scheduleLike research interviews, theinterview schedule for focus groups is often no more structured than a looseschedule of topics to be discussed. However, in preparing an interview schedulefor focus groups, two general principles suggested by Stewart and Shamdasaniare used:1.

      Questionsshould move from general to more specific questions2.      Questionorder should be relative to importance of issues in the research agenda.There can, however, be someconflict between these two principles, and tradeoffs are often needed, althoughoften discussions will take on a life of their own, which will influence ordetermine the order in which issues are covered. Usually, less than a dozenpredetermined questions are needed and, as with research interviews, theresearcher will also probe and expand on issues according to the discussion.ModeratingModerating a focus group lookseasy when done well, but requires a complex set of skills.

The moderator shouldfacilitate group discussion, keeping it focused without leading it. They shouldalso be able to prevent the discussion being dominated by one member, ensurethat all participants have ample opportunity to contribute, allow differencesof opinions to be discussed fairly and, if required, encourage reticentparticipants.ConclusionInterviews and focus groupsremain the most common methods of data collection in qualitative research, andare now being used with increasing frequency in dental research, particularlyto access areas not amendable to quantitative methods and/or where depth, insightand understanding of particular phenomena are required. The examples of dentalstudies that have employed these methods also help to demonstrate the range ofresearch contexts to which interview and focus group research. CHAPTER 3: LITERATURE REVIEWMD.

comTelemedicine.Book doctor appointments 24/7 and see adoctor on your smartphone or tablet from the privacy of your home or officewith MD.com Telemedicine!Skip crowded waiting rooms (and theirgerms), request appointments anytime, and prevent the costs of missed appointmentswith automated email/SMS reminders — get started now to enjoy privacy,convenience and access to doctors at your fingertips.AdvaitTelemedicineAdvait telemedicine is an app whichallows patients to have access to their doctors 24/7 365 days.This app links a patient with hisdoctor and the patient can send voice messages, text messages take picturesfrom the camera and send those pictures using the app to the doctor. The doctorcan also reply to the voice messages and text and view those pictures sent bytheir patients.

The app is a 2 way communication toolsfor the patients and their doctor.ChironHealthIs a website that promotes telemedicineto patients has never been easier. It promotes video visits to your patientswith personalized campaigns.

Custom web pages and automated email notificationsallow you to announce your new service and keep patients informed abouttelemedicine in in your practice.It has the following key products:HIPAA-Compliant: Secure video overpeer-to-peer connection and a signed BAA for each client;   Co-Pay Collection: Accurate paymentdetermination is processed through our insurance Rules Engine and depositedinto your account; Patient Notifications: Once an appointment is scheduled,patients automatically receive an email to set up account and join appointment;Clinical Protocols: Customized telemedicine formula specific to your practice –Know exactly when and how to use telemedicine; Custom Patient Marketing: Easilymarket to patients about telemedicine with custom in-office and onlinematerials; Streamlined Patient Workflow: Automated appointment reminder emailsand an experience that mimics the in-office workflow with a virtual waitingroomCHAPTER 4: FINDINGS AND OBSERVATIONHow is Telemedicine impactingpatients and providers?A fast-growing field in thehealthcare industry, telemedicine holds a lot of promise in solving variouschallenges that health professionals and patients are facing today. Providing arange of benefits for both patients and medical providers, it offers:Prosof TelemedicineAdopting the latest telemedicineinitiatives can help your practice achieve numerous benefits. You can lowerhealthcare costs, drive up practice efficiency and revenue, provide yourpatients better access to healthcare services, and ultimately get happier,healthier patients who stay in your practice.1.

      MoreConvenient and Accessible Patient CareAccording to a recent Ciscoglobal survey, 74% of patients prefer easy access to healthcare services overin-person interactions with providers.2.      HealthcareCost SavingsRemote analysis and monitoringservices and electronic data storage significantly reduce healthcare servicecosts, saving money for you, your patients, and insurance companies.Telemedicine also reduces unnecessary non-urgent ER visits and eliminatestransportation expenses for regular checkups. Recently, the American HospitalAssociation reported on a telemedicine program that saved 11% in costs and morethan tripled ROI for investors. Beyond these general cost-savings, telehealthcan help boost doctors’ revenue by turning on-call hours into billable time,attracting new patients, reducing no-shows, and even reducing overhead forphysicians who decide to switch to a flexible work-from-home model for part ofthe week.3.

      ExtendedSpecialist and Referring Physician AccessWith telehealth, patients inrural or remote areas benefit from quicker and more convenient specialistaccess. In the U.S., for every 100,000 rural patients, there are only 43specialists available. These patients endure longer appointment commutes andhave trouble accessing lifesaving consultations for specific diseases orchronic care plans.4.      IncreasedPatient EngagementWhen patients are committed totheir own healthcare goals, it leads to lower costs and improved health. Ernst& Young Senior Advisory Services Manager Jan Oldenburg told Healthcare ITNews that the high cost of disengaged consumers affects everybody.

“Engaging your patients throughtelemedicine can help them maintain appointments and care schedules. Increasedengagement initiatives can also curb obesity rates and tobacco use by helpingyou to encourage your patients’ healthy lifestyle choices.5.      BetterPatient Care QualityTelemedicine offerspatient-centered approaches, such as improved timeliness of care. This iscritical to quality patient care. Patients can address healthcare issuesquickly with real-time urgent care consultations and learn about treatmentoptions within minutes. A new study shows that telemedicine patients scorelower for depression, anxiety, and stress, and have 38% fewer hospitaladmissions.

  Consof TelemedicineWhile telemedicine promises togrow rapidly over the next decade and has clear benefits, it still poses sometechnical and practical problems for healthcare providers.1.      TechnicalTraining and EquipmentRestructuring IT staffresponsibilities and purchasing equipment takes time and costs money.

Trainingis crucial to building an effective telemedicine program. Physicians, practicemanagers, and other medical staff need to be trained on the new systems toensure a solid ROI. In addition, your staffing requirements may decrease. Forinstance, a nurse in a rural Alaska facility can monitor up to 33 patients atonce from a single location using telemedicine services.2.      ReducedCare ContinuityIn cases where patients areusing on-demand telemedicine services that connect them with a randomhealthcare provider, care continuity suffers.

A patient’s primary care providermay not have access to records from those other visits and end up with anincomplete history for the patient. Service provider shuffling increases therisk that a doctor won’t know a patient’s history or have notes about careroutines.3.

      FewerIn-Person ConsultationsWorried about technology’slimitations? You’re not alone. Many doctors worry about technical problemsassociated with telemedicine. Senior Healthcare Group Consultant Arun Ravi toldBecker’s Hospital Review that poor broadband connections could lead to”possible patient mismanagement.” Many physicians and patientsalike still like a “personal touch,” and not all procedures – even simplecheckups – can be performed digitally. However, in cases where patients justcan’t get in to see their doctors’ in-person, and for many cases that don’trequire a physical exam, telehealth can be a good alternative.

4.      TrickyPolicies and Reimbursement RulesHealthcare laws, reimbursementpolicies, and privacy protection rules struggle to keep up with thisfast-growing industry. As a healthcare provider, you want to promote bestpractices when approaching telemedicine. While major developments have beenmade to telehealth reimbursement over the past couple years, it still remains acommon stumbling block for providers interested in telemedicine.  It’s best to do a little research into thereimbursement policy landscape in your state before you get started. CHAPTER 5: RECOMMENDATIONSImproving patient assessment andreviewAll sites chose to improve theprocess for assessing and reviewing telehealth users to ensure efficient use ofresources. This included collecting additional information from referringclinicians at assessment to identify goals for use and specify a date forreview.

Improving service deliveryThree sites aimed to improve theprocesses for monitoring and triage of telehealth patients. Each site hadpreviously completed some standardization, and therefore targeted specificelements of their service that were not working efficiently, or where practicewas variable. Case study findings helped to identify which processes needingimprovement.

Improving data sharing andaccessThree sites worked on improvingdata sharing and access. Acknowledging that solutions to address theinteroperability problems between monitoring software and electronic patientrecord systems were not readily available, participants considered other waysto reduce the additional workload associated with having to access two, andsometimes three, different systems. Other work focused on how to ensure thatpatient records were updated with monitoring information so that otherclinicians involved in the care of a patient could access this information.

Raising awareness of telehealthAll sites were keen to raiseawareness of telehealth and ideas for action included training sessions fornursing teams who were reluctant to use telehealth; working more closely withnew clinical commissioning groups; and hosting events to promote telehealth toother clinical providers. Because of competing priorities, this work wasdifficult to achieve and in two sites was discontinued after the first cycle. Improving evaluation oftelemedicineAll sites agreed that better evaluationwas required to understand more about telemedicine outcomes. However, only twosites chose to work on this activity. Divided opinions about the rationale forinvestment in telehealth created uncertainties about which outcomes to measureand consequently, while participants agreed that this work was important, theycould not agree on how to take it forward. Securing financial investmentfor telemedicineThe short-term funding oftelehealth was identified as a barrier to implementation. To secure futureinvestment, participants focused on establishing relationships with technologyproviders and local decision-makers; scoping out the potential of newtechnologies that were available; and identifying the needs of users andclinicians that could be addressed with telehealth. Only one site was able tosecure financial investment during the study timeframe, and in two sites therewere real concerns about the future of telehealth.

 

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