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Telehealth modalities

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Telehealth is an overarching term encompassing telemedicine, tele-education, teletherapy, telementoring, and telemonitoring. A range of modalities are included: the telephone, video conferencing, store-and-forward, remote monitoring, and the use of clinical apps. Clinicians need to determine the most appropriate modality to support the clinical needs of the patient. For staff who are unfamiliar and may lack confidence with the use of technology, it is recommended to start to use the technology in non-clinical situations. This may include meetings and education sessions, which will boost skills, knowledge, and confidence. iii 

Telephone: The use of the telephone to support and deliver health services is the most common telehealth service contact mode reported.  A telephone is often used to provide results, follow up patient progress following discharge, or between consultations where real-time images are not required for consultation and where there is electronic medical record (eMR) access to the relevant results. Telephone consultation occurs between the patient and the healthcare provider(s). 

Video conferencing: The use of video conferencing to support clinical care provides a real-time audio and video interactive link between multiple participants. As video conferencing technology has advanced and quality and access has improved, its use is more accepted. Where patients have access to good internet access and suitable equipment, video conferencing provides a more interactive and engaging experience for the clinician(s), the patient, and their carer(s).  Health employees have access to video conferencing platforms backed by state infrastructure that has the flexibility to connect all Health facilities. They also can connect with external providers, states, and countries to support the workforce to connect worldwide. 

Store-and-forward: The use of email is a tool to communicate between patients, carers, and healthcare providers to support patient care. Store-and-forward is an electronic communication method of acquiring and storing clinical information (including data, images, sound, and video). The information is forwarded to, or retrieved by, another clinician for clinical review for intervention, management, or advice. The advantage of this is that consultation can occur when there is available time. For example, an MRI can be taken on Monday, then consultation with the interdisciplinary team and the patient can occur Tuesday. Wound consultation with a nurse and GP occurs on Tuesday with the patient. Interdisciplinary team consultation with a podiatrist and infectious disease specializes in using clinical data, wound images, and wound culture results is scheduled on Friday, ahead of the next GP and nurse review on the following Tuesday. There are many digital cameras, scopes, and diagnostic instruments (e.g., otoscope, digital stethoscope, blood pressure, ultrasound, ECG) that can capture both still and video images. It is paramount to securely store and manage these images and videos.  

Remote monitoring devices: Remote monitoring is a relatively new modality that uses mobile technology to collect and send medical and healthcare data to an app, device, or service outside the traditional clinical setting. This includes wearable devices and peripherals. Depending on the functionality of the device, the patient diagnostic information collected should be entered into the patient’s record (automatically or manually) or provided to a healthcare professional for advice and management. Remote monitoring can be passive (where measurements are sent from a device automatically) or active (where people collect their clinical readings and send them to their healthcare provider). It can also involve an alert or alarm in high-risk situations, e.g., a notification when a patient’s monitored vitals are outside of the flags. All remote monitoring services should have clinical procedures in place that identify escalation procedures that are communicated to patients.

Websites and applications (apps): There is a wide range of websites and apps available to support forms of telehealth functionality, including phone calls, video conferencing, remote monitoring, appointment scheduling, and educational information. These apps and websites provide a tailored interface for both the clinical user and the consumer. As there is a large commercial market for these products, thousands already exist and are tailored to both specific and general health conditions. Programs are available that encompass the entire patient journey from prevention to palliative care support. Before implementing an app or website, either through buying/using an existing one or developing something new, there are several key considerations, including privacy as well as interoperability.