Telemedicine in Education | Our Future Decision-Makers

Telemedicine has made significant strides in the marketplace throughout 2015, with legislative and reimbursement hurdles being addressed to enable greater deployment of services nationwide. Considering the advancement of telemedicine, one of the often-overlooked subjects is how the educational system is embracing telemedicine and how the training of new healthcare professionals is supporting the deployment of services.

Telemedicine training and education is imperative to equip students with the knowledge and tools they will need in their future role as decision makers to detect a need for, design, implement, maintain, or evaluate a telemedicine application.

The continued advancement of telemedicine and the future accessibility of quality healthcare in the U.S. require a trained, skilled, and competent workforce.  Enabling clinicians, administrators, and engineers with competencies in telemedicine ensures that the healthcare system best utilizes the emerging technologies in telemedicine and remote healthcare.

Telemedicine and teleheath cirricula are increasingly important for graduate and postgraduate education in health professions. Embracing the broad potential of telehealth in remote learning, mentoring, and consultation will enable institutions to teach anything, anytime, anywhere — with the same quality as delivered in traditional classroom settings.

In this article iTelemedicine explores some of the developments occurring at the university level as well as how some university research is empowering the deployment of services.

Telemedicine Simulation

One of the projects we found most interesting is a telemedicine simulation training solution known as TeleOSCE (Objective Structured Clinical Exams applied via Telemedicine). Developed at Oregon Health and Sciences University, the TeleOSCE program originated as a way for rural students to access remote training for medical encounters and has expanded to become a vital part of the university curriculum for patient-centered care. With the goal to find ways to keep telemedicine technology patient-centered, the program engages students in simulated telemedicine cases. Currently the concentration has been in diabetes and depression.

Ryan Palmer, developer of the TeleOSCE simulation program, indicated that the university was recently awarded a national grant to increase its program. TeleOSCE is now expanding to encompass multiple cases, including urban underserved patients and added rural cases. The program is also being

integrated into the University of Texas at San Antonio family medicine program and has already been adopted by the University of South Dakota.

Telemedicine and Telehealth Cirricula

Dr. Mari Teitze of Texas Woman’s University told iTelemedicine about the telemedicine and telehealth courses offered at the university. She explained that they have specifically categorized the curriculum into the following three phases:

1. Telemedicine where diagnosis is the outcome.
2. Remote monitoring where a case manager can oversee a patient in their home by protocol, helping to avoid re-admissions.
3. Mobile health where patients or consumers are using applications to monitor their food intake, diet, exercise, etc.

“We teach nurse practitioners and advanced health professionals how to maximize the use of sensory devices worn by the patient or consumer,” Teitze added. “Video conferencing is something that can be part of all three phases of what we teach. “

For example, they transmit actual data from a telemedicine cart into a classroom.

“We can teach what the ear looks like, what the heart sounds like, or what the dermatology exam looks like,” she said. “We see it on a big screen in the classroom while the specialist is seeing it on the desktop.”

The cart used by the university is the AMD telemedicine cart equipped with pulse oximeter, basic exam camera, otoscope, stethoscope, and a 12-lead EKG cardio glove. The cart is operated with AMD AGNES software.

Research Impacting Deployment

What kind of research is being conducted at the university level, and what kind of impact could it have on the near-term deployment of telemedicine services?

Dr. David C. Grabowski, of the Department of Health Care Policy at Harvard Medical School, has focused his research on the economics of aging with a particular focus on long-term care. In particular, his studies have considered issues related to long-term care financing, organization, and delivery of services. He recently conducted a research project in a large chain of nursing homes in Massachusetts, evaluating the impact of telemedicine in the economy and in quality of care. One of the big problems in long-term care settings generally — in nursing homes in particular — is the lack of physician presence. One group of academic authors titled this “physicians missing in action.”

Dr. Grabowski wanted to discover whether a telemedicine service could be introduced into these nursing homes during off-hours. That way, when an issue came up, the nurse wouldn’t have to call the covering physician. Rather, they could contact the doctor via telemedicine. The nurse would roll a telemedicine cart into the room so that the patient is looking eye to eye with a physician instead of simply talking over the phone. For example, the physician can remotely hear the patient’s cough, monitor their heart rate, or listen to their lungs. In addition, the doctor can speak with the RN and the patient, as well as talk to family members who might be in the room. Communication is enhanced because the doctor can see expressions that convey how they are feeling about the family member’s condition.

“The introduction of this off-hour coverage via telemedicine was found to measurably decrease the rate of inappropriate hospitalization.” Dr. Grabowksi explained. “This is an exciting result when you can introduce telemedicine into this space and actually see a decrease in hospital transfers.“

So why isn’t there telemedicine in every nursing home in the U.S.?

“First, it is because of the fragmented nature of our payment systems,” Dr. Grabowksi explained. For example, the nursing home in their study indeed invested in the technology. However, the savings didn’t go to that nursing home, it went to the Medicare program. “How do we better align the cost of the technology and who pays for it, with who actually gets the savings?” Dr. Grabowski offered. “This is the first issue that we really have to work out if we want to see wide-scale adoption of this technology.”

The second challenge to wide-scale deployment in nursing homes is adoption, specifically the changing of behaviors. In the Harvard study, half of the facilities received the technology and got telemedicine coverage, while the other half of the facilities (the control group) remained as normal. They found that not all of the nursing homes that received the technology actually used it. Dr. Grabowski cites one example where the director of the home did not have confidence in the new technology and chose not to use it. He jokingly added, “What we found was that a telemedicine cart left in a closet was definitely not able to reduce inappropriate hospitalization”.

Other barriers may also impede the widespread use of teleheath innovations in education. For example, there is a shortage of qualified instructors to guide trainees during remote simulations. This need may be fulfilled through models such as communities of collaboration and automated guidance systems based on learner feedback. Network time delay is also an issue, especially for remote simulations. Social barriers include resistance to adopting the new technologies and models for collaboration.

 

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