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Objective: With the explosion in the use of telehealth technologies, it is essential to address the challenges in global telehealth inequity in order to create a path to healthcare equality. To this end, this research paper focuses on investigating telehealth as it relates to the COVID-19 pandemic and its impact on healthcare inequality, telehealth inequity, and the continued vulnerabilities with increased demand in implementation. Study Design: A set of voluntary questions were e-mailed to active members of the IEEE-SA (Institute of Electrical and Electronics Engineers Standards Association) Transforming the Telehealth Paradigm: Sustainable Connectivity, Accessibility, Privacy, and Security for all. The interview answers were analyzed via deductive thematic analysis organized into higher themes and theme-specific codes. Setting: The country of residence varied among individuals who are the IEEE-SA Telehealth program members. These continents included: North America, South America, Africa, Asia, and Europe. Participants: Global healthcare leaders who are active members of the IEEE-SA Transforming the Telehealth Paradigm: Sustainable Connectivity, Accessibility, Privacy, and Security for all participated. The occupations of these individuals ranged from a variety of areas within the healthcare domain, such as physicians, scientists, and public health experts. Main outcome measure: Qualitative data obtained voluntarily from global healthcare leaders participating in the IEEE-SA Transforming the Telehealth Paradigm: Sustainable Connectivity, Accessibility, Privacy, and Security for all. Results: The major themes that emerged from the participants' responses included: telehealth infrastructure and access, digital literacy and user interface, government regulations, and telehealth legislation. Conclusions: Telehealth has the power to decrease healthcare disparities, thus getting closer to achieving health equity. However, there are three significant common global barriers to the implementation of telehealth: infrastructure, digital literacy, and government regulations. Because the results were based on interviewer responses, the conclusions acknowledged how the background of respondents, including career and education, influenced their experiences and, thus, the responses. Suggestions for change in reducing barriers to telehealth accessibility are detailed in this research. These suggestions were derived from respondents and focused on the global barriers to implementation. To reduce these barriers, changes in political health policy, patient health education, health provider telemedicine support, and in regulation for telemedicine are suggested. Limitations in our research project included a small sample size and the ensuing lack of representation from more geographical regions.
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Among its many side effects, the COVID-19 pandemic left several positive results. This article talks about one of the main positive effects in the post-pandemic period: the adoption of telemedicine and telehealth, two related disciplines that were already present in several Latin American countries, but which in the past two years came to be a solution for delivering medical care to patients. Factors such as social-distancing measures, the lack of knowledge about the virus at the beginning of the pandemic that led to strict protective measures being taken in hospitals and doctors' offices, restricting face-to-face care of patients to a bare minimum, and the rapid response of governments, health care institutions, payers, and professionals, provided the conditions that telemedicine and telehealth had needed for many years to flourish and occupy the predominant place they currently have in the global health ecosystem. All the benefits of remote patient care became clear at a time in world history that marked a turning point in the advancement of information and communication technologies for health. In this report we will look at the regulatory frameworks adopted during or since the COVID-19 pandemic from 2020 onward in Argentina. Spanish Language Translation https://doi.org/10.30953/tmt.v8.417 Este informe describe los marcos regulatorios adoptados durante y desde la pandemia de COVID-19 a partir de 2020 en Argentina, así como el impacto de estas disciplinas y cómo se relacionan con la expansión de la telemedicina y la telesalud en el sector sanitario de la región. Entre muchos de sus efectos inesperados la pan-demia de COVID-19 dejó varios saldos positivos. Este artículo habla acerca de uno de los principales efectos positivos en la post pandemia: la adopción de la telemedicina y la telesalud, dos disciplinas relacionadas que ya estaban presentes en varios países de Latinoamérica, pero que en los últimos dos años se revelaron como la solución para hacer llegar la atención médica a los pacientes. Factores como las medidas de distanciamiento social, el desconocimiento sobre el virus al comienzo de la pandemia que obligó a tomar medidas estrictas de protección a hospitales y consultorios médicos, restringiendo la atención presencial de pacientes al mínimo indispensable y la rápida respuesta de gobiernos, instituciones sanitarias, pagadores y profesionales, posibil-itaron el impulso que desde hacía muchos años precisaba la telemedicina y la telesalud para ocupar el lugar preponderante que actualmente está ocupando en el ecosistema sanitario mundial. Todos los beneficios de la atención remota de pacientes quedaron en evidencia en un momento de la historia del mundo que representa un punto de inflexión en el avance de las tecnologías de la información y la comunicación para la salud. En este reporte veremos cuáles fueron los marcos regulatorios adoptados durante o con posterioridad a la pandemia de Covid-19 a partir de 2020 hasta la fecha en Argentina.
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Background: The literature supporting telehealth management is growing accelerated by the COVID-pandemic. We hypothesize that there are risks of adverse events associated with telehealth interventions. Methods: A review of PubMed (including MEDLINE), Embase, ISI (Web of Science), VHL/GHL, Scopus, Science Direct, and PsycINFO was conducted for all adverse events associated with telehealth from January 1, 1960 to March 1, 2021. This systematic review and meta-analyses were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Of 5,144 citations 78 published studies met criteria for quality evaluation and underwent full text ion including the qualitative synthesis. Of the 78 included studies 8 were included in the quantitative synthesis resulting in 2 meta-analyses. The results of the meta-analysis suggest that monitoring patients using telehealth techniques is associated with 40% lower mortality risks among patients suffering from heart failure, compared to those who received traditional care. The results of the random-effects meta-analysis showed the pooled relative risk of mortality to be 0.60, indicating that patients that underwent telemonitoring had a lower mortality risk compared with the patients that underwent usual care. Among patients with heart implants, patients who received telemonitoring had a 35% lower mortality risk compared to patients receiving traditional care. Conclusions: While RCTs of telehealth interventions demonstrate enhanced patient outcomes in a number of studies and pave the way to evidence-based practice, the heterogeneity of the research questions suggest an important need for more complementary studies with consistent outcome assessments.
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Introduction: With the onset of the COVID-19 pandemic in 2020, the utilization of telemedicine now offered an alternative diagnostic and treatment resource to providers in many areas of medicine including oncology and cancer genetics. This care option paired with genetic testing labs' ability to send saliva-based DNA collection kits to patients, enabled our community hospital in Detroit to offer diagnostic testing without the patient coming to a healthcare setting for a host of reasons. Social determinants of health have been found to influence success with telehealth, and this study sought to analyze how successful telehealth cancer genetics care was throughout the Detroit Metro area. Methods: Patient demographics for in person visits six months before COVID were analyzed, and then compared with demographics of patients during the 2020-2021 pandemic period where visits were telehealth. Results: Pre-pandemic there were , 192 unique patients seen in person with the top three cities patients were from were Detroit (12.1%), Clinton Township (8.3%), and Saint Clair Shores (10.4%). During the pandemic, with telehealth as the major modality, the top three cities were Macomb (7.2%), Detroit (7%), and Clinton Township (7%). Detroit is in Wayne County, while St.Clair Shores and Clinton Township are in Macomb County. Per the US Census Bureau Macomb county has a median income of $64,641 and Wayne county has a median income of $49,359, and poverty level in Macomb county is 9.2% versus in Wayne the level is 20%. Conclusions: This paper outlines the challenges of initiating a telemedicine program in an urban community area and highlights the benefits of a concierge service in serving cancer patients who may have economic and historically poor perceived technologic abilities.
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The purpose of this study was to investigate the effects of a "human immersion model” (HIM) in improving psychological well-being in caregivers of patients with acquired brain injury (ABI) during the Omicron wave in Italy. Fifteen subjects affected by ABI, who attended our intensive neurorehabilitation unit from January to March 2022 and their caregivers were submitted to the HIM. This novel approach consisted of "real” long-lasting meetings between the patients and their careers in a hospital setting (1–72 h meeting per week for 8 weeks). Each ABI caregiver was assessed through the administration of a short psychometric battery before starting the first immersion session with their family member and at the end of the HIM. We found significant changes in the caregivers' scores analyzed for anxiety, as per SAS (p < 0.0007, d = 1.02), burden and stress (ZBI-22;p < 0.001, d = 0.65), and emotive intelligence (TEIQue-SF;p < 0.0007, d = 0.82). Our data suggest that the HIM may be useful to promote ABI caregivers' psycho-emotional well-being in the context of critical periods such as the COVID-19 pandemic.
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COVID-19 prediction models are highly welcome and necessary for authorities to make informed decisions. Traditional models, which were used in the past, were unable to reliably estimate death rates due to procedural flaws. The genetic algorithm in association with an artificial neural network (GA-ANN) is one of the suitable blended AI strategies that can foretell more correctly by resolving this difficult COVID-19 phenomena. The genetic algorithm is used to simultaneously optimise all of the ANN parameters. In this work, GA-ANN and ANN models were performed by applying historical daily data from sick, recovered, and dead people in India. The performance of the designed hybrid GA-ANN model is validated by comparing it to the standard ANN and MLR approach. It was determined that the GA-ANN model outperformed the ANN model. When compared to previous examined models for predicting mortality rates in India, the hypothesized hybrid GA-ANN model is the most competent. This hybrid AI (GA-ANN) model is suggested for the prediction due to reasonably better performance and ease of implementation.
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When The Learning Center, a consumer health library at a cancer center, closed its doors in March 2020 due to the COVID-19 pandemic, there was not a robust system of virtual outreach in place. Staff decided to implement a chat/SMS service as one way to reach patrons during the library's 16-month shutdown, but usage numbers were low. A variety of factors can affect use and complicate success, and quantitative measures may not be the sole factor in evaluating a new service and whether it should continue. This article will talk about service implementation, challenges and context, patron and staff satisfaction, and lessons learned from the process.
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Objective: The COVID-19 pandemic posed unprecedented leadership challenges to health care organizations worldwide, especially those on the journey to high reliability. The objective of this pilot quality improvement initiative was to describe the experiences of medical center leaders continuing along the journey to high reliability during the pandemic. Methods: A convenience sample of Veterans Health Administration medical center directors at facilities that had initiated the journey to high reliability prior to or during the COVID-19 pandemic were asked to complete a confidential survey to explore the challenges experienced and lessons learned. Results: Of the 35 potential participants, 15 completed the confidential web-based survey. Five major themes emerged from participants' responses: (1) managing competing priorities, (2) staying committed, (3) adapting and overcoming, (4) prioritizing competing demands, and (5) maintaining momentum. Conclusion: This pilot quality improvement initiative provides some insight into the challenges experienced and lessons learned during the COVID-19 pandemic to help inform health care leaders' responses during crises they may encounter along the journey to becoming a high reliability organization.
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Objective Well-child visits and immunizations among children in the U.S. declined at the pandemic's onset and vulnerable populations have been disproportionately affected. This pilot project tested an innovative mechanism to use chatbots to engage caregivers in evidence-based preventive care for children. Design We used artificial intelligence (AI)-enabled chatbots to personalize messages and facilitate appointment scheduling over a five-month period. Chatbots introduced a novel way to connect vulnerable populations to care and challenged traditional convention of provider-patient engagement. Setting The pilot study was conducted at a Community Health Center in Chicago, Illinois that serves roughly 10,500 children, and 82% of patients are racial and/or ethnic minorities. Participants We targeted outreach to 250 English and Spanish-speaking families with children 0-17 years of age for proactive outreach using chatbots promoting well-child visit completion and up-to-date immunization status;moreover, a special emphasis was placed on the 0-2 age group as the first two years represent a critical time for primary prevention of vaccine-preventable diseases. Interventions The intervention focused on pre-visit engagement by launching an AI-enabled chatbot to deliver personalized messages and facilitate appointment scheduling via mobile devices. CHEC-UP also provided evidence-based anticipatory guidance prior to an appointment. Coaching in preparation for the visit with trusted information has the potential to educate, improve confidence and promote shared decisions between the parent and provider. Patient experience was measured via surveys deployed via the chatbot. Main Outcome Measures & Results Chatbots facilitated a relative increase in well-child visits and immunizations by 27% in the intervention group. Well-child visits and immunizations in the intervention group increased 13% compared to the control group. Survey results and patient interviews indicated a high level of patient satisfaction using the chatbot. In addition to a favorable perception of the chatbots, patients also identified future use cases for chatbots. Conclusions Engaging patients with chatbots improved vaccination and well-child uptake. Patients were highly satisfied with chatbot engagement. By engaging patients and caregivers, chatbots present the potential to proactively engage patients in care and optimize vaccination uptake and realize one of societies' greatest public health achievements: decreasing the spread of communicable diseases.
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Background: Digital health tools to bridge gaps in managing infectious pandemics was a proposition grounded until recently more in the hypothetical than in reality. The last two years have exposed the extraordinary global need for robust digital solutions. Objective: The objective of this study was to determine the ability of remote patient monitoring (RPM) during the COVID-19 pandemic to improve clinical outcomes and assure continuity of care in patients with asthma. Methods and Findings: Design: The intervention combined health coaching telephone calls and remote telemonitoring. Participants: 102 patients with asthma were enrolled in a telemonitoring protocol at the beginning of the COVID-19 pandemic in the United States. Setting: A private, university affiliated, outpatient clinical adult and pediatric allergy/immunology and pulmonary practice. Intervention: Patients were enrolled with the primary rationale of maintaining continuity of care in the face of uncertain clinical care options. Enrollment and data collection proceeded in a fashion to allow detailed retrospective analysis. Telemonitoring included a pulse oximeter linked to a smart phone using the software platform Plan-it Med (PIM)®. A healthcare professional monitored data daily, and patients were contacted by providers due to vital sign abnormalities and treatment plan alterations. Patients were encouraged to remain on the platform daily during the first three months of the pandemic. After respiratory and or clinical stability was achieved and clinic visit opportunities were resumed, patients were encouraged to maintain engagement with the platform but were not expected to use the platform daily. Main Outcome measures: Asthma Control Test (ACT) scores were recorded before and after 6 months. Paired Wilcoxon signed-rank tests (dependent groups, before vs. after) and Wilcoxon rank-sum (Mann-Whitney) tests were performed for unpaired results (independent groups, RPM vs. Control). Results: 19 of 102 patients had physiological abnormalities detected (18.6%). Eight of these 19 patients had actionable changes in prescription regimens based on RPM findings (42.1%). In patients utilizing RPM, there was a reported decrease in shortness of breath episodes and a decreased need for rescue inhalers/nebulizer medications (P=0.005). Daily engagement in the first three months of the protocol was 61%. In a subset analysis, 48 study participants (47.1%) chose to continue to actively use the program for at least 14 months. 54 RPM patients were 99.1% compliant with RPM after 110 patient months. Of the patients that chose to discontinue the RPM program the reasons included: (1) symptom alleviation (41.7%);(2) out-of-pocket costs to patients (38.9%), and (3) difficulty using the RPM program (16.7%). Conclusions: A novel RPM technology positively impacted continuity of care, asthma outcomes, quality of life, and self-care.
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The healthcare industry has already been burdened by longstanding trends like aging populations, provider burnout, and patient dissatisfaction. Healthcare burnout has increased significantly during the pandemic. Many factors are putting strain on the industry: expanding healthcare roles, squeeze in reimbursements, competition for patient volume, shifts in the delivery of care, and a shortage of providers and staff. These factors have contributed to the unprecedented challenge forcing healthcare organizations to rethink established norms and operational best practices. While new technologies have promised significant clinical and operational benefits for healthcare organizations, COVID-19 has turned them from nice-to-haves to imperatives. This session will discuss how today's workforce crisis can be addressed through new models of care such as telehealth. Objectives: Discuss the business process and business applications revolution Explain the experience revolution Describe the impact of new models of care on the clinical workforce
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Telemedicine's growth during the COVID-19 pandemic exposed digital and health disparities in U.S. communities. Public health advocates suggest disparities in healthcare access may be mitigated through free or low-cost broadband. However, prior research shows that many factors influence patient adoption of information technologies;therefore, increasing access to broadband alone is insufficient. This paper advances a patient-centered model of telemedicine (TM) adoption supported by qualitative interview data. The model illustrates that patient adoption of TM is driven by a complex sociotechnical system comprised of technology factors, structural factors underlying the provider's provision of TM, and individual patient factors. Findings highlight the importance of the physical place of the TM visit, the need for experienced TM healthcare workers and technology support for patients, the impact of provider-mandated technology on task-technology fit (TTF), and the strength of the patient-provider relationship. These factors affect patient perceptions of TTF and ultimately TM adoption.
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Dermatology is facing a worsening scarcity of providers, especially since the onset of the COVID-19 pandemic. With lengthening waiting periods for skin cancer screening examinations, there is a distinct need for alternatives to in-person evaluation. Delayed diagnosis is associated with poorer outcomes, especially in melanoma. Teledermatology has the potential to prevent the increased morbidity and mortality associated with late-stage diagnosis, especially when utilized with dermoscopy. In the literature, this novel field of "teledermoscopy” has exhibited accuracy and reliability comparable to face-to-face visits and is a promising alternative intervention for those who require triaging or for patients who are unable to access in-person care (rural, underserved populations). Although the early data is promising, formal guidelines for acquisition and interpretation of dermatoscopic images need to be established before wider implementation is possible. With standardization, use at-home or in in primary care offices will with such standardization, may relieve some of the pressure on an overburdened dermatologic care system and help patients who require urgent care to be seen more expediently.
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This article discusses the penetration of telemedicine in Latin America in relation to its implementation by hospitals in the region, considering key Latin American hospital markets, including Argentina, Brazil, Chile, Colombia, Mexico, and Peru. It gives an overview of the hospitals, the challenges they face in implementing telemedicine and telehealth services in each country, with a characterization of the various health systems, and presents telemedicine as an aid to the shortage of doctors and specialists in remote or hard-to-reach areas. It discusses the anticipated effects on patients and providers, and the main challenges for implementation. To prepare the report, interviews were held with specialists, who spoke about some of the major initiatives in the region. Lastly, it offers recommendations based on market intelligence gleaned from Global Health Intelligence data. Spanish language translation Este artículo es el primero de una serie que analizará la penetración de la telemedicina en América Latina en relación con su implantación por parte de los hospitales de la región. Los principales mercados hospitalarios latinoamericanos estudiados incluyen Argentina, Brasil, Chile, Colombia, México y Perú. Se presenta un panorama general de los hospitales, los desafíos a los que se enfrentan para la implementación de servicios de telemedicina y telesalud, caracterizando los distintos sistemas de salud. Se presenta la telemedicina como un aporte al problema de escasez de médicos y especialistas en zonas remotas o de difícil acceso. Además de la bibliografía publicada, se incluyen las perspectivas de especialistas con el fin de ofrecer una visión del éxito y los desafíos de las principales iniciativas en la región. Asimismo, el autor ofrece recomendaciones basadas en la inteligencia de mercado obtenida de los datos de Global Health Intelligence
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The study identifies characteristics of the explosive implementation and scale of telehealth use in the first year of COVID-19 pandemic - forever changing traditional healthcare practices and patient access in the United States. To view the article, please visit DOI https://doi.org/10.30953/tmt.v6.280 The award selection is based on the number of online views, article downloads, citations, and market impact. Authors and affiliations appear below: Francis X. Campion, MITRE Corporation;Atrius Health;and Harvard Medical School Stephen Ommen, Mayo Clinic Helayne Sweet, MITRE Corporation Nilay Shah, Mayo Clinic Barbra Rabson, Massachusetts Health Quality Partners Nick Dougherty, Allways Heath Partners Jennifer Goldsack, Digital Medical Society Peter Sylvester, MITRE Corporation Karen Jones, MITRE Corporation Aaron Burgman, MITRE Corporation Nathalie McIntosh, Massachusetts Health Quality Partners Lindsey Sangaralingham, Mayo Clinic David Jiang, Mayo Clinic Jeffrey McGinn, Change Healthcare Ricardo Rojas, Mayo Clinic Tim Suther, Change Healthcare Brian Anderson, MITRE Corporation John Halamka, Mayo Clinic (Dr Halamka is editors-in-chief of the THMT journal) Congratulations, authors!
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The COVID pandemic exacerbated feeling of isolation for students in George Mason University's (GMU) Health Informatics Program and challenged their interactions in many of the program's online classes. This study tested ways to improve the experiences of students and faculty with online courses. Twentytwo undergraduate students enrolled in an 8-week Electronic Health Record Configuration and Data Analysis (HAP 464) course participated in the study. Three changes were made to the structure of the course. First, the course was taught as a "flipped" online course;second, students were required to collaborate on assignments (not exams), third, the instructor trained peer-instructors one on one, and these instructors taught the rest of the students in small group sessions. The results indicated that interaction among the students increased: 75% of students were talking between 80% to 100% of class time. The classes were intensely interactive, unlike traditional class lectures. All 22 students received a grade of B or better, indicating that intense online interaction did not reduce the rigor of the training.
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This narative challenges readers to discuss a diagnosis of a suspicious lesion during a telemedicine consultation in the era of COVID-19.
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The COVID-19 pandemic had an immediate and enduring impact on society at-large and specifically on health administration education. Initially, the priority was to survive the pandemic by abandoning all levels of normalcy, and then, rather quickly, it shifted to finding new ways to maintain some level of normalcy as the higher education community transitioned to remote and hybrid modalities. The effects of this shift on health administration students were captured by Louis et al. (2021), and similar effects have been captured on health administration faculty as well (Brooks et al., 2021). But, as we have adapted to new ways of living during a pandemic, other societal forces and phenomena have begun to emerge that may prove to have durable effects on health administration education for decades to come. The following is the result of a discussion of a brain trust of health administration faculty, representing various health administration program levels (undergraduate, graduate, and executive) from various regions of the United States, who have enumerated areas of concern (and opportunity) for health administration education over the next 10 years. The topics discussed include (a) course delivery and modali ties;(b) diversity, equity, inclusion and justice;(c) wellness and well-being;and (d) the evolving professional field of health administration in an effort to understand what the future may hold for health administration education.
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Employee satisfaction has been shown to affect productivity and turnover among faculty in higher education. The COVID-19 pandemic has required significant organizational changes in higher education, including hiring freezes, furloughs, and a rapid move to online teaching. Little is known about the effects of these changes on health administration faculty. Therefore, the current study utilizes data from a national survey of health administration faculty conducted in 2018 and 2021 to perform three analyses: quantification of the proportion of faculty respondents experiencing furloughs or whose depart ments implemented a hiring freeze brought upon by the pandemic;changes in career satisfaction and employment perceptions between the years 2018 and 2021;and a cross-sectional analysis of the relationship between furloughs and/ or hiring freezes and 2021 career satisfaction and employment perceptions. Overall, 17.9% experienced a furlough and 81.4% indicated their department had a hiring freeze. We observed no significant changes in career satisfaction or employment perceptions from 2018 to 2021. However, receipt of furloughs was negatively associated with multiple indicators of career satisfaction and employment perceptions. The results of this study will be of interest to health administration program administrators and faculty as well as leaders in higher education who would benefit from understanding the impact of the pandemic on faculty more broadly.