LEME
CINE
EARCH
POSAL
RESEARCH PROPOSAL FOR TELEMEDICINE
Contents
BACKGROUND.......................................................................................................................................2
LITERATURE REVIEW..............................................................................................................................3
AIMS AND OBJECTIVES..........................................................................................................................4
METHODS..............................................................................................................................................6
REFERENCES........................................................................................................................................10
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RESEARCH PROPOSAL FOR TELEMEDICINE
BACKGROUND
When the physician and the patient are not physically present at the same location,
telemedicine assists in the interaction between the parties ensuring necessary services are
delivered to the patient. The three essential components involved are; healthcare services
provided on-site, healthcare services provided off-site and through computers without any
direct interaction between the parties. Modern technologies combined with enhanced
supply chain network have enabled it to deliver health care services to a large consumer
base in a shorter period of time. Telemedicine is a convenient tool especially for those who
are facing financial or time constraints. There is a potential to make healthcare services
more automatized and systematic. Though the research work that is ongoing in this sector is
in the early stages, it is still progressing. Lack of adequate resources and irregular resource
allocation has become a worldwide problem (AlDossary et el, 2017). Modern
communication and information technology tools have made providing such services easier
(Kamsu-Foguem et el, 2015). Hence, the innovation has the potential to positively impact
the efficiency and equity of health care services and enable the patients to specialist
expertise. This was not available or completely accessible earlier. Variations in diagnosis and
treatment across geographies can be reduced with this tool [13]. Many other studies have
also confirmed that this will reduce healthcare cost, reduce waiting time and increase
efficiency of resource utilization. For convenience, patients will use the advanced
technologies to get access to healthcare services.
Policymakers and insurers have resorted to telemedicine or telehealth to provide assistance
to patients in their homes as professionals look out for new ways to serve patients and
prevent the fast spread of the novel coronavirus. This style to care allows patients to
maintain social distancing, safeguard themselves against the virus and prevent
overcrowding at medical centres at time when many people are confined to their shelters.
Telemedicine allows patients to obtain medical care at a time that is convenient for both the
doctor and the patient. Telemedicine service providers could have lower overhead rates.
Allowing clinicians to cater to more patients, telemedicine will supplement their income.
Moving to online health care service platform will help avoid the risk of infections.
Eliminating the need for physical presence, the tool has enhanced the capacity of healthcare
providers. Apart from just providing telehealth through video conferencing, telemedicine
technologies will offer much more. Natural language processing can be used by clinicians to
take notes automatically. Specialists will prove useful during critical situations. The data
collected by healthcare instruments can be fed to an Internet of Things (IoT) cloud platform.
The healthcare provider can then summarize it. This will then be sent to IoT systems used by
healthcare providers for patient management. The latest advancements in telemedicine
technologies include Artificial Intelligence (AI) which helps clinicians work in a more effective
manner. This tool equips patients with wearables and other remote patient tracking
resources. Also robots can deliver services to remote areas.
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RESEARCH PROPOSAL FOR TELEMEDICINE
LITERATURE REVIEW
On Demand telemedicine can disrupt the healthcare market by breaking regional barriers
and other human factors. However, it is to be understood that the system takes time to
create and quality check is the most important factor in Telemedicine. Wrong diagnosis or
treatment advice can be fatal and lead to loss of lives (Haleem et al., 2021. USA has created
a formidable system of telemedicine and so has India. Singapore also is at the forefront of
telemedicine (Haleem et al., 2021).
An important tool in telemedicine implementation is organizational barriers. The barriers don’t
accept any alterations within the health care model or an absence of a strategic plan or any
irregular monitoring of project. Project management is a vital tool. Imperfect management is
associated with a potential risk. Human barrier is the next important tool. Responsibility for
avoiding malpractice is a critical form of human barrier. Major ones among them are lack of
adequate knowledge about the patient, resistance posed by the employee, problems related
to licensing and absence of technical staff. Economic barrier is another type of barrier. Cost
related to equipment and software, training costs are examples of economic barriers.
Another barrier which plays a crucial role in telemedicine implementation is technical
barrier.
Different barriers have been observed during the studies conducted on
implementation. Lack of focus and non-introduction of telemedicine in the firm are the
issues that were observed when choice of implementation was taken at high level. The
conclusion is that telemedicine implementation often takes much time. In the absence of
high-level planning, it is meaningless to focus on other aspects of telemedicine. Insurance
and reimbursement are other issues in an organizational context. There is need for
additional data on finance to supply evidence to the insurance companies. This evidence is
related to the profitability of implementing telemedicine which causes reduction in upper
costs of medical aid. Users often struggle with privacy concerns and technology barriers and
a disconnect between doctors and patients. However, online appointments may be
conducted in suitable locations to help medical workers eliminate this issue. Health
providers got to uphold an equivalent privacy expectation as they might on-site. Doxy.me
which is an online program and similar other programs are using HIPPA-compliant
software which retain the confidentiality of appointments. Critical and sensitive information
such as history of the cases or diagnosis of the patient using video enable clinicians to
maintain physician-patient privilege.
According to an article in the Journal of Medical Systems, "To ensure privacy, both patient
and physician should take the virtual consultation in a quiet space with reduced background
noise." Doctors need to make a choice between making telehealth calls from their home or
from their clinic or from hospitals. Since scheduling online appointments may be challenging
and intimidating for some people, it is necessary that practitioners recreate the same
environment as traditional appointments as much as possible.
Chronic care management (CCM), complex chronic care management (CCCM) and principal
care management (PCM) have often proved as the most lucrative Medicare programs and
hold scope for the future. Hence, they should aim at providing this from 2022 onwards to
the patients.
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Licensing was not a big issue when telemedicine systems were formed for the 1 st time. This
is because most of them were operating within a single state. Nowadays, multiple practices
are being conducted across multiple states. As the scaling is being done at national level, a
barrier which is coming up is licensing. Another barrier which is more critical than licensure
is state regulations. State medical boards require than in-person consultation must occur
before any such telemedicine services can be provided. Barriers are also encountered with
regulatory agencies such as FDA (Food and drug administration). Some telemedicine
applications don’t cost a lot. Realistic methods are required for progress in this field.
Sometimes, providers tend to resist innovation on account of competition. Providers might
resist solutions to licensing barriers since there might be competition from telemedicine
network of a different state. When scaled nationally, this resistance increases. Since a ling
time, the sector has focussed on technology. However, the crucial factor in telemedicine
services is service. How services can be provided and how it can bring about a change in the
lives of people rather than some new piece of technology. Implementation several
technologies will result in huge data flows and not add any value to the process. Though few
areas have shown great progress in other areas there is lack of adequate research work or a
critical analysis of existing work to evaluate their value. For instance, implementation by
large players is not an issue, but more focus should be there on cost saving. Ut is becoming a
part of business planning in the industry. It is also progressing towards urban areas because
of recent trends. However, there is a need to focus on rural population as well.
Telemedicine networks are extending ICUs and stroke care capabilities, although many of
these networks are separate from typical telemedicine networks. Traditional health care
providers may not embrace mobile telehealth (mHealth) applications, which offer a lot of
promise.
To expand access to excellent treatment for all persons at the correct location and time
when it is required, the country requires ubiquitous, sufficient, and inexpensive broadband
to facilitate telehealth and health information exchange. This might increase access to care,
improve health outcomes, and save costs. However, there still a wide gap between rural and
other areas with respect to broadband access. Access is also essential for meeting the needs
of individuals and community as a whole in training and governance. Rural communities and
their development is impacted by the rise of public health problems. This is majorly on
account of poor access to health care services. Telehealth technology play a critical role in
assisting individuals and their health-care professionals in improving health management.
Some healthcare practitioners like telehealth because it allows them to see more patients in
the same amount of time while still being paid at the same rate as in-person treatment.
Even more than licensure, physician payment may be the most significant hurdle in
telehealth.
AIMS AND OBJECTIVES
Telemedicine will prove effective in reducing burden at hospitals and utilization of
resources. The total cost of the system will be reduced with implementation of
telemedicine. The tool will prove more effective in situation where the cost of
transportation is high. Also, when there is a gap in sensitivity of patients to online and
offline waiting time. The following questions are to be answered in the research:
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● Should there be implementation of telemedicine in hospitals?
● What impacts can implementation of telemedicine can have on the patient’s behaviour?
● What return can the healthcare providers expect?
The goal of this research is to find out how healthcare decision-makers should plan and
build the system. Patients are evenly divided and have the option of using either standard
offline or telemedicine services. In these three healthcare systems, the hospital's capacity
decision and patients' medical choices must be evaluated first. It is necessary to choose the
best strategy and service capacity by evaluating the overall expenditures of various
healthcare system types.
As more hospitals transition from fee-for-service to value-based payment models that
reward physicians for keeping costs low, telemedicine will become an increasingly
important tool in attaining that aim. Doctors want a convenient timing for interacting with
the patients, smartphones have become an essential good and there is availability of cheap
and faster internet services. Greater than 15 million Americans are using some form of
remote healthcare. The numbers are also expected to grow by 30% as per American
Telemedicine Association. However, implementation of telemedicine network necessitates
critical planning. ROI can be improved with better interaction levels between patient and
clinicians. Costs can also be improved by reduction of emergency room visits. During
planning and setting up of infrastructure for such a system, following queries are to be kept
in mind:
● A specific strategy to be used by the hospital to approach telemedicine? What is the
primary aim, does it involve only increasing access or increasing customer base, or to
improve outcome of such services for patients or to expand reach?
● Suitable telemedicine techniques to achieve the goal
● Identify the telemedicine practice's location of treatment (outpatient, inpatient, ER),
pain points and goals
● Create a framework to support the practise.
● Take the time to familiarise oneself with each specialty's operations, legal and regulatory
difficulties, and technological components of the profession — software and hardware,
training, and systems integration.
● Determine how telehealth providers will be compensated. Will you be able to do so with
the help of a grant? Reimbursement from the institution? Self-paying patients?
Contract? Or taxpayers, both public and private?
● Adapt to the regulatory and reimbursement environment in the state or states where
the organisation operates
Another important factor is whether to do it alone or enter into a partnership with an
already established company in the field. Availability of limited resource may push hospitals
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to enter into partnerships for addressing such issues, rather than burden. Demonstrations
and relationships with vendors may also assist an organisation better define what they want
to accomplish with a telehealth practise. If a hospital decides to cooperate, they should
thoroughly assess the capabilities of the various vendors.
The most common objectives for such a program are usually
● Improving patient outcomes
● Increasing patient engagement and satisfaction
● Improving patient convenience
● Providing remote and rural patients with access to care
● Improving leverage of limited physician resources
● Reducing cost of care delivery
● Reducing hospital readmissions
● Improving specialist efficiency
● Providing access to new specialties
● Providing 24/7 access to specialists
Reduction in overcrowding of emergency room, creation of more revenue and getting more
funding for doing clinical research are some of the other goals.
METHODS
1. The COVID-19 epidemic in India has proved the value of telemedicine in bolstering health-
care capacity. India is undergoing a digital transformation, spurred by rising smartphone and
internet usage. Smartphone and internet usage is on the rise, growing at 20 to 30% CAGR.
Even India's smartphone population might surpass that of the United States in the next few
years. Greater connection and cooperation and better access to information and services
are the benefits of digital adoption. While primary care networks and health and wellness
centres are being developed as part of Ayushman Bharat, the Telemedicine Guidelines 2020
present a chance to leapfrog and flip the healthcare delivery paradigm.
By empowering the patients and overall enhancement of user experience in the delivery
process will improve health seeking behaviour when considered in the long term.
When such services are taken up at a large scale at a national level, it would enhance usage
of electronic health records. Hence achieve the objectives specified in the National Digital
Health Blueprint and the parameters specified by Niti Aayog.
Human experts can leverage this opportunity and use the technology to their advantage.
The health professionals should use the same to their competitive advantage. Many
entrepreneurs and investors have turned telehealth into a viable company. India already has
more than 133 financed telehealth firms and 5,295 health tech startups, according to a
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recent research. 'Tele-ICU,' a technological concept that allows an intensivist to remotely
oversee ICU patients across various sites from a command centre rather than at the
patient's bedside, has also been popular during the epidemic. An intensivist may supervise
60-80 patients using Tele-ICU, compared to 10-12 patients previously, and use diagnostic
tools to enhance patient outcomes.
While primary care networks and health and wellness centres are being developed as part
of Ayushman Bharat, the Telemedicine Guidelines 2020 present a chance to leapfrog and
flip the healthcare delivery paradigm.
By empowering the patients and overall enhancement of user experience in the delivery
process will improve health seeking behaviour when considered in the long term.
Telemedicine has become a means of ‘forward triage,’. Triage refers to the order in which
the patients are provided service depending on the severeness of injuries or ailments. This
was observed specifically during the COVID-19 pandemic. Direct-to-consumer or on-demand
telemedicine will help in screening patients despite being in quarantine. This means of
Triage helps in maintaining patient oriented services ensuring protection of the patient and
the healthcare provider.
There has been positive changes in public health with implementation of telemedicine.
Along with facilitation of triage there has been rapid deployment of providers in large
numbers. Also, provision of services when there is an inability to meet demand by hospital
and healthcare centres. Healthcare information has been shared with not only infected but
also non-infected people during the pandemic via telemedicine. Till the pandemic, growth of
telemedicine has been slow. Video conferencing with doctors, any sort of digital
communication such as email or phones were almost non-existent. Rise of telemedicine can
be attributed to the following reasons:
Reason 1: Prepared for deployment
With improvements in technology, there has been developments in training methodology
and delivery of telemedicine services.
Benefit of such services in providing access has been witnessed by the American Healt
Network despite slow progress. 320 providers were trained and 3000 visits occurred, which
was a robust figure as per statistics of fourth quarter in 2019.
The shift from clinic-based visits to telemedicine was quick as COVID-19 forced offices to
shut down and made face-to-face contacts dangerous.
Our curriculum and platform, were ready to go. We increased trainings to meet demand and
expanded our platform to assist physicians and patients who now require a secure
environment in which to provide and receive care.
Preparation allowed us to make a swift decision that allowed us to continue providing
treatment using safe and well-developed technologies. The importance of investing in
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innovation cannot be overstated. COVID-19 shown that this is true for both general care and
acknowledged high-tech disciplines like neurosurgery.
Reason 2: Reimbursement for telemedicine
The blame often falls on rules of reimbursement for the slow implementation of
telemedicine. Till 2019, the Centers for Medicare and Medicaid Services (CMS) had not
initiated consultations on call or internet transactions.
COVID-19's cascading ramifications brought in yet another round of Emergency Orders.
Telemedicine consultations become chargeable or reimbursable transactions as a result of
one of these instructions. Medicare and Medicaid were the first to make this adjustment,
followed by private payers.
The recent change in public policy has given new life to the telemedicine seedling. It is now
well established for further growth in the industry with increasing participation of patients
and healthcare providers.
Reason 3: Doctor-patient relationships
The strongest motivation for providers has proved to be their patients, in a critical phase
such as the pandemic. This has helped them unify between themselves. Once telemedicine
proved to be the safest way to deliver healthcare, it enhanced engagement of healthcare
providers.
Experience or digital inclination were not barriers to acceptance of the optimum ways to
care for patients.
Patients were also motivated to try new technologies because of the necessity of
maintaining communication with their preferred practitioner. The doctor-patient connection
was filled with trust, which was reflected in the care delivery techniques.
The centrality of the doctor-patient interaction in telemedicine affected the largely good
outcomes recorded. The doctor and the patient are staring at each other during a video
appointment. The computer is no longer interfering with eye contact, allowing them to
concentrate on each other.
83 percent of patients who attempted video visits confirmed that they had a positive
experience.
1. Despite concerns regarding the quality of medicine supplied through devices before to
the pandemic, 96 percent of physicians said their patient visits were successful.
2. Impact: Telemedicine has been steadily gaining traction over the last five years, but its
use has surged in the months since the outbreak began. Virtual communication with a
healthcare professional eliminates the need for an individual to attend a hospital, urgent
care centre, or medical office in person, reducing their coronavirus exposure. Telehealth
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visits also helped to reduce overcrowding in emergency rooms and urgent care facilities by
focusing on severe COVID-19 patients.
Also, many regulatory barriers have been abolished to accelerate telehealth services during
the Covid-19 pandemic. This is the reason that there has been rapid growth of telemedicine
services. Parity in payment between telehealth and physical clinics has been one of the most
important changes related to telehealth. Many states in the United States formerly
mandated insurers to cover telehealth but did not require payment parity. Some
commercial payers and Medicaid programmes have established payment parity for
telemedicine for the duration of the pandemic, recognising the need for incentives.
The acceptance of telemedicine by patient and the professionals is essential; though both
parties are more comfortable with traditional form of physical encounters. They may be
unaware of the potential benefits or there might be a fear in the minds of the professionals
related to usage of computers. Also fear of job loss or that the amount of investment
required initially will be very high and beyond viable limits. Also, there is a concern that the
bedside presence of consulting physicians in local hospitals will decline (51, 57). Concerns
have also arised related to the probable phasing out of existing work methods with the
advent of modern technologies, there might be interruptions in the work process flow
which might affect the acceptance of this tool.
To achieve acceptable and meaningful acceptance of telemedicine systems in low-income
settings, designers must create systems that complement rather than disrupt established
work practises, as well as properly communicate them to practitioners.
CONCLUSION
Despite the benefits offered by telemedicine in the form of elimination of travel time and a
shorter waiting time, it might not be a suitable choice in few cases. For patients with
complicated diseases telemedicine services is not an effective tool since there is
requirement of understanding the ailments on a deeper level which is not possible in online
method.
Despite the enthusiasm for telemedicine, several reservations exist. Telehealth is controlled
by a jumble of state rules that might be difficult to decipher. Other possible problems
include the interoperability of electronic health records as well as privacy and security
concerns. Some doctors may be hesitant to conduct a virtual patient exam, provide a
diagnosis, or give a treatment plan without meeting with the patient in person. This might
limit when and how people utilise the services. There are also expenditures and obstacles
associated with technical advancements. Telehealth services need specialised software,
which necessitates additional training and maintenance. During a doctor-patient contact, if
either the programme or the hardware fails, the session stops without resolving the health
concern that provoked it. There are benefits and drawbacks to delivering telemedicine
services. Healthcare providers will not have much of a say in the matter for a long time.
Consumers are becoming to demand telemedicine services. There will be expectations of
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suitable telemedicine services from the healthcare provider and payment for the same via
insurance, similar to the way in which traditional services are paid for as they expect banks
deposit checks via mobile platforms without going into a brick-and-mortar facilities.
REFERENCES
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