Tele-Medicine in a Satellite Facility
Telemedicine is an old concept but new technology that enables a healthcare provider at one location to provide basic healthcare services such as diagnosis, intra-operative assistance, and medical consultation to patients, physicians or paramedical staff in a satellite or remote facility. Most researchers and scientist believe that there is no substitute for patient-doctor face to face interaction; however, telemedicine could be used to manage a few medical cases efficiently and remotely. In first prototype of telemedicine was introduced in the 1980’s in the form of slow-scan images, facsimile machine or telephone (Hsieh, & Hsu, 2012).The mode of communications was through the biomedical signal transmission of the patient with the help of the landlines through the Integrated Services Digital Network (ISDN) or Public Switched Telephony Network (PSTN). Most of the conventional telemedicine applications had certain limitations owing to fixed communication and conventional handsets. Thus, based on the concept of fixed communication networks, researchers focused on the wireless communication- for telemedicine based on satellite communications (Hsieh, & Hsu, 2012).
Telemedicine is associated with skilled manpower, dedicated web-based links, and expensive equipment. The short-range Radio Frequency (RF) and the wireless Local Area Networks (LANs) cannot be used for telemedicine, especially ambulatory applications. Based on the aforementioned limitations (Hsieh, & Hsu, 2012).Third Generation network (3G) or Global System for Mobile (GSM) communication platforms are required for a full-service telemedicine system. Through this advanced communication system, patients from a satellite location can be monitored regularly through the mobile without the hassles of travelling to the hospital. Physicians can also access patient’s medical data while travelling or at home without the hassles of a face-to-face intervention. Telemedicine would also reduce the burden on hospitals with respect to number of patients and emergency care services (Hsieh, & Hsu, 2012).
In a vast expansive population and high population per physician (approx. 2000 patients per physicians) and a high population based in remote locations, the concept of telemedicine has gained significant importance (Hsieh, & Hsu, 2012).The key areas of medicine that would benefit from telemedicine would include cardiology, nephrology, infectious disease, and surgery. Due to the high rate of incidence of chronic health conditions such as hypertension, obesity, and cardiovascular disease, the concept of telemedicine is justified. Furthermore, through the help of telemedicine, many patients can be saved from life threatening conditions at remote locations with the help of telemedicine (Hsieh, & Hsu, 2012).
Federal mandated requirements
Based on the current regulatory requirements for healthcare IT-based delivery systems, the FDA and EMEA have set down stringent rules and regulations which are as follows: (a) Patient privacy and confidentiality should be maintained as per Health Insurance Portability and Accountability Act (HIPA) at all time of service (b) Security features should safeguard all parties involved in the platform (c) Patient should have no harm due to the technology involved including mental or psychological (d) A standard protocol for the tele-ECG platform should be approved, regulated, and followed during all service hours (e) The FDA and EMEA has also set minimum educational qualifications and experience of all staff included in the delivery of tele-ECG system (f) The regulatory agencies also require a 24*7 support team for all health IT related services in order to cope with a major breakdown or backup services (g) The FDA has also made specific mandates on the confidentiality of data and cloud storage facilities for health IT systems in order to cope with a complete breakdown of the system, and lastly (h) The health authorities require every agency involved in health IT delivery system to maintain patient informed consent directory including any discrepancies involved before, during, or after the service provision. Thus, the concept of telemedicine is based on a large number of regulatory requirements that should be followed by the interdisciplinary team (Vivek & Vikrant 2016).
Interdisciplinary Team Members
The project lead would have to arrange for key stakeholders that would comprise of interdisciplinary team members who would cater to the requirements of the Tele-ECG services. The key members would include the Information Technology Administrator, Head Nurse, Head Physician, Project Co-ordinator, and Technology Partner. Each member would be part of the core team to address the service delivery of the tele-ECG based platform. The IT administrator would hold a Master’s degree in Biomedical Engineering with minimum of 5 years in healthcare IT. The Head physician would have 10+ years of experience in both healthcare IT and hospital administration. The physician would have an MD degree in general medicine. The project coordinator should have an MBA with 5 years of experience in healthcare IT. The technology partner should have 15+ years of experience in IT-based healthcare platforms and should be familiar with cross-platform systems excluding ECG.
Role of Interdisciplinary Team
The interdisciplinary team would have a comprehensive role in the conceptualizing and management of the entire telemedicine project. The IT administrator along with the technology partner would coordinate for all platform related queries. The physician would handle all healthcare related activities including patient related services and medical emergencies. The project coordinator would assess and overview the various teams involved in the function of the telemedicine platform. The head nurse would play a closer role with patients and physicians to cater to the needs of patient education, healthcare IT education, and physician interaction.
The importance of Interdisciplinary Team
The interdisciplinary team would act as the backbone for the entire platform including patient and healthcare delivery systems. The entire support system for the telemedicine framework is dependent on the interdisciplinary team (Vivek & Vikrant 2016).
Importance of Interoperability to Healthcare Delivery
The inclusion of the telemedicine system along with trained and experienced staff would enhance the overall healthcare delivery. The interoperability of the key system would help healthcare staff to reciprocate and provide faster, accurate, and improvised delivery services. For example, tele-ECG services would enhance emergency care delivery services and also reduce the rate of time and errors in processing vital information (Fatehi, et al. 2015). The facility of tele-ECG at the remote facility would also help healthcare professionals to render quick diagnosis and process necessary information for treatment. The importance of interoperability thus plays a key role in the overall healthcare delivery (Singh, et al. 2014).
Importance of Nursing Terminology in Tele-ECG
Nursing professional would play a key role in the development and management of tele-ECG services (Fatehi, et al. 2015). However, there is regulatory mandate on the requirement for the provision of nursing terminology on all aspects of tele-ECG services. It is important for nurses to understand the various concepts of tele-ECG including conceptualizing, operations, and regulation of all services (Singh, et al. 2014). Some of the basic terminology that should be processed by the technology partner and IT administrator include (a) Cloud-based operating system (b) Patient data information monitoring and capture (c) Emergency contact information and regulation (d) Patient confidentiality and privacy over cross platforms (d) User access and restricted service areas (e) Healthcare IT terminology such as user access, data authentication, server, hyperlink, error codes, encrypted information, and data locks and (f) Nurse-Physician-Patient communication network protocols (Fatehi, et al. 2015).
Currently approved federal regulatory requirements
The federal regulatory agencies have approved three key requirements associated with telemedicine, specific to tele-ECG which are as follows: (a) Cloud-based storage services for all health IT systems with encrypted information (b) Patient privacy and confidentiality through secure access and encrypted services over the system and (c) Data backup services in the event of natural calamity or untoward emergency services including data lock-in. All the three approved components play a key role in healthcare information technology. Since most IT-related services are prone to vulnerable to many security threats and a potential for data theft or loss, the inclusion and approval of cloud-based secure services provides an enhanced, optimized, and structured process (Ibaida, Khalil, & Al-Shammary 2010). The second component of patient privacy and confidentiality is a critical factor in most IT-based healthcare delivery systems. Since most systems are vulnerable for patient data theft, the approval of the inclusion of data encryption and restricted access would enhance the security features of the tele-ECG services (Hsieh, & Hsu, 2012). It is essential to have all data stored in a back-up or retrieval system in healthcare IT in order to store and access vital information that may have been corrupted or lost. Thus, the inclusion and approval of data lock-in and retrieval by the federal would improve the delivery of the tele-ECG services (Singh, et al. 2014).
Two components of the new system approved by the federal regulatory agency
Based on current evidence and the newly formulated and regulated federal requirements, two new components of the tele-ECG system have been approved which include (a) Restricted access by intervening physician and nurse to patient information and (b) Permission to provide subsidized costs to both Medicare and Medicaid patients who would utilize remote (telemedicine) services (Singh, et al. 2014).
Potential Security Threats of Tele-ECG and Tele-Radiology
The tele-ECG platform provides a robust and secure system for patient privacy and confidentiality. There are a total of 4 stage security measures taken in order to provide patient data security and confidentiality (Fatehi, et al. 2015). The first step involves encryption of data from an ECG receiver in the physician’s office from the satellite facility which generates files such as SCP-ECG, XML-ECG or DICOM-ECG. Some files may also be derived from ambulatory services (based in remote locations) to the physician’s office. The second stage involves a encrypted ECG decoding program that comprises of extraction of ECG-based waveform data into patient-centric ECG files at the physician’s office. The third stage involves a software procession program for all waveform files within the system into low noise/articraft files in order for faster and improved processing, The same files are viewed and evaluated by the physician in-charge in order to extrapolate data and process a series of recommendations. This step is the essence of telemedicine and remote data transfer facility. The fourth and final stage includes the generation of the ECG report which is based on the data encryption and data verification program. Both programs are known to enhance quality and safeguard patient information as per regulatory mandate laid by the regulatory agencies. The project lead would be in-charge of monitoring all aspects of the program; however, the physician would be the ultimate personnel to authorize users and authenticate data to generate and distribute final date. The software would also have a separate secure database of clinical cases (captured data from patients) which would be used as e-material for doctor education. However, no patient information would be revealed throughout the process. The software would also have a dedicated tab for clinician’s queries regarding e-learning material that would be discussed on social groups. Based on current evidence and regulatory norms, all patient data would be kept confidential and private which is a mandate by regulatory norms. Thus, patient confidentiality and privacy would be maintained based on a four-stage security protocol (Fatehi, et al. 2015).
Data Integrity and Risk Mitigation
The tele-ECG platform would be coupled with 3-layer protection and 2-layer anti-theft protection. The 3-lyaer protection comprises of secure access and data safety for all users associated with the system. Only authorized personnel would be allowed to access without information. (Ibaida, Khalil, & Al-Shammary 2010). The physician in-charge would have most of the access; however, the ability to share or disclose patient information including identity is restricted and would not be disclosed until emergency protocols are implied. The data stored within the system is secured with multiple security features with core access only to the IT administrator. (Ibaida, Khalil, & Al-Shammary 2010). The security of cloud storage is covered by a risk mitigation strategy wherein, upon loss of data or theft of data, all patient-centric information would be deleted. Furthermore, patient associated information including images, scanned records, and photocopies would be sealed and destroyed using artificial intelligence and computer-based data analytics (Ibaida, Khalil, & Al-Shammary 2010).
Implications of current technological applications of Tele-Medicine services
Telemedicine has been a new concept in developing nations such as India, however, the in the US, telemedicine has been practiced for over a decade (Fatehi, et al. 2015). Tele-medicine platys a critical role in the healthcare industry since it has many advantages over conventional healthcare delivery. Based on current evidence, tele-medicine is associated with many clinical and non-clinical applications that are known to improve and enhance the overall performance of healthcare staff along with faster and improved delivery. Since telemedicine is associated with easy access and real-time monitoring physicians can cater to more patients without the inconvenience of travel and time needed as observed in an in-clinic setting.
Non-clinical Applications of Tele-ECG and Tele-Radiology in Delivery of Patient Care
The most important factor of telemedicine is the ease of use, faster healthcare service, and improvised healthcare systems. Some of the key non-clinical applications include (a) Reduction in patient burden (b) Improved healthcare delivery (c) Improved emergency care services (d) reduced mortality and morbidity on acute care conditions (Singh, et al. 2014). (e) Low healthcare costs associated with acute care (d) Improvised nursing interventions (f) Low risk of medical errors (g) Increased patient satisfaction and (h) Improved health outcomes (Singh, et al. 2014). The most fundamental non-clinical application is reduction in patient admission and increase in quality of care (Hsieh, & Hsu, 2012). Based on current evidence, the non-clinical applications of tele-medicine is inclined towards the remote facilities. The non-clinical applications may include the reduced burden of patient delivery and handling during an emergencies (Singh, et al. 2014). The faster delivery and monitoring would provide sufficient inventory and resources to healthcare staff to cater to only necessary and critical cases. The inclusion of tele-medicine services would also reduce burn-out rates among nursing staff in order to meet the needs of an increasing patient population (Hsieh, & Hsu, 2012).
Clinical Applications of Tele-ECG and Tele-Radiology in Delivery of Patient Care
Tele-ECG has gained significant importance in the field of emergency care and cardiology. In the case of cardiology, physicians could use Tele-ECG to assess patients with acute myocardial infarction based in a remote location. Physicians could assist patients immediate care and medications; thus saving the time interval for diagnosis, travel, and treatment. The concept of Tele-ECG is also widely accepted in emergency care in the accident or trauma cases. Physicians could access the patient’s vital including ECG and recommend basic medical care and facilities to the doctor based in a remote area (Singh, et al. 2014). Based on current evidence, tele-ECG services would allow real-time monitoring of patients for both physician and nursing staff in critical and emergency services. Clinical monitoring, real-time diagnosis and treatment is possible with the help of tele-ECG services. It is a key milestone in the health industry which provides a platform for all healthcare staff to provide enhanced, improved, and error-free healthcare services (Hsieh, & Hsu, 2012). Since tele-ECG includes mobile-based clinical monitoring, patients can provide feedback on their real-time health condition without a visit to the physician from a remote locality. This process saves the travel cost and time along with speedy and improved healthcare delivery (Singh, et al. 2014).
Conclusion
Although telemedicine is an old concept but is current applications and usability has surpassed conventional nursing interventions. As a project lead of telemedicine with an interest on tele-ECG, ii is an overwhelming concept to be introduced and implemented in different areas of medicine. Although telemedicine is associated with high cost and skilled manpower, its clinical and non-clinical applications provide a comprehensive and practical approach to the field of nursing and medicine. Telemedicine has been regulated by the worlds most powerful and secure regulatory agencies such as the FDA and EMEA which provide a regular updates on the current requirements for Tele-ECG. The most critical aspect of telemedicine is patient data confidentiality and privacy which is also regulated by the FDA and EMEA. The current nursing. The key areas of medicine that would benefit from telemedicine would include cardiology, nephrology, infectious disease, and surgery. Furthermore, through the implementation of telemedicine, healthcare delivery would improve along with patient safety and integrity (Hsieh, & Hsu, 2012).
References
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Hsieh, J., & Hsu, M.-W. (2012). A cloud computing based 12-lead ECG telemedicine service. BMC Medical Informatics and Decision Making, 12, 77.
Ibaida A, Khalil I, Al-Shammary D. (2010). Embedding patients confidential data in ECG signal for healthcare information systems. Conf Proc IEEE Eng Med Biol Soc. 2010;2010:3891-4.
Singh, M., Agarwal, A., Sinha, V., Manoj Kumar, R., Jaiswal, N., Jindal, I, Kumar, M. (2014). Application of Handheld Tele-ECG for Health Care Delivery in Rural India. International Journal of Telemedicine and Applications, 2014, 981806.
Vivek C & Vikrant K. (2016). Tele-ECG and 24-hour physician support over telephone for rural doctors can help early treatment of acute myocardial infarction in rural areas. J Telemed Telecare. 2016 Apr;22(3):203-6
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