What has been the biggest challenge to implementing telemedicine and telehealth across state lines quizlet?

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Terms in this set (96)

Which of the following best describes HIV telemedicine in the Pennsylvania prison system?

Telemedicine promotes continuity of care after release from prison.

In this single group, prospective study of a store-and-forward pediatric teledermatology mobile
application, which of the following was associated with increased user satisfaction?

Receipt of a prescription

Typically, the information retrieval workflows in electronic health records (EHR) are not oriented
around clinical conditions, forcing clinicians to retrieve relevant data from a variety of places in
the EHR. Thus, physicians must spend significant amounts of time retrieving and synthesizing
data from EHRs. Which of the following EHR features can help address this problem?

disease-specific dashboards

Both custom-designed, condition-specific dashboards and recommender systems can make
information retrieval from EHRs more efficient. Recommender systems analyze past search and
information retrieval patterns in EHRs to identify information that may be relevant to a clinician's
review of a patient case. Compared to dashboards, recommender systems:

may cause clinicians to miss important data.

You are an ER physician when a patient is brought in with life-threatening injuries from motor
vehicle accident involving a drunk driver. After the patient has been stabilized, your third year
medical student, who diligently obtained information about the accident from the EMTs, remarks
that the accident is 'all over the news.' You review the medical student's note and are concerned
that there is a risk that it could be used to re-identify the patient if released in the future even if
HIPAA identifiers are removed. What information is it most important for you to redact from the
note to protect patient privacy while preserving the value of the anonymized note for research?

The model of car the patient was driving

When conducting a breach risk assessment, what threshold must be assessed to consider a
disclosure a breach?

Low probability of compromise

Which of these controls represent a "physical safeguard" under HIPAA?

Security cameras

Which of the following represents the BEST strategy for recovering from a ransomware
infection?

Tape backup

The HIPAA Privacy Rule

Provides federal protections for individually identifiable health information held by
covered entities and their business associates.

The HIPAA Privacy Rule

Does not protect all health information wherever it is found.

The HIPAA Security Rule does not

Extend to all wearable fitness trackers.

How does electronic symptom assessment and tracking benefit patients?

Enables participating patients to more consistently track and monitor their symptoms

Which of the following competencies in clinical informatics is most appropriate for a healthcare
provider?

Retrieve all relevant data from a patient record in an EHR

Which of the following have been shown to positively affect patient trust and loyalty with
primary care providers?

Provider offering secure email and sharing clinic notes online

This Patient Safety Learning Laboratory combines multiple units and clinical services in the
implementation of a suite of patient- and provider-facing tools all geared toward improving
patient safety. There are benefits and drawbacks for each element in being part of such a large
implementation. This shows through in the "stepped wedge" design of the project (where
units/services are randomized into "steps," and each step goes live incrementally). This design
is intended to reduce the temporal, contaminating effects of a single go-live date. We learned that
it also comes with a series of challenges.
Which of these was the most significant learning of our experience in mitigating those challenges?

Defining your "step" design with input from unit leadership

You are a provider and your medical center is facing increasing financial pressures. Payers are
negotiating lower contracted rates, and your organizations costs are going up. Leadership is
advocating cuts to staff that would lead to more work by providers. Which is the best option?

Accelerate quality reporting initiatives, despite increased costs, to improve contract
negotiation strength.

You are an informatics leader and your medical center has acquired several new practice sites and
a new hospital has joined the network. Everyone is talking about improving clinical integration;
however, it is likely that all sites will eventually migrate to the same EHR platform. Since the
change to a single platform is expected to take three years, which option appears best as an
interim strategy for clinical content access?

Deploy targeted FHIR applications to share key clinical data.

Your organization, one of several in a city, is contemplating a telemedicine initiative with a goal
of significantly reducing in-person visits at your medical center given the existence of newly
supportive contacts in this regard. Which approach appears both most cost-effective and likely to
achieve this goal?

Identify high volume low, complexity conditions and develop algorithms to manage
conditions asynchronously through the existing patient portal.

Which of the following best describes access control policies in modern electronic medical record
systems?

Provide too broad access rights

Employees have used their EMR access rights to inappropriate access patient data in the past.
Which of the following best describes a process to detect one-off inappropriate access?

Context-based access monitoring systems

The explanation-based auditing system discovers what type of pattern from the EMR database?

A connection between the patient and the employee accessing the patient's record using
EMR data.

The only speciality in medicine that has expienced dramatic advances in patient safety.

anestieology

How have incorporated this intiative which helped dramatically reduce mishaps

crew resource management

The patient safety intiative called for voluntary reporting of med errors w/o recrimination

patient safety and quality improvement act

the minimization of risk and occurence of patient harm events

safety

inappriopiate or avoidable psychological/physical injury to the and family

harm

an injury resulting from a medical intervention

adverse event

errors that result in an adverse event that are preventable

preventable adverse event

delivery of care of little or no value (widespread use of antibiotics for viral infection)

overuse

The use of certain services in situation where they are not clinically indicated

misuse

award recognizing hospitals with occurence of preventable patient safety events

health grades 2013 patient safety excellent awards

Useful for military members who return from war with Posttraumatic Stress Disorder and Traumatic Brain Injury.
A comprehensive resource "The Online Couch" was published in mid-2012 that categorized technology-enabled treatment of depression into: computer based cognitive behavioral therapy (CCBT), online counceling, online social networks mobile platforms, games and VR
This is an example of_______

Telemental Health

With the advent of good quality digital cameras and cell phones with medium quality cameras, this concept of was born.
Physicians can easily obtain a teleconsultation and diagnostic and therapeutic advice using the store and forward mode.
A 2003 survey indicated that there were 62 of these programs in the United States

Teledermatology

This field arose because of a particular shortage .
Vendors now sell systems with video cameras to allow the approval of prescriptions from a remote location.
There is a project in North that operates 36 remote sites where technicians receive approval for a drug via teleconferencing.

Telepharmacy

Due to the increased malpractice risk and decreased reimbursement situation of treating emergency patients there is a shortage of a particular specialist in many regions.
With the advent of telemedicine, cases such as patients with stroke-like symptoms and next actions can be discussed real time and the patient and their x-rays can be viewed remotely by a stroke specialist to determine if they need thrombolytics or to be transferred to a higher level of care.

Teleneurology

Data is transmitted via phone lines
• Vendor has over 15,000 monitors currently in use and more than 300,000 patients have been
Monitored
• Standard and optional features: digital weight scale, blood pressure, oximetry, glucometer,
peak flow meter, blood tests (PT/INR), temperature and EKG

Telehomecare

HoneyWell HomMed

When it comes to telemedicine, there is a fear of malpractice

true

Medicare will reimburse if there is a formal consultation linked by live 2-way video
teleconferencing and the patient resides in a professional shortage area

True

Low resolution images or video require significant bandwidth, particularly if x-rays or
images or pills have to be read by remote clinicians.

False

Telemedicine is mostly needed in rural areas, but there are bandwidth issues and the connection can be a bit slow. However, VPN connections speeds processes up

false

At the Federal level, Medicaid will provide reimbursement for telemedicine

false

Previously known as Teleburn Project
Specialists can view videos or digital photos of burn patients for initial determination or follow up.

Teleburn at the Ottawa Telemedicine Network (OTN)

Created in Spokane, Washington
A consortium of four healthcare systems
This initiative has 100 sites using advanced audio-visual technology
Clinical care, teleER and telepharmacy are a few of the services that are offered

Northwest Telehealth

The program has allowed the children and their parents to not leave the centers or their jobs.
The program was started by grants but insurers have been willing to cover this initiative, presumably because it cuts down on emergency room visits.
The director of the project has stated that he believes about 28% of pediatric visits to the emergency room in upstate New York could have been treated with telemedicine

TelePediatrics and TeleDentistry

Using a non-proprietary, open source web
based program (EyePACS) images can be forwarded to an ophthalmologist for interpretation.
Images are stored on a SQL Server and images are viewed with a web browser. A simple software program on the PC allows for uploading images to the server.
There is e-mail notification to the consultant and back to the individual who sent the images

California Central Valley Teleretinal Program

Store and Forward

The largest government sponsored telemedicine program in the US.
The project evaluated approximately 1650 computer illiterate patients living in urban and rural New York State.
Patients received a home telemedicine unit that consisted of a computer with video conferencing capability, access to a web portal for secure messaging and education and the ability to upload glucose and blood pressure data.
These same subjects were assigned a case manager who was under the supervision of a diabetic specialist.
They used the Veterans Affairs clinical practice guidelines on diabetes.
They were compared to a control group that didn't receive the home monitoring system.

Informatics for Diabetes Education and Telemedicine (IDEATel)

The first instance of remote
monitoring has been attributed to monitoring the health of astronauts in space in the 1960's

Telemedicine

Remote non-clinical services, such as administrative meetings, provider training, and continuing medical training

telehealth

-Cost Factor
-Technical
-Security
- Regulatory

What are Mobile Technology Challenges?

the use of medical information exchanged from one site to another via electronic
communications to improve patients' health status

telemedicine

the use of electronic information and telecommunications technologies to support
long-distance clinical health care, patient and professional health-related education,
public health and health administration

Office for the Advancement of Telehealth (OAT)

How many major types of telemedicine transmission does your book mention?

3

A project developed by volunteers from many departments at the Massachusetts Institute of Technology. Remote healthcare workers can input data into the phone, inkling images and they are sent to the EHR OpenMRS where specialist can view the record and respond back to the healthcare worker.

Sana Mobile

a Free open source initiative developed by Johns Hopkins Center for Clinical Global Health Education. The program consist of two components: 1) android Os phone uses XML_ ....... 2) Remote Server, data from phone sent to MySQL

eMocha

False
- windows

True or False: The first generation of tablets PCs were all apple operating system based and required a stylus and keyboard for input.

Apple Newton PDA

Which PDA (Personal Digital Assistant)?
-In the early 1900's
-monochrome screen
-costly ~$700
-short battery life

Palm Piolet 1000

Which PDA (Personal Digital Assistant)?
-Released in 1996
-smaller
-less expensive

...

Which PDA (Personal Digital Assistant)?
-released 1999

This particular mode often involves two way interactive televisions. This mode enables synchronous communication such as the sharing of images from peripheral devices.

real time

In terms of hardware and networks, this mode of communication was listed as the most expensive. This more personal than just messaging a physician.

audio video

Through this particular mode, physicians/specialists are able to oversee patients at home, in a nursing home or in a hospital for disease management or PHI

remote monitoring

What major type of telemedicine transmission is described below?

This mode can be noted as asynchronous. As an example, in ophthalmology, eye screenings for diabetic retinopathy, a disease that is a major cause of blindness among individuals with diabetes, can be captured digitally by retinal cameras and transmitted to a specialist for review when time permits. These screenings are particularly effective in preventing vision loss or blindness.

Store and forward

Connect with healthcare system

Patient portal to check on appointments, lab results, etc.

Personal Health Record

Mobile PHR platform that backs up to the clous

Telemedicine

With forward facing camera video-teleconferencing is possible for virtual visits

Modification reminders

Medication and refill reminder. Can connect to your pharmacy

Fitness coach

Tracks activity and fitness

Mind fitness

Cognitive training

Immunization Guides

Guide for what immunizations are needed based on age and gender. Other important info.

Disease Management

Monitors meals, blood sugar and insulin doses; Blood pressure cuff or weight scale sends results to iPhone/iPad

Prevention Guide

Guide for national recommendations for preventative care based on age, gender, smoker, etc.

Diagnostic

Phone camera takes picture of skin lesion and estimates risk of malignant melanoma

Vital Sign Monitoring

Dashboard of vital signs (pulse, respirations, activity, body position) transmitted from sensor patch to smartphone or to remote server

Mental Health

Programs to relieve stress, particularly for deployed or returning military memories

Mobile telemedicine projects

Electronic Mobile Open-Source Comprehensive Health Application (eMocha)
- Sana Mobile

father of PACS

Dr. Andre Duerinchx

History of Picture Archiving (PACs) (taken from PPT)

Concept began with Albert Jutras in Canada in the
1950s
-Digital imaging appeared in the early 1970's by
pioneers such as Dr. Sol Nudelman and Dr.Paul Capp
-The first reference to PACS occurred in 1979 when
Dr Lemke in Berlin published an article describing a
similar concept
-The work on the radiology data standard DICOM
began in 1983 by a team lead by Dr Steven Horii at
the University of Pennsylvania
-The University of Maryland hospital system was the
first to go "filmless" in 1999

3 pictures

computed radiology

2 pictures

Digital radiology

Standard for medical imaging and informatics

DICOM

main uses PACS

all of the above

x-ray, MRI, secured workstation

all of above

What is Interoperability

Describes the extent to which systems and devices can exchange data, and interpret that shared data.
- The ability of one information system to exchange data with one another.

Health Level 7 (HL7)

The most common healthcare application-level standard that helps ensure communication across information systems
- Uses XML markup language
- "Your information as a whole" - Entirely your electronic health records

Digital Imaging and Communications in Medicine (DICOM)

"Common standard that radiologist use"

Logical Observation: Identifiers, Names and Codes (LOINC)

Standards of lab results"
- Used by labs such as LabCorp and Quest

International Classification of Diseases 9th revision (ICD - 9)

Used by the CDC
- Identify various diseases
- Digits
- Upgraded to ICD - 10 (7 characters instead of 5 - more descriptive)

HIPPA

Health Insurance Portability and Accountability Act

SECURITY RULE

The HIPAA Security Rule establishes national standards to protect individuals' electronic personal health information that is created, received, used, or maintained by a covered entity. The Security Rule requires appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected health information. .

PRIVACY RULE

Strictly limits how a covered entity and their business associates can use patient data and mandates that organizations de-identify the data by removing 18 identifiers

Regulations establish standards for protecting individually identifiable health information and for guaranteeing the rights of individuals to have more control over such information

HIPAA privacy regulations were implemented on April 14, 2003.

1996 scenario

pilot 1000

windows were the first tablet based pc

true

no widespread definition of what a smart phone is

true

Sana Mobile

A similar project developed by volunteers from many departments at the Massachusetts Institute of Technology (MIT).
- Remote healthcare workers can input data into the phone, including images and they are sent to the EHR OpenMRS where specialists can view the record and respond back to the healthcare worker.

Two components of eMocha

Android Os Phone
- Uses XML-based forms to collect data in multiple formats (text, pictures, bar codes, audio and video) that is geo stamped and backed up to the server. Can deliver multimedia courses and lectures that can be accompanied by quizzes on the phone. Phone can be used for voice calls and e-consultations using the phone camera
Remote Server
- Data from the phone is sent to a MySQL database which can also send info to the mobile devise such as forms, videos, webcasts, and lectures. Data is then available for mining.

1990 apple newton was the first, small processing, expensive not as popular as the apple

true

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