Health Technology Sourcebook, 2nd Ed.

By Omnigraphics

Consumer health information about the application of science to develop solutions to health problems or issues such as the prevention or delay of onset of diseases or the promotion and monitoring of good health. Includes index, glossary of related terms, and other resources.

• Language: English
• Publisher: Omnigraphics
• Release date: Jul 1, 2021
• ISBN: 9780780819122

Book preview

Preface

About This Book

Technology has revolutionized the way healthcare is being delivered today, from preventive medicine to rehabilitation. Future technological innovations will transform healthcare, helping health-care professionals provide better services with enhanced precision. More than anything, technology drives healthcare, enabling good health and wellness to people all over the world. The emergence of health information technology (HIT) has made things easier, faster, and simpler for health-care professionals. It provides information they need with the click of a button. According to the Office of the National Coordinator for Health Information Technology (ONC), in 2018 a majority of individuals (84 percent) are confident that their medical records are safe from unauthorized viewing but (66 percent) have concerns when health information is electronically exchanged. More individuals are now confident that their records are safe from unauthorized viewing, compared to 2017.

Health Technology Sourcebook, Second Edition provides facts about health technology, telehealth, its expansion benefits, and uses during COVID-19, telemedicine technology, digital health, innovations in preventive medicine, screening and detection, imaging, and patient monitoring services. It further discusses medical and surgical treatment technologies, new cancer technologies, nutrigenomics, nanotechnology, robotics, rehabilitation, assistive devices, and health information technology. In addition, it details ethical and legal concerns of medical technology, cloning and cloning laws, and the future of health technology. The book concludes with a glossary of related terms and a directory of resources for additional information.

How to Use This Book

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part 1: Introduction to Health Technology gives an overview of medical technology, telehealth, and its uses during COVID-19, telemedicine, and e-health concepts. It also provides information about health technology assessment, and technology and healthcare-related expenditures. The part also details on blockchain technology and the Internet of Things (IoT).

Part 2: Technology and Preventive Healthcare begins with information on the types of telemedicine technology and goes on to discuss the use of technology in preventive healthcare. It offers detailed information about digital-health concepts and innovations namely sensors, body area networks (BANs), wearables and safety, etc. It also gives insights on medical device data systems, medical device interoperability, and clinical decision support systems. Additionally, it discusses the use of big data in healthcare and screening and detection technologies such as advanced molecular detection (AMD), DNA microarray technology, genetic testing, AI-assisted medical devices, etc.

Part 3: Diagnostic Technology deals with various technologies used in the field of diagnoses such as imaging, diagnostic testing, precision medicine, cinematic rendering and digital twin technology, and wireless patient monitoring systems. It also discusses various advanced imaging concepts, the application of digital technology in the COVID-19 pandemic, and other innovations in diagnostic technology.

Part 4: Role of Technology in Treatment provides information about medical and surgical treatment technologies such as computer-assisted surgical systems, robotic angiography gantry, smart operating rooms of the future, and much more. Nanomedicine, genomic medicine, nutrigenomics, nanotechnology, and robotics are also discussed. In addition, it provides details on various advanced therapies such as tissue and cartilage engineering, regenerative medicine, and light therapy.

Part 5: Rehabilitation and Assistive Technologies discusses various rehabilitative and assistive technologies such as prosthetic engineering, cybernetics, robotic wheelchairs, and vision, hearing, and mobility aids. It further discusses the role of electrical signals and stimulations in rehabilitation and research and scientific advances in the field.

Part 6: Health Information Technology and Its Future deals with the basics and benefits of health information technology and trends in its use. Facts about information and communication technologies, digital-health records, and other aspects are also discussed. It also gives insight into the various health technologies of the future such as artificial brain, artificial intelligence, augmented reality, virtual reality, computational modeling, stem cell research, genome sequencing, and photonic dosimetry. Additionally, it provides information on medical applications of 3D printing and microneedle patches for flu vaccination.

Part 7: Medical Technology – Legal and Ethical Concerns discusses medical records privacy, confidentiality, and health information privacy law and policy. It also provides details about health IT legislation and regulations, and cloning and law.

Part 8: Additional Help and Information provides a glossary of important terms related to health technology and a directory of agencies that offers information related to health technology.

Bibliographic Note

This volume contains documents and excerpts from publications issued by the following U.S. government agencies: ADA.gov; Agency for Healthcare Research and Quality (AHRQ); Argonne National Laboratory (ANL); Center for Limb Loss and Mobility (CLiMB); Centers for Disease Control and Prevention (CDC); Centers for Medicare & Medicaid Services (CMS); Congressional Research Service (CRS); Education Resources Information Center (ERIC); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); Federal Trade Commission (FTC); Fogarty International Center (FIC); HealthIT.gov; MedlinePlus; National Aeronautics and Space Administration (NASA); National Cancer Institute (NCI); National Center for Biotechnology Information (NCBI); National Cybersecurity Center of Excellence (NCCoE); National Eye Institute (NEI); National Human Genome Research Institute (NHGRI); National Institute for Occupational Safety and Health (NIOSH); National Institute of Allergy and Infectious Diseases (NIAID); National Institute of Biomedical Imaging and Bioengineering (NIBIB); National Institute of Dental and Craniofacial Research (NIDCR); National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Institute of Mental Health (NIMH); National Institute of Standards and Technology (NIST); National Institute on Aging (NIA); National Institute on Deafness and Other Communication Disorders (NIDCD); National Institutes of Health (NIH); Networking and Information Technology Research and Development (NITRD); NIH News in Health; Office of Disease Prevention and Health Promotion (ODPHP); Office on Women’s Health (OWH); U.S. Consumer Product Safety Commission (CPSC); U.S. Department of Energy (DOE) Office of Science; U.S. Department of Health and Human Services (HHS); U.S. Department of Homeland Security (DHS); U.S. Department of Veterans Affairs (VA); U.S. Food and Drug Administration (FDA); U.S. National Library of Medicine (NLM); and U.S. Senate Special Committee on Aging.

It also contains original material produced by Omnigraphics and reviewed by medical consultants.

About the Health Reference Series

The Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. Each volume provides comprehensive coverage on a particular topic. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series. The Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a substitute for the physician–patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate healthcare provider.

A Note about Spelling and Style

Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms and The Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers, and the editor’s primary goal is to present material from each source as accurately as is possible. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).

Medical Review

Omnigraphics contracts with a team of qualified, senior medical professionals who serve as medical consultants for the Health Reference Series. As necessary, medical consultants review reprinted and originally written material for currency and accuracy. Citations including the phrase Reviewed (month, year) indicate material reviewed by this team. Medical consultation services are provided to the Health Reference Series editors by:

Dr. Vijayalakshmi, MBBS, DGO, MD

Dr. Senthil Selvan, MBBS, DCH, MD

Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

Health Reference Series Update Policy

The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to:

Managing Editor

Health Reference Series

Omnigraphics

615 Griswold St., Ste. 520

Detroit, MI 48226

Part 1 | Introduction to Health Technology

Chapter 1 | Understanding Medical Technology

The advancement of basic science about human health and the onset of diseases have been so rapid in the second half of the twentieth century that we have been labeled as living in a biological revolution. It is with the help of technology and strategy that the field of healthcare is flourishing.

Medical technology is the application of science, research, and organized knowledge to create solutions to health concerns. It involves the usage of devices, procedures, vaccines, and medicines to identify health problems, prevent diseases, monitor good health, and improve the quality of life (QOL).

Medical technology is the key to a hospital’s positioning and understanding in the dynamic healthcare world. Every year, plenty of exciting new biomedical instruments and technologies are being unveiled. Since the advent of eyeglasses and the stethoscope, medical research has advanced significantly. The growth of a more wealthy middle class, as well as an aging world population, are both pushing transformations in the healthcare market, and the infrastructure that supports it is transforming faster than ever before.

The COVID-19 pandemic in 2020 pushed healthcare forward, and as a result, many promising medical innovations were put to the test on a large scale. The challenge in the forthcoming years is how such innovations will be combined in a postpandemic environment. The following are a few advancements of technology in the medical field.

Advanced Telemedicine

During the COVID-19 pandemic, telemedicine made significant progress. In January 2020, it was reported that 24 percent of healthcare institutions had a telehealth service in place. The nation was on track to complete over a billion virtual treatment visits by the end of the year. Many of telehealth’s regulatory hurdles have been lifted as a result of its forced implementation, and healthcare providers now have almost a year’s worth of research on how to assess and develop telehealth systems.

Development of Drugs

One of the greatest scientific achievements in human history could be the discovery of several safe and reliable COVID-19 vaccines in less than a year. The procedure was accelerated not only by regulatory expediting but also by advancements in the way drug trials are performed.

Nanomedicine

Nanomedicine has applications in imaging, sensing, detection, and dissemination by medical devices, and the potential is enormous for anything so small.

Connectivity

A secure and lightning-fast internet access is the base for cutting-edge technologies such as artificial intelligence (AI), Internet of Things (IoT), and big data to achieve their maximum potential in healthcare. The most immediate benefits of a secure real-time link can be seen in telemedicine, which will increase access to treatment for millions of people. More embedded sensors with authentic data streams open the door to a healthcare revolution.

Clustered Regularly Interspaced Short Palindromic Repeats

Clustered regularly interspaced short palindromic repeats (CRISPR) is the most sophisticated gene-editing technique available that functions by using the immune systems of invading virus-infected bacteria cells, which are then able to cut out infected deoxyribonucleic acid (DNA) strands. This cutting of DNA has the potential to revolutionize the way we approach disease. Any of the most serious risks, such as cancer and HIV, can be resolved in a couple of years by altering genes.

Telehealth

Many healthcare providers will be concentrating their efforts on how to better align telehealth systems with traditional physical ones. Virtual visits can continue to be used to enhance collaboration with hospitals, long-term care facilities, dialysis centers, and mental-health providers, as well as to expand access to primary care and urgent care.

In today’s technologically advanced world, instead of waiting for face-to-face visits with their doctor, telehealth helps people to access medical attention from their digital devices. For instance, highly personalized smartphone applications are being created that enable patients to communicate remotely with doctors and other medical professionals in order to obtain an immediate diagnosis and medical advice. Telehealth is particularly beneficial to people who are undergoing treatment for chronic illnesses because it provides them with regular, convenient, and cost-effective care.

Wearable Devices

Wearable devices have increased in popularity in recent years, especially after the release of Bluetooth in 2000. People nowadays use their phones to keep track of everything from their walking steps, exercise, calories burnt, and heartbeat to their sleeping habits. These wearable devices are advancing in tandem with the rise of chronic diseases such as diabetes and cardiovascular disease (CVD), and they seek to tackle them by assisting patients in monitoring and improving their health.

Robotic Surgery

In minimally invasive operations, robotic surgery is used to assist with accuracy, stability, and flexibility. Robotic surgery allows surgeons to perform very complicated operations that would either be impractical or very difficult. While some fear that the invention will ultimately replace human surgeons, it is more likely to be used to aid and improve surgeons’ practice in the future.

Smart Inhalers

Inhalers are the most common medication for asthma, and if used properly, they will help 90 percent of patients. Bluetooth-enabled smart inhalers have been designed to assist asthma sufferers in properly managing their illnesses. The inhaler has a small tracker attached to it that tracks proper administration and date and duration of each dosage. This information is then sent to the patients’ smartphones, allowing them to monitor and maintain their health. Clinical research revealed that those who used the smart inhaler system used a lesser amount of medication than the conventional inhaler.

Virtual Reality and Augmented Reality

Virtual reality (VR) has uses in fields such as emotional trauma, where it can relieve phobias and posttraumatic stress disorder (PTSD) by personalized exposure and care. Cambridge Consultants created augmented reality (AR) glasses for operating rooms that enable surgeons to see within a patient’s body by superimposing data from 3-D (three-dimensional) scans and computerized axial tomography (CAT) scans. This allows for unprecedented exposure during minimally invasive keyhole surgeries and needs almost no extra preparation.

References

David, Yadin; Zambuto Peter, Raymond. Medical Technology, Science Direct, December 2, 2018.

The Ten Hottest Medical Technologies in 2021, Medical Technology Schools, January 15, 2019.

Top 10 New Medical Technologies of 2019, Proclinical, February 27, 2019.

10 Ways Technology Is Changing Healthcare, The Medical Futurist, March 3, 2020.

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Understanding Medical Technology, © 2021 Omnigraphics. Reviewed June 2021.

Chapter 2 | Basics of Telehealth

Chapter Contents

Section 2.1—Understanding Telehealth

Section 2.2—Telemedicine and E-health

Section 2.3—Uses of Telehealth during COVID-19

Section 2.1 | Understanding Telehealth

This section includes text excerpted from documents published by three public domain sources. Text under the headings marked 1 are excerpted from Telehealth, National Institute of Biomedical Imaging and Bioengineering (NIBIB), August 2020; Text under the headings marked 2 are excerpted from What Is Telehealth? Telehealth.HHS.gov, U.S. Department of Health and Human Services (HHS), May 19, 2021; Text under the heading marked 3 is excerpted from Telehealth and Telemedicine: Frequently Asked Questions, Congressional Research Service (CRS), March 12, 2020.

What Is Telehealth?¹

Telehealth is broadly defined as the use of communications technologies to provide healthcare at a distance. Telehealth has become a valuable tool thanks to combined advances in communications, computer science, informatics, and medical technologies.

Telehealth often involves remote monitoring of blood pressure, heart rate, and other measurements obtained by a device worn by the patient and electronically sent to medical personnel. Smartphones and other smart personal devices are increasingly utilized for the collection, dissemination, and even analysis of health status due to their increasing presence around the globe, even in remote, underserved communities.

In the last several years, virtual visits between doctors and patients have become very common, especially with the onset of the COVID-19 pandemic. The willingness of physicians, patients, and insurers to embrace virtual medicine is likely to cause it to remain a popular option in healthcare.

What Types of Care Can You Get Using Telehealth?²

You might be surprised by the variety of care you can get through telehealth. Services such as medication management and online counseling are particularly suited to telehealth as consistent and regular visits improve outcomes. Your doctor will decide whether telehealth is right for your health needs.

If you need care – especially during COVID-19 – it is worth checking to see what your telehealth options are.

For example, you may meet with a doctor in real time to discuss:

Lab test or x-ray results

Therapy and online counseling

Recurring conditions such as migraines or urinary tract infections

Skin conditions

Prescription management

Urgent care issues such as colds, coughs, and stomach complaints

Postsurgical follow-up

Doctors may ask you to:

Send blood pressure, blood sugar, or other condition monitoring information

Send images of how a wound, eye, or skin condition is healing

Document symptoms

Request medical records sent to another doctor (e.g., x-rays to a physical therapist)

Doctors can send information to you such as:

Notifications to remind you to do rehabilitation exercises or take a critical medication

Encouragement to stick with your treatment plan

New suggestions for improving diet, mobility, or stress management

Detailed instructions on how to continue your care at home

How Can Telehealth Technologies Improve Medical Care?¹

Teleconsultations

This allows a physician in a remote area to receive advice from a specialist at a distant location about special or complex patient conditions. Such consultations can be as simple as a phone call. Increasingly, they involve sophisticated sharing of medical information such as computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound scans. These images can be taken by the local physician, incorporated into an electronic medical record, and sent to the specialist for diagnosis and treatment recommendations.

Remote Patient Monitoring

It enables patient monitoring outside of clinical settings, such as at home. Patients use or wear sensors that wirelessly collect and transmit physiological data to health professionals. Remote patient monitoring (RPM) can significantly improve an individual’s quality of life. For example, in diabetes management, the real-time transmission of blood glucose readings enables health-care providers to intervene when needed and avoid acute events and hospitalizations.

Telehomecare

It provides the remote care needed to allow people with chronic conditions, dementia, or those at high risk of falling, to remain living in their own homes. The approach focuses on reacting to emergency events and raising a help response quickly. Sensors monitor changes in chronic conditions as well as other risks including floods, fires, and gas leaks. Sensors can also alert caregivers if a person with dementia leaves the house. When a sensor is activated, a monitoring center is alerted to take appropriate action such as contacting a caregiver or sending emergency services.

Point of Care

Medicine relies on diagnostic devices that can perform at the time and place of patient care, which includes at home, in doctor’s offices and clinics, and in remote areas without electricity or laboratory equipment. Point-of-care (POC) devices can detect micronutrient deficiencies, anemia, infectious agents, and even some cancers. Combined with telehealth, POC technologies allow health-care workers to test patients and rapidly obtain results without the need for a complex laboratory setting which can result in significant cost-reduction.

Benefits of Telehealth²

Although virtual visits may not be as common as traditional in-person doctor’s appointments, there are many benefits that explain why this type of care is growing in popularity.

Limiting physical contact reduces everyone’s exposure to COVID-19

Visiting virtually can address health issues wherever patients are, even from the comfort of home

Staying put cuts down on commuting, travel in bad weather, time off from work, need for child care

Using virtual health-care tools can shorten wait times to see a provider and expand the range of access to specialists who live further away

Telehealth is not a perfect fit for everyone or every medical condition. Make sure you discuss any disadvantages or risks with your doctor.

Frequently Asked Questions about Telehealth³

Telehealth Modalities

What Is a Telehealth Modality?

A telehealth modality refers to the mode in which a telehealth service transpires. There are four common telehealth modalities: (1) clinical video telehealth or live video, (2) mobile health, (3) remote patient monitoring, and (4) store-and-forward technology. Other telehealth modalities include the use of the telephone and facsimile (fax) machine.

How Does the Clinical Video Telehealth Modality Function?

The clinical video telehealth (CVT) modality allows a health-care provider who is not located in the same location as a patient to view, diagnose, monitor, and treat medical conditions of the patient in real time. The CVT modality functions by allowing a health-care provider and the patient to see each other via interactive live video technology.

How Does the Mobile Health Modality Function?

The mobile health (mHealth) modality allows a provider to deliver educational materials and other health-care resources to patients through a mobile application. Patients who use mHealth can access health-care information such as disease-specific resources and mental-health resources on their mobile devices.

How Does the Remote Patient Monitoring Modality Function?

The remote patient monitoring (RPM) modality allows a health-care provider who is not located in the same location as a patient to provide the patient with daily case management services for the patient’s chronic medical conditions, such as chronic heart disease (CHD) or diabetes.

How Does the Store-and-Forward Technology Modality Function?

The store-and-forward technology (SFT) modality facilitates the interpretation of clinical information. SFT enables a health-care provider who is not in the same location as a patient to assist a health-care provider who is in the same location and who has provided in-person care to the patient. The SFT modality is similar to the exchange of videos, pictures, and files through an e-mail or personal mobile device. However, the exchange within a telehealth encounter is sent from a health information technology (HIT) system; for example, when a patient’s electronic health record (EHR) is sent to the consulting provider’s HIT system.

Telehealth Services

What Types of Health-Care Services Can Health-Care Providers Provide through Telehealth?

Health-care providers generally can provide any health-care service via telehealth that the provider can provide in person. Such health-care services include dietician services, disease management, genetic counseling, palliative care, psychological assessment, and speech therapy. However, federal and state laws prohibit health-care providers from delivering certain services via telehealth. For example, Medicare providers can provide only telehealth services authorized by the Centers for Medicare and Medicaid Services (CMS), of the U.S. Department of Health and Human Services (HHS), such as diabetes management and counseling for tobacco use. Medical abortions are another heath-care service regulated by law; some states have or are considering measures to either allow or prohibit medical abortions via telehealth.

What Is a Direct-to-Consumer Telehealth Service?

A direct-to-consumer (DTC) telehealth service refers to a health-care service provided on-demand via a clinical video telehealth modality to a patient, upon the patient’s request. Patients generally can access DTC telehealth services 24 hours a day on any day of the week. DTC telehealth services typically consist of urgent care services for illnesses such as headaches, sore throats, and urinary tract infections (UTIs). Some DTC telehealth organizations offer the same behavioral health-care services as DTC telehealth services.

Two aspects of a DTC telehealth service make it convenient. First, a patient does not have to be enrolled in a health-care facility to receive services. The patient generally receives telehealth service from a health-care provider who has contracted with a DTC telehealth organization such as American Well or Teladoc. A patient can access DTC telehealth services from a local health-care facility, her or his workplace, or a school that has chosen to integrate DTC telehealth services into the respective facility.

Second, a patient can access a DTC telehealth service immediately at the time of her or his request. The patient can also schedule a future DTC telehealth service with her or his health-care provider. The provider does not have to be located in the same location as the patient when the telehealth service transpires, withstanding state licensing laws for the delivery of telehealth services across state lines. The health-care provider can prescribe medications, withstanding federal and state licensing laws for the prescribing of medications across state lines.

Section 2.2 | Telemedicine and E-health

Telemedicine and E-health, © 2021 Omnigraphics. Reviewed June 2021.

Telemedicine uses telecommunication technology to help healthcare professionals remotely diagnose and treat patients in a virtual setting and deliver medical services. Technology in telemedicine is used to provide services such as managing medications, and chronic conditions, along with consultations from specialists. Telemedicine has made healthcare accessible, affordable, and engaging. Telemedicine is beneficial to the rural and senior citizen faction of the population. A health insurance portability and accountability act (HIPAA, 1996) compliant video conferencing software is the most basic requirement for telemedicine services. There are three types of telemedicine services such as:

Interactive medicine – live video or synchronous virtual visits between a person and their caregiver, using telecommunications technology

Remote patient monitoring

Store and forward or asynchronous virtual visits

Mobile health, often called mHealth or eHealth

Present-day applications of telemedicine include remote posthospitalization care, assisted living support, school-based telehealth, and preventive care, sharing medical information, reducing the load on hospital emergency rooms, access to multiple medical opinions, access to specialist consultations for fragile medical cases such as premature babies, providing disaster relief, and mobile health. Fields that utilize telemedicine are radiology, pediatric, mental health, and dermatology. Medical care devices that are easy to use and install at home help practitioners monitor vitals and other parameters such as blood glucose levels. Some devices that can stream their data over long distances are digital stethoscopes, EKGs, pulse oximeters, dermatoscope, otoscopes, and ultrasounds. Telemedicine is a continuously improving industry and was estimated at a value of $35 billion in 2020.

Benefits of Telemedicine

Telemedicine provides a wide range of benefits for patients and providers, such as:

Convenience. Telemedicine allows patients to access medical care from the comfort of their homes. Accessing healthcare services through telemedicine does not interfere with work schedules which is beneficial for patients.

Preventive care through telemedicine leads to better health outcomes since people with low incomes or rural areas who cannot afford to make in-person doctor appointments can access preventative care options.

Lower costs. Healthcare services obtained through telemedicine lead to reduced overall costs such as fuel costs, child care costs, and lower consultation fees as video consultations only incur data usage charges.

Better access to quality healthcare for those with a disability, at a disadvantage such as under-house arrest or in prison, or solitary senior citizens

Safety. During a pandemic, or to protect individuals with low immunity caused by conditions such as HIV/AIDS or cancer, or for people who are highly susceptible to infections, it can be the safest option to harness the services of telemedicine technology and enlist medical services remotely.

For health-care providers, telemedicine offers a more significant revenue or return on investment (ROI) since they can reach many more patients than what a physical clinic could accommodate.

Telemedicine providers can ensure customer satisfaction as going mobile helps them offer various services to the customers on a single platform rather than outsourcing services. Customers look for convenience and a one-stop solution to all their healthcare needs which can quickly be delivered through telemedicine.

Health-care providers can save costs by avoiding overhead expenses such as customer support expenses or extra office space.

Figure 2.1. Architecture of the WBAN and E-healthcare System

E-health is the use of the Internet along with information and communication technology (ICT) in the delivery of healthcare services. E-health specifically combines intuitive data aggregating technology and coordination of clinical referrals. E-health is beneficial in managing disease care for the patient. Telehealth and telemedicine are services under e-health along with electronic medical records, health IT systems, consumer health IT data, virtual healthcare, electronic health records (EHRs), and big data systems. E-health is involved in improving the overall efficiency of healthcare. It allows medical practitioners to access and manage patient health records through electronic channels for better patient care. E-health permits patients to be actively involved in their treatment, understand their condition better and manage it efficiently.

Benefits of E-Health

The key benefits of e-health include:

Improves self-care. Services provided under e-health encourage patients to take better care of their health conditions, and it helps them recognize if they need medical attention. This also helps in reducing the load on the healthcare system.

Helps save time. Telemedicine and other similar services help cut waiting times drastically, which patients can use for other daily activities. The direct approach employed by health IT removes the need and time spent on mediatory services.

Administrative processes are more secure and more manageable with the induction of e-health services such as electronic health records. Such approaches can avoid cumbersome paperwork and are a more sustainable method.

Enables patients to stay informed about their diagnoses and prescriptions and any other services or diagnostic services that may be required

Encourages transparency in services from providers to transactions for payments from patients. Patients require precise information on their medical history, and EHRs help provide the same.

Services under e-health can sometimes prevent unnecessary deaths by providing remote medical interventions in the form of paramedic help through telemedicine.

E-health allows for earlier detection, diagnosis, and subsequent treatment, which can improve overall health outcomes.

Removes geographical barriers to quality healthcare and helps bridge the gap between medical services and access to the same, especially among minorities, low-income groups, and rural populations

Telemedicine and e-health come with some disadvantages, such as not being considered by insurance and health coverage providers, susceptibility to cybercrime, or delays in immediate care. It must be noted that these types of healthcare services are digitally relevant and highly beneficial. Both services aid in improving healthcare delivery, increasing the quality of services, and help to reinforce patient–physician interactions. For patients, these services help instill a sense of confidence in the physician and a stronger sense of healthcare responsibility in both.

References

What Is Telemedicine? Chiron Health, March 4, 2016.

What Is Telemedicine? VSee, October 13, 2012.

eHealth, Innovate Med Tec, May 29, 2016.

What Is eHealth? USF Health, April 19, 2021.

Dividing E-health, Telehealth and Telemedicine, Electronic Health Reporter, March 20, 2018.

Villines, Zawn. Telemedicine Benefits: For Patients and Professionals, Medical News Today, April 20, 2020.

Section 2.3 | Uses of Telehealth during COVID-19

This section contains text excerpted from the following sources: Text in this section begins with excerpts from Uses of Telehealth during COVID-19 in Low Resource Non-U.S. Settings, Centers for Disease Control and Prevention (CDC), July 21, 2020; Text beginning with the heading The Role of Telehealth in the COVID-19 Crisis is excerpted from Telehealth and Patient Safety during the COVID-19 Response, Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services (HHS), May 14, 2020.

Changes in the way that healthcare is delivered during the COVID-19 pandemic have occurred to reduce staff and patient exposure to sick people, preserve personal protective equipment (PPE), and minimize the impact of patient surges on facilities. Health-care systems may need to adjust the way they triage, evaluate, and care for patients using methods that do not rely on in-person encounters. Telehealth services help provide necessary care to patients while minimizing the transmission risk of SARS-CoV-2, the virus that causes COVID-19, to health-care workers and patients.

Telehealth modalities include:

Synchronous. Real-time telephone or live audio-video interaction, typically with a patient, using a smartphone, tablet, or computer.

In some cases, peripheral medical equipment (e.g., digital stethoscopes, otoscopes, ultrasounds) can be used by another health-care provider (e.g., nurse, medical assistant) physically with the patient, while the consulting medical provider conducts a remote evaluation.

Asynchronous. The provider and patient communication does not happen in real time. For example, store and forward technology allows messages, images, or data to be collected at one point in time and interpreted or responded to later. Patient portals can facilitate this type of communication between provider and patient through secure messaging.

Remote patient monitoring. This allows direct transmission of a patient’s clinical measurements from a distance (may or may not be in real time) to their health-care provider.

What Are Potential Uses of Telehealth during COVID-19?

Triaging and Screening for COVID-19 Symptoms

Telehealth can be used to screen for COVID-19 symptoms and assess patients for potential exposure. Phone screening, online screening tools, mobile applications, or virtual telemedicine visits can be used to evaluate patients for COVID-19 symptoms, assess the severity of their symptoms, and decide whether the patient needs to be seen for evaluation, admitted to the hospital, or can be managed at home. Screening algorithms can be used in telehealth communication. For patients who may need to be hospitalized, mobile phones and tablets or other telehealth technology can be used by mobile home health-care units, community health volunteers/workers, or emergency services to communicate with health-care providers at a health facility.

Health-care providers can use telehealth to conduct a remote evaluation of the patient’s medical condition and determine if the patient needs to be in a regular hospital bed or in an intensive care unit. Making this decision remotely can avoid rushing the patient through the emergency room upon arrival at the hospital, limiting the exposure of emergency department personnel and other health-care workers, and preserving PPE. Telehealth can also be used to screen patients before they visit the health-care facility for non-COVID-19 care. If COVID-19 symptoms are reported during the telehealth interview, patients could be advised to delay nonemergent care and first seek testing for COVID-19.

Contact Tracing

Telehealth, especially via phone, can be used to interview patients with COVID-19 to determine who they were in contact with during the time they were potentially infectious, and to follow up with their contacts to inform them of the need to quarantine, assess whether they have any symptoms, and tell them what to do if symptoms develop.

Monitoring COVID-19 Symptoms

Patients with mild or moderate COVID-19 symptoms can often isolate and be monitored at home to avoid overcrowding in health-care facilities and save hospital beds for more severe cases. Using telehealth technology such as phones or apps, health-care providers can check in with patients frequently to monitor their condition, provide advice, and determine if the patient’s condition is deteriorating and they need to be evaluated for in-person care, such as hospitalization.

Providing Specialized Care for Hospitalized Patients with COVID-19

Patients who are hospitalized with COVID-19 may require care from a diverse team (e.g., nurses, respiratory therapists, physicians). One member of the team can enter the patient’s room and consult with the rest of the team using telehealth technology (tablets, phones) to assess the condition of the patient, adjust respiratory and other therapy, adjust the treatment plan, and manage complications.

In addition, health facilities can use telehealth to consult with physicians who have specialized training or expertise in respiratory infections such as COVID-19. Teleintensive care unit platforms, which consist of real-time audio, visual, and electronic connections between remote critical care teams (intensivists and critical care nurses) and patients in distant ICUs, can also be used to monitor critically ill patients and provide expert guidance for care. Tele-radiology can also be used to consult with radiologists at remote locations. Telehealth can also be used to provide online training on COVID-19 for medical professionals and health-care workers.

Providing Access to Essential Healthcare for Non-COVID-19 Patients

Telehealth can be used as a strategy to maintain continuity of care, to the extent possible, to avoid negative consequences from preventive, chronic, or routine care that might otherwise be delayed due to COVID-19 concerns. Telehealth visits can help determine when it is reasonable to defer an in-person visit or service. Follow-up visits can be conducted by phone or Internet to reduce the number of in-person visits and overcrowding in outpatient settings.

Providers can use Internet-based drug prescriptions and provide multimonth dispensing of medications to further reduce the need for in-person encounters. Remote access can also help assure health-care access when an in-person visit is not practical or feasible due to COVID-19 concerns. To mitigate stress during ­COVID-19, mental- and behavioral-health services can be provided to the population through hotlines or virtual provider-patient visits.

Monitoring Recovering COVID-19 Patients

After COVID-19 patients are discharged from the hospital, health-care providers can use telehealth technology to follow up with those who might need to continue isolation at home or be monitored for any sudden deterioration or long-term health effects due to COVID-19.

The Role of Telehealth in the COVID-19 Crisis

In March 2020, the U.S. Department of Health and Human Services (HHS) issued a series of new rules and temporary waivers designed to assist the medical community in addressing the COVID-19 pandemic. This has included several provisions related to the use of telehealth, including the expansion of what services may be provided virtually. Private insurers are also taking steps to support the use of telehealth, such as expanding lists of eligible services, waiving cost-sharing, and providing monitoring devices to patients. Through necessity and as a result of these emergency provisions, the use of telehealth technologies, and broader application of telehealth concepts outside of the CMS technical standards, has rapidly increased. Its expanded use has served as a means of ensuring the safety of both patients and frontline providers, as well as conserving the use of critical PPE supplied.

Ensuring Patient Safety

Telehealth can be an effective way of limiting patient exposure to individuals who have – or may have – contracted the virus that causes COVID-19. One approach is to use telehealth in place of traditional in-person visits for care unrelated to COVID-19 that cannot be postponed, such as required monitoring of medications for chronic disease. This allows patients to receive care from the safety of their homes and avoid exposure to the virus during transit or at in-person appointments.

Another approach is to use telehealth as a means of performing an initial evaluation and triage of patients with COVID-19 symptoms. Such virtual triage processes can protect other patients by directing potentially infected individuals to the most appropriate location to seek care or testing and keep them out of primary care waiting rooms.

Ensuring Provider Safety

In addition to the more traditional uses of telehealth, the COVID-19 crisis has necessitated creative thinking about how telehealth technology can help protect providers. For example, approaches such as video conferencing and remote diagnostic tools can allow hospital and ambulatory care providers to employ telehealth best practices and patient evaluation techniques that avoid direct patient contact, while still treating the patient on-site. Telemedicine using remote monitoring technologies can facilitate treatment and even decrease the frequency of virtual and in-person patient encounters. Using these remote and virtual capabilities can reduce the number of providers that need to come into direct contact with a patient in the hospital and can conserve single-use PPE.

While telehealth is providing powerful approaches for protecting patients and providers during the COVID-19 outbreak, its increased and evolving use raises other potential patient safety concerns. First, providers need to understand the limitations of delivering care remotely and the implications on their diagnostic capabilities, particularly among providers who have limited prior telehealth experience.

Secondly, strategies need to be in place for connecting with patients and caregivers who are less technologically enabled, have multiple comorbid conditions, do not have access to broadband, and/or have low health or digital-health literacy.

In addition, providers will need to ensure reasonable accommodations are in place for patients who are deaf, hard of hearing, are blind, or have low vision. They will also need to be responsive to linguistic minorities who may have limited English proficiency.

Finally, in the effort to maximize the use of telehealth services and minimize the risk of patient exposure to the virus, remote evaluations allow providers to recommend more judicious use of ancillary services, recognizing that there is a continued need to ensure patients are able to receive all necessary services when appropriate (e.g., labs, x-rays, procedures).

Alleviating Patient Safety Concerns

Rapidly accelerating telehealth capabilities may be necessary for many institutions as the health-care community tackles the COVID-19 epidemic. However, there are critical precautions that can be taken to minimize the risk to patient safety.

Establishing Escalation Protocols

Institutions should establish escalation protocols that dictate when a patient receiving telehealth services should be transitioned to urgent in-person follow-up care, or even to receiving emergency services. Follow-up care can continue to occur remotely, but consideration should be made for conditions in which the patient may require in-person services, particularly in more vulnerable populations. Escalation protocols should be identified, developed, and applied in the context of a given practice and should cover the range of scenarios that practice may encounter, including the need for a higher level of care, such as an emergency visit, or the need for diagnostic studies. The protocols should align with existing clinical workflows and take into consideration the level of comfort and familiarity physicians have with practicing telehealth.

These types of guidance documents help to ensure that patients are receiving telehealth and in-person care in a consistent way, that the capabilities and limitations of telehealth are communicated effectively, and can ease the adjustment for providers with minimal prior experience performing telehealth. All clinical staff within a given institution should be aware of these guidance documents and of when to use them.

Encourage Precharting of Upcoming Patient Visits

Providers should be encouraged to conduct a detailed review of their upcoming patient appointments and determine if any can be appropriately converted to telehealth appointments. This may require additional communication and outreach to the patient by nurses or medical assistants to review and update information regarding the patient’s medical history, validate that the reason for their visit is complete, accurate, and identifies the need for any necessary ancillary services (i.e., lab work, imaging), and ensure that the patient understands what to expect if they will be participating in a telehealth visit.

It may be necessary, in some cases, to arrange for patients to obtain remote monitoring devices in advance of more complex virtual assessments. Where ever possible, maintain in-person pediatric visits for vaccinations so children remain on schedule.

Quality Assurance Plan

As with in-person visits, a quality assurance plan should be in place for telehealth visits. Medical staff should hold patient safety huddles to discuss cases with both positive and negative patient safety outcomes. It is important for institutions to maintain good patient safety culture and ensure that providers have the opportunity to learn from what went right and what went wrong in telehealth cases.

Provider Tutorials of Telehealth Basics

Telehealth tutorials can provide awareness of basic telehealth communication best practices. Understanding such fundamentals, such as regulating speech patterns or positioning the video camera, lighting, and location can make the experience more user-friendly for the patient and facilitate a smooth and effective visit.

If implemented appropriately, telehealth can be an incredibly effective approach to ensuring patient and provider safety during this unprecedented outbreak. This unique opportunity to implement innovative and creative approaches to patient care will have long-lasting impacts on the future of telehealth. As providers and patients become more familiar with the technical aspects of telehealth, and as patients’ understanding of both the benefits and limitations of telehealth increases, telehealth will become a part of standard practice for delivering safe, high-quality healthcare.

Chapter 3 | Health Technology Assessment

Technological innovation has yielded truly remarkable advances in healthcare during the last five decades. In recent years, breakthroughs in a variety of areas have helped to improve health-care delivery and patient outcomes, including antivirals, anticlotting drugs, antidiabetic drugs, antihypertensive drugs, antirheumatic drugs, vaccines, pharmacogenomics, and targeted cancer therapies, cardiac rhythm management (CRM), diagnostic imaging, minimally invasive surgery, joint replacement, pain management, infection control, and health information technology (HIT).

The proliferation of health-care technology and its expanding uses have contributed to burgeoning health-care costs, and the former has been cited as culprit for the latter. However, this relationship is variable, complex, and evolving. In the U.S., the Congressional Budget Office (CBO) concluded that roughly half of the increase in health-care spending during the past several decades was associated with the expanded capabilities of medicine brought about by technological advances.

Few patients or clinicians are willing to forego access to state-of-the-art health-care technology. In the wealthier countries and those with growing economies, adoption and use of technology have been stimulated by patient and physician incentives to seek any potential health benefit with limited regard to cost, and by third-party payment, provider competition, effective marketing of technologies, and consumer awareness.

In this era of increasing cost pressures, restructuring of health-care delivery and payment, and heightened consumer demand – yet continued inadequate access to care for many millions of people – technology remains the substance of healthcare. Culprit or not, technology can be managed in ways that improve patient access and health outcomes while continuing to encourage useful innovation. The development, adoption, and diffusion of technology are increasingly influenced by a widening group of policymakers in the health-care sector. Health product makers, regulators, clinicians, patients, hospital managers, payers, government leaders, and others increasingly demand well-founded information to support decisions about whether or how to develop technology, to allow it on the market, to acquire it, to use it, to pay for its use, to ensure its appropriate use, and more. The growth and development of health technology assessment (HTA) in government and the private sector reflect this demand.

Health technology assessment methods are evolving and their applications are increasingly diverse. This chapter introduces fundamental aspects and issues of a dynamic field of inquiry. Broader participation of people with multiple disciplines and different roles in healthcare is enriching the field. The heightened demand for HTA, in particular from the for-profit and not-for-profit private sectors as well as from government agencies, is pushing the field to evolve more systematic and transparent assessment processes and reporting to diverse users. The body of knowledge about HTA cannot be found in one place and is not static. Practitioners and users of HTA should not only monitor changes in the field but have considerable opportunities to contribute to its development.

Origins of Technology Assessment

Technology assessment (TA) arose in the mid-1960s from an appreciation of the critical role of technology in modern society and its potential for unintended, and sometimes harmful, consequences. Experience with the side effects of a multitude of chemical, industrial and agricultural processes, and such services as transportation, health, and resource management contributed to this understanding. Early assessments concerned such topics as offshore oil drilling, pesticides, automobile pollution, nuclear power plants, supersonic airplanes, weather modification, and the artificial heart. TA was conceived as a way to identify the desirable first-order, intended effects of technologies as well as the higher-order, unintended social, economic, and environmental effects.

The term technology assessment was introduced in 1965 during deliberations of the Committee on Science and Astronautics of the U.S. House of Representatives. Congressman Emilio Daddario emphasized that the purpose of TA was to serve policymaking, technical information needed by policymakers is frequently not available, or not in the right form. A policymaker cannot judge the merits or consequences of a technological program within a strictly technical context. He has to consider social, economic, and legal implications of any course of action.

Congress commissioned independent studies by the National Academy of Sciences, the National Academy of Engineering (NAE), and the Legislative Reference Service of the Library of Congress that significantly influenced the development and application of TA. These studies and further congressional hearings led the National Science Foundation to establish a TA program and, in 1972, Congress to authorize the congressional Office of Technology Assessment (OTA), which was founded in 1973, became operational in 1974 and established its health program in 1975.

Many observers were concerned that TA would be a means by which government would impede the development and use of technology. However, this was not the intent of Congress or of the agencies that conducted the original TAs. In 1969, an NAE report to Congress emphasized that technology assessment would aid Congress to become more effective in assuring that broad public, as well as private interests, are fully considered while enabling technology to make the maximum contribution to our society’s welfare.

With somewhat different aims, private industry used TA to aid in competing in the marketplace, for understanding the future business environment, and for producing options for decision-makers.

Technology assessment methodology drew upon a variety of analytical, evaluative, and planning techniques. Among these were systems analysis, cost-benefit analysis, consensus development methods (e.g., Delphi method), engineering feasibility studies, clinical trials, market research, technological forecasting, and others. TA practitioners and policymakers recognized that TA is evolving, flexible, and should be tailored to the task.

Early Health Technology Assessment

Health technologies had been studied for safety, effectiveness, cost, and other concerns long before the advent of HTA. The development of TA as a systematic inquiry in the 1960s and 1970s coincided with the introduction of some health technologies that prompted widespread public interest in matters that transcended their immediate health effects. Health-care technologies were among the topics of early TAs. Multiphasic health screening was one of three topics of experimental TAs conducted by the NAE at the request of Congress. In response to a request by the National Science Foundation (NSF) to further develop the TA concept in the area of biomedical technologies, the National Research Council (NRC) conducted TAs on in vitro fertilization, predetermination of the sex of children, retardation of aging, and modifying human behavior by neurosurgical, electrical or pharmaceutical means. The OTA issued a report on drug bioequivalence in 1974, and the OTA