Introduction
The use of ICT in the healthcare sector has been rapidly growing since them, especially with the discovery of the internet and other advanced technologies. Currently, many healthcare providers are heavily relying on telehealth and telemedicine to save time, money, and to improve the quality of healthcare services. Telehealth and telemedicine were mainly introduced in the healthcare sector to lower the cost of delivering healthcare services, enhance the efficiency of the healthcare workforce, to improve the equitable as well as timely access to the healthcare services. For instance, studies have shown that the USA can save about $4.3 billion annually if it allows the implementation of telehealth in its main health facilities. New Jersey is one of the states that are encouraging the use of telehealth and telemedicine in its healthcare facilities. Recently, it enacted a law that helps in broadening the definition of a healthcare provider to enable health professionals to deliver telehealth and telemedicine services ( Wade et al ., 2010) . Telehealth and telemedicine are not only beneficial to patients, but also healthcare professionals because they because they enhance their efficiency and effectiveness in delivering healthcare services.
Current Use of Telehealth
The terms telehealth and telemedicine are always used interchangeably by many people, including health professionals, even though they slightly mean different things. The term telehealth incorporates technologies as well as services that are aimed at providing patient care and enhancing the efficiency of healthcare delivery system as a whole. Telehealth is different from telemedicine mainly because it involves a broader scope of online or remote healthcare services compared to the latter. Unlike telemedicine that is only based on remote clinical services, telehealth can involve both remote clinical and non-clinical services such as training health professionals and conducting administrative meetings. According to the definition of the World Health Organization (WHO), telehealth includes health promotion, public health functions, and surveillance ( Wade et al ., 2010) . Therefore, telehealth is a sub-set of e-health.
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Telemedicine, on the other hand, is the sub-set of telehealth because it is restricted to the provision of healthcare service through remote means such as telecommunication. Telemedicine is mainly used to manage chronic conditions, provide specialist consultations, and to conduct remote follow-up visits ( Schwamm et al ., 2017) . Hence, there is some difference between telemedicine and telehealth, especially regarding the scope of use. However, they are both used to provide remote healthcare services and healthcare-related activities.
Both telehealth and telemedicine are used to provide various health care services to needy patients. They are used to conduct remote follow-up visits, especially through the use of video, which is essential because it enhances compliance with aftercare visit recommendations while at the same time reducing the cost of moving from one place to another ( Fatehi & Wootton, 2012) . Health professionals in the USA, including New Jersey have successfully used telehealth to significantly reduce the case of last-minute cancellation and no-shows that are mainly associated with time constraint and geographical locations. Telehealth and telemedicine have also effectively been used to manage patients with chronic diseases. It is estimated that 164 million US citizens will be affected by chronic diseases by 2025 ( Fatehi & Wootton, 2012) . At the same time, about 80% of total hospital admissions in the country are associated with chronic illness. Besides, chronic illness accounts for 76% of total physician visits. Consequently, health professionals in the USA and New Jersey State are using telehealth and telemedicine to improve the effectiveness of chronic disease care. Also, they are used to manage to reduce the cost of managing chronic conditions.
Telehealth is currently being used in many hospitals in New Jersey to provide hyper-specialty care. Specifically, telehealth is used to offer hyper-specially care because of its ability to break down geographical barriers. Patients seeking hyper-specially care do not have to visit hospitals or doctors' offices to access such care services ( Schwamm et al ., 2017) . Also, telehealth is used to provide team-based medicine. It enables specialty doctors and other health professionals to collaborate and work together to provide the best healthcare outcome to patients suffering from various diseases. Telehealth makes it possible it possible for health professionals to communicate with one another while at the same time remotely communicating with patients. Therefore, telehealth and telemedicine are used to provide various healthcare services in various setting.
The main population currently using telehealth and telemedicine are people with high income. Telehealth systems, for instance, involves the use of technology that may not be easily accessed by people with low income. As a result, it is estimated that only 3% of people from the low-income household can access telehealth and telemedicine services. Therefore, the penetration of telehealth and telemedicine in New Jersey is still low, even though it is gaining momentum. Another group of people who are main consumers of telehealth and telemedicine is millennials. Millennials are techno-savvy, and they place a high value on convenience and the need to reduce the cost, making them prefer remote healthcare services. About 60% of millennials prefer to use telehealth instead of in-office visits while seeking healthcare services. Also, patients who are chronically ill are most likely to use telehealth than other patients because of the need of close care they need all the time ( Fatehi & Wootton, 2012) . Specifically, telehealth is used to monitor the conditions of patients who are suffering from chronic diseases.
According to Fatehi & Wootton (2012), n urses play important role in the healthcare sector and it is not possible for telehealth and telemedicine to be implemented without the input of nurses. Nurses mainly act as a go-between for the patient and the doctor. Nurses are the health care professionals who actively play a role in monitoring how patients are doing through telehealth system. Also, nurses take care of patients who are treated and monitored through telehealth and telemedicine. For instance, it is nurses who capture the photo of a wound or condition of the patients and then transmit it to physicians who recommend the proper clinical action to be taken. Therefore, the role of nurses is being reshaped by the introduction of telehealth and telemedicine in the health care sector in New Jersey and the US as a whole.
Also, the implementation of telehealth and telemedicine required various equipment and systems. However, it is important for the hospital to create a convenient and effective working environment because of the possibility of disrupting the existing healthcare process. The environment should be designed in a way that it can address various needs of patients. Secondly, there is need to install a system that makes interaction and communication possible, especially between the patient and the doctor. Hence, some factors should be considered in the implementation of telehealth and telemedicine ( Fatehi & Wootton, 2012) .
Advantages and Disadvantages of the Use of Telehealth
Almost every technology has advantages and disadvantages, and the same applies to the telehealth. However, it is obvious that the advantages of telehealth outweigh its disadvantages. One of the main advantages of telehealth is that it helps in saving the cost of healthcare ( O’Connell, 2015) . Studies have shown that remote analysis and monitoring of healthcare services substantially lowers the cost of health, making health professionals, patients, and insurance companies to save some money. According to the recent study that was conducted by the American Hospital Association, both telehealth and telemedicine help in reducing the cost of healthcare by about 11% ( O’Connell, 2015) . At the same time, it is estimated that the online medical consultation costs about $45 compared to in-office consultations that cost between $100 and $160. Hence, telehealth and telemedicine significantly reduce the cost of health.
Secondly, telehealth increases the convenience and easy accessibility of the healthcare services. The use of telehealth gives the hospital the opportunity to provide simple on-demand care without wasting time for both patients and doctors. Besides, it makes it possible for patients who like in geographically remote areas to access quality healthcare services ( O’Connell, 2015) . Thirdly, telehealth and telemedicine are advantageous because they enhance patient engagement. Engaging patients through the use of technologies such as telehealth encourage them to encourage appointments and care schedules, which is essential in maintaining a healthy life.
However, telehealth is also associated with some disadvantages. One of the main disadvantages is the initial cost of setting up a telehealth system. Many patients are not able to access telemedicine equipment while physicians find it expensive to set and maintain the system. The second disadvantage is lack of face-to-face interaction between patients and healthcare professionals ( Bull et al ., 2016) . This reduced bonding between patient and doctors and it can also prevent patients from disclosing necessary information. Thirdly, telehealth is disadvantageous because it forces health professionals to go through additional technical training, which may be time wasting and expensive.
Future Recommendations for Telehealth
The first recommendation is the need to make telehealth services accessible to many people regardless of their socio-economic status. Currently, only a few people can access the services due to the initial cost and the need to poses technical skills on how to use the technology. The fact that only 3% of poor people can access telehealth services is worrying and should be addressed. New Jersey State can solve this, and the federal government funding telehealth related programs and ensure that as many people can access it as possible.
The second recommendation is about the training of healthcare personnel. The success of telehealth in achieving its objectives is mainly influenced by the ability of healthcare personnel to use the technology effectively. Telehealth and telemedicine are new technologies that are not taught in many medical classes. Hence, medical personnel should be trained on technical skills required to use the technology. Thirdly, states should come up with laws that ensure that the confidentially and health information of the patients are protected ( Bull et al ., 2016) . Health personnel using the technology should ensure that unauthorized persons cannot access private health information of patients.
Summary
Even though the terms telehealth and telemedicine are always used interchangeably, they are different. Telemedicine only focuses on remote clinical services while telehealth involves both clinical and non-clinical services. Both state and national government are supporting the use of telehealth and telemedicine because it reduced the cost of health, make healthcare services accessible, and improves the quality of health. However, the rate of use of telehealth is still low, especially in rural areas and among people with low income. Telehealth is associated with many benefits such as reduced cost of health, enhance convenience, and increased patient engagement, which makes necessary in the modern world. Therefore, there is a need to make telehealth and telemedicine accessible to many people, ensure that health professional have technical skills, and they be designed in a way that they protect the privacy and confidentiality of patients.
References
Bull, T. P., Dewar, A. R., Malvey, D. M., & Szalma, J. L. (2016). Considerations for the telehealth systems of tomorrow: An analysis of student perceptions of telehealth technologies. JMIR medical education , 2 (2).
Fatehi, F., & Wootton, R. (2012). Telemedicine, telehealth or e-health? A bibliometric analysis of the trends in the use of these terms. Journal of telemedicine and telecare , 18 (8), 460- 464.
O'Connell, P. (2015). Advantages and Challenges of using Telehealth Medicine. Global Journal of Medical Research , 15 (4), 19-22.
Schwamm, L. H., Chumbler, N., Brown, E., Fonarow, G. C., Berube, D., Nystrom, K. ... & Lacktman, N. (2017). Recommendations for the implementation of telehealth in cardiovascular and stroke care: a policy statement from the American Heart Association. Circulation , 135 (7), 24-44.
Wade, V. A., Karnon, J., Elshaug, A. G., & Hiller, J. E. (2010). A systematic review of economic analyses of telehealth services using real-time video communication. BMC health services research , 10 (1), 233.
