Introduction
Patient engagement in the management of chronic conditions is a worldwide concern for policymakers, researchers, and clinicians. Consequently, the delivery of personalized healthcare at any time and any place is gaining significance. A care model where the healthcare organizations are linked to the external community and one that links healthcare providers to the patients’ life contexts is fundamental in ensuring timely and appropriate personalized care is delivered at the patients’ location without the need to travel or incur time and cost implications (Wiederhold & Riva, 2014). Models that favor a care system that is accessible and responsive to effective communication and care coordination between providers and patients highlight the importance of patient engagement.
Furthermore, systems that facilitate patient-centered care are sensitive to treatment adherence, patient outcome improvements, and reduction in the cost of care. In order to understand people’s health and care experiences, their engagement and participation are necessary. As a result, changes in service delivery and in practice which define the quality of care can be achieved. Patient engagement through modification of healthcare systems to suit effective information exchange between providers and patients is one costly venture that calls for a shift in the healthcare cost curve (Wiederhold & Riva, 2014). In the wake of a period where healthcare costs are a major challenge, the use of telemedicine or e-health technologies would serve the role of both controlling healthcare costs as well as improving quality of care.
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Quality and accessibility of healthcare remain a concern for many states. In developing countries, the delivery of quality and accessible healthcare is curtailed by poor connectivity and limited infrastructure in remote regions. This reason informs the discrepancies in healthcare witnessed between rural and urban dwellers. In order to bridge this gap, the integration of telemedicine technology into healthcare has been adopted worldwide. The establishment of telecommunication infrastructure in rural and remote areas is easier as compared to placement of medical specialists in those regions (Rai & Acharya, 2016).
Scope of Telemedicine
Telemedicine is the integration of information and communication technologies in the delivery of healthcare services to patients whose location is distantly far from the healthcare centers or medical specialists. Telemedicine facilitates the exchange of information necessary for injury and disease diagnosis, treatment, prevention, research evaluation and continuing education of healthcare professionals. The overall aim of telemedicine is the advancement of quality health care to individuals and communities (Bauer et al., 2014). This advancement is ensured through critical care monitoring, disease surveillance, disaster response and management, use of robotics, program tracking, public awareness, and continuing medical education and research.
The conditions and specific needs of patients must be central in the implementation of telehealth technology thereby informing the choice of the best telecommunication approach to utilize. In the market, variety e-health technologies whose choice can be considered when necessary exist. First, emailing and mobile phones usage (calls or texting) may be chosen for enabling patient linkage to healthcare provider whenever a need arises and for facilitation of remote monitoring and coordination of care. Secondly, social media platforms such as Twitter, Facebook, Google+, etc. can be chosen for purposes of sharing health topics with patients. Thirdly, the internet through websites, Wikipedia, eBooks etc. can be chosen for creating awareness through making health and health literacy information available and accessible to the patients (Wiederhold & Riva, 2014). Lastly, electronic health record (EHR) can be chosen for sharing patient information amongst care providers within an organization. Patients or authorized laypeople may also share such patient information.
Role of Telemedicine in Patient Personalized Care Model
Telemedicine seeks to bring patients into attention about their pathological status and how to manage it through use of available resources. Patients can access information laid in healthcare web portals to get knowledge on action or direction to take. New communication technologies facilitate real-time patient-practitioner consultations through video-chatting, distant delivery of health services, and synchronization of data and information for purposes of analysis and further consultation (Wiederhold & Riva, 2014).
The effect of an illness on a patient’s physiological and emotional status leads to a reduced level of self-efficacy. In order to realize self-management of the disease while in this state, simulation technologies present an opportunity for patients to exercise their abilities in virtual settings. Mobile applications assist in facilitating patient education, remote monitoring of one’s status, and disease self-management. In addition, social networks facilitate sharing of experiences and information thus improving patient condition through positive interactions (Wiederhold & Riva, 2014). Social networking, simulations, and interactions are important tools in patient education and care. Healthcare providers must be in contact with the patients in all these processes. Advancement of health and health wellness is the ultimate goal for the integration of such mobile technologies. The inception of smartphones must be appreciated in the enhancement of consultations and interactions between providers and patients, in the registration and supervision of psychological and behavioral data, and in facilitating instant feedback delivery to patients.
Telemedicine further seeks to ensure that interactions and collaborations among patient and provider communities positively impact the patients. Patients are taken through a personalized therapy experience where health guidelines become a reality of meaningful experiences. Consequently, patients experience a social presence through the social support they exchange in their virtual community contexts. In this sense, the patients’ identity management and reconstruction are propped up. This is because the information shared through people’s stories plays an active role in a person’s identity construction and emotional wellbeing especially when in conditions such as illness. Web blogs are examples of a digital story-telling tool commonly utilized in health-related settings. Patient’s blogs on their experiences and knowledge are usually shared extensively in patient community networks to trigger socialization, dialogue, expression of feelings and quests for assistance among peers (Wiederhold & Riva, 2014). As a result, educational objectives in such settings are realized.
Strengths of Telemedicine
It ensures that patients easily access medical specialists through reduced travel and appointment times and increased interaction periods with medical providers (Rai & Acharya, 2016, p. 801). Therefore, the accuracy of diagnoses is enhanced through a personalized care process. As a result, both the patients and the providers achieve economic savings and improved effectiveness. Through telemedicine, rural-based patients, who could have otherwise missed healthcare services, are able to access the services of medical specialists. Apart from its cost-effectiveness, telemedicine reduces work shortfalls due to time employees take off to seek medical consultations thus increasing workplace productivity.
Additionally, telemedicine improves the quality of care by ensuring patient-centered decision-making approaches are put into use. Through health information technology, interdisciplinary communication and practitioner performance is increased thus reducing adverse patient events, and ultimately improving patient satisfaction with care (Rai & Acharya, 2016, p. 801). Also, patients have access to disease information, available remedies and prevention measures.
Weaknesses and Barriers to Telemedicine
In rural or remote regions, telemedicine use is limited by inadequate connectivity, power supply and challenges in the repair of equipment (Rai & Acharya, 2016). These inadequacies may hinder the clarity and speed of networks. Equally, the purchase, installation, and maintenance of the equipment are costly investments that require not only big budgetary allocations but also policy formulation which may not be a priority for the political class. Also, telemedicine technology involves technicalities that require appropriate skills to operate. The attainment of the skills and expertise is time-consuming and expensive thereby calling for increased commitment and investment in the development and advancement of such skills.
The benefits of telemedicine notwithstanding, there are potential risks and penalties stipulated under the Health Insurance Portability and Accountability Act (HIPAA) that restrict the sharing of patient information due to concerns of patient confidentiality in healthcare provider ethical standards (McLaughlin, 2017). Patient information constitutes electronic protected health information (ePHI) that is subject to such security and privacy standards similar to electronic health records (EHRs) usually stored and maintained on health care facilities’ servers. On the other hand, some patients may develop negative attitudes towards telemedicine. This attitude may be as a result of technical difficulties in using user unfriendly applications or illiteracy levels that limit the use of such modern technological advancements. Delayed feedbacks can also influence the patients’ attitudes to the use of telecommunication technologies in healthcare. Patients may also lack the consistency to make follow-ups on their medication therapies because some patients prefer face-to-face consultations and feel uncomfortable on video conferencing or such indirect interactions.
Moreover, some healthcare providers may be deficient in the knowledge of information technology and as a result, may develop reluctance using telemedicine approaches. Apparently, in some countries, there is a broad diversity in language use thus making it difficult to have effective communication between patients and medical specialists or among communities of patients participating in social networking. User unfriendly interfaces of systems that are poorly designed are associated with risks such as security breaches, user error, and downtime thus, threatens the safety of patients, lower the quality of care, and cause misrepresentation of the capability of health information (Nemec & Chan, 2017).
Solutions to the Barriers
Increased connectivity can be achieved through the use of fast wired and wireless internet networks and mobile computers. Use of wireless mobile computers would facilitate quicker processing and transmission of videos, long distance patient-provider consultations, and enhance video conferencing approaches. With modern smartphones that have strong wireless connectivity, patients can make direct contacts with healthcare providers and schedule appointments easily (Nemec & Chan, 2017). In addition, smartphone software applications can be used in data collection, self-reporting, and evaluation that is essential in care and research.
Challenges in technical difficulties and user knowledge can be addressed through continued advancement of healthcare professionals to ensure they are equipped with the appropriate competencies and knowledge required for the proper use of the telemedicine technologies. It is the responsibility of the policymakers, healthcare administrators and funders to ensure that even as more widespread usage of finances are channeled towards achievement, sustenance, and enhancement of such skills (Nemec & Chan, 2017). Finally, in order to enhance communication among healthcare professionals and reduce the time taken in the documentation, search and retrieval of records, technological systems, and user interfaces must be well designed.
Conclusion
There are cost implications associated with the introduction and widespread of new e-health technologies. Other than the cost of acquiring such technologies, their effectiveness implies an added cost in training of the existing workforce and recruitment of new workers with the right skills for purposes of offering technical support services and appropriate use (Nemec & Chan, 2017). Also, organizations will have to revise their cultures on continuing education and innovation to conform to the dynamic digitalization of the healthcare delivery. The need for further research shall arise to address the existing theories on the program’s patient safety standards. Telecommunication technologies possess a huge potential for improving the quality of care delivery, fostering self-management, enhancing care accessibility, promoting monitoring and evaluation of symptom changes, and improving health literacy.
References
Bauer, M. A., Katon, W., Unützer, J., Areán, P., &Thielke, M. S. (2014). Aligning health information technologies with effective service delivery models to improve chronic disease care. Preventive Medicine , 66 (1), 167-172. doi:10.1016/j.ypmed.2014.06.017
McLaughlin, P. (2017). HIPAA security challenges in the current technology ecosystem. Journal of Health Care Compliance, 19 (2), 5-12.
Nemec, P. B., & Chan, S. (2017). Behavioral health workforce development challenges in the digital health era. Psychiatric Rehabilitation Journal , 40 (3), 339-341. doi:10.1037/prj0000283
Rai, J., & Acharya, R. (2016).Evaluation of patient and doctor perception toward the use of telemedicine in Apollo Tele Health Services, India. Journal of Family Medicine and Primary Care , 5 (4), 798. doi:10.4103/2249-4863.201174
Wiederhold, B. K., & Riva, G. (2014). Positive change: connecting the virtual and the real . In Annual Review of Cyber therapy and Telemedicine 2014 (pp 3-9). Netherlands: IOS press
