Telehealth and the health librarian
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Telehealth (also telemedicine) is broadly defined as the delivery of health services via information technologies to those at a distance from major urban centres and hospitals. This entry is an introduction to telehealth for health librarians who may be interested in providing library services using telehealth technology. Although telemedicine is used synonymously for telehealth, the terms are different. Telehealth refers to the delivery of a range of general health services using information and communication technologies (ICTs) whereas telemedicine deals with the specific delivery of diagnostic and treatment services for patients using ICTs.
According to Health Canada, eHealth can be defined as “a term used today to describe the application of information and communications technologies in the health sector”. Both mHealth and telehealth fall under the term eHealth, which is a broader concept. eHealth is used for the purpose of administrative ease i.e., electronic health records (EHRs) and facilitation of health informatics projects. mHealth, more specifically, refers to the use of mobiles such as smartphones or tablets to communicate and access health information. mHealth is also used to refer to telemedicine; telemedicine is not restricted to any one technology but may feature the integration and combination of a variety of technologies.
Telemedicine has been shown to help patients be more engaged in their health and enable better management of chronic diseases, resulting in fewer and shorter hospital stays, fewer emergency room visits, less severe illness, and fewer deaths. Telemedicine services are widely available in most Canadian provinces and territories. For a discussion of the regulatory framework for the provision of telemedicine services, see College of Physicians and Surgeons of Ontario Primer on Telemedicine.
Canada Health Infoway’s website on teleheath describes the process of a typical medical telehealth exam or consultation. Typically, it is facilitated by a trained consultant and achieved by using a combination of ICTs such as computer screens, cameras, microphones and telephones as well as specialized medical equipment such as a digital stethoscope.
A divide within the discipline of telehealth exists between synchronous (“real-time” interactions, enabled by phone calls, video feeds, and instant message systems) and the store-and-forward variety (consultations and communications between patient and practitioners that are not strictly time-dependent). Each event or service has its own set of advantages and disadvantages and factors that affect decisions about which is more appropriate. These factors include convenience, potential for relationship-building and technological and budgetary limitations such as low-bandwidth. The precise type of patient care required plays an important role in the selection of service as does the existence of technology that supports its practice.
Benefits of telehealth
An often cited advantage of telehealth is that it eliminates the need to have doctors, nurses and other health providers onsite to provide patient care. Consequently, telehealth is seen as a viable solution to the provision of certain types of care for remote and rural communities, and those with no convenient access to hospitals and medical specialists. Similarly, telehealth is frequently used for emergencies when immediate care is a life or death matter. ICTs can be used to provide care to patients even in the absence of trained local health professionals.
Telehealth has the potential to empower health consumers in their day-to-day care, rehabilitation and ongoing health management. Its convenience is an important factor as it accommodates patients who are unable to travel to treatment centres due to cost, lack of time, mobility or because they are homebound. Telehealth is also valuable for patients who want to stay at home in a familiar environment and be nearer their support networks. Another benefit of telehealth, especially for those living in small communities, is the availability of services that preserve anonymity. For some patients with certain infections and diseases, telehealth may reduce fears of stigmatization or being "found out" that they are suffering from a specific condition or illness.
Challenges and critiques of telehealth
Telehealth is a relatively new form of healthcare delivery, and one in a constant state of evolution due to its dependence on and development of information technologies. Health providers and patients need access to supportive technologies and training about how to use them. Depending on the complexity of equipment and devices, costs can pose additional challenges. In any case, medical facilities, as well as communities or individuals, must see the purchase of telehealth systems as important investments.
Once patients have reached a level of proficiency with telehealth, there are still other barriers to consider. For example, in the absence of face-to-face interactions with health providers, there may be more onus placed on patients to interpret health information on their own. The development of health literacy programs may introduce an additional dimension to telehealth implementation. There is also some disagreement over the value and quality of telehealth care due to the small but growing body of evidence evaluating services and patient satisfaction.
Some health providers are concerned that telehealth is used mainly because it reduces costs. In the United Kingdom, the large-scale adoption of telehealth services has raised concerns due to a lack of evidence and studies of effectiveness. In Canada, where telehealth has been used for many years, the practice is well-established. However, there are concernts that some administrators view telehealth as a panacea to problems in accessing care. The provision of telehealth should not preclude establishing proper clinical services in all regions of Canada. The perception of telehealth as cost-effective is open to debate. Since it aims to increase access to services for more people, it may in the end result in increased costs overall.
Telehealth and the librarian
In "Information connection: telehealth, telemedicine, and the virtual health sciences librarian", Moore argues for positioning the library as a natural locale for hosting telehealth facilities. The 1997 article is one of the few articles that explores the issues of telehealth for health librarians. In her paper, she cites the University of Kentucky and the Texas Tech University Health Sciences Center as examples of where the telemedicine consultation room is part of the library’s physical structure. The idea of the library as a telehealth resource centre is reiterated by Trivedi. In "Health science libraries in the 21st Century", he envisions health libraries as integrated learning centres for health practitioners. The idea is that the library can represent access points to biomedical information as well as for hands-on training with telehealth equipment and technologies that support remote diagnosis and patient care.
Health librarians have potential roles to play in managing telehealth information and telehealth databases such as the Telemedicine Information Exchange. In the future, health librarians may want to provide reference services and prioritize collection development activities related to telehealth. Information professionals working in health records management may find additional challenges in providing access to and disseminating health information especially given privacy and security concerns. Other concerns include legal limitations on healthcare services, health information management and licensure requirements related to telehealth which prohibit medical practice across states and provinces.
With experience in providing information retrieval training and evaluation of resources, health librarians are well-positioned to serve and support health literacy initiatives for medical practitioners and patients. The key is to ensure access to new telehealth resources and technologies. Health information-seeking via digital libraries and the discipline of human-computer interaction put health librarians in a good position to inform developers and designers of telehealth interfaces how to meet the needs of users. Masys argues that the effect of future information technologies on healthcare may trigger the creation of a new profession, possibly requiring its own licensure for practice, called a "personal health advocate and adviser". This type of information professional would provide customized information services and education for the public, and assist patients to understand their health issues and manage them accordingly.