OPT 219 Telehealth in optometry

Why is telehealth important?

-breaking down barriers to care
-preventing vision loss
-improving quality of life

what is one of the top ten disabilities in the US?

blindness

What percent of diabetic medicare patients received an eye exam in the past year?

54.1% (2017)

What percent of respondents in the 2020 AOA eye-Q survey has not had an eye exam in the past two years?

58%

What are examples of barriers to care?

-access to quality care
-transportation
-resources (insurance and ability to pay for services, time)
-perceived need (pt education)

according to the CDC, can reducing barriers to healthcare limit vision loss?

yes

What is the role of telehealth?

helps eliminate some barrier to care; works well when utilized alongside in person care to prevent vision loss

T or F: all comprehensive eye telehealth modalities aim to remove barrier to accessibility while bridging the gap in service delivery by reaching remote and underserved areas including reducing conventional travel time and expense for patients.

True - Quote by Dr. Maa MD

What is telemedicine?

designed to integrate telecommunications into diagnostic and therapeutic intervention. refers specifically to remote clinical services

What is telehealth?

designed to integrate telecommunication systems into the practice of protecting and prompting health. Includes telemedicine and store and forward imaging, patient education, etc

T/F telemedicine is more all-encompassing.

False, telehealth is more all encompassing

What is meant by synchronous?

either a clinic or home based telehealth visit where the patient and provider meet in real time via video conference, live chat, or telephone

What is meant by asynchronous?

health information is acquired transmitted to a secure location, and reviewed by a distant provider at a different time

What is clinic based telehealth?

a synchronous or asynchronous visit in a clinical setting with a clinical staff member/facilitatory supporting the visit

What is home based monitoring telehealth?

the patient collects and/or submits information to a provider from home or a non clinic setting (ex: home IOP monitoring)

What are examples of telehealth facilitators?

-technician
-imaging staff
-nurse
-anyone supporting the visit

What is a telehealth provider?

clinical provider (optometrist, ophthalmologist) who provides the patient care

Are clinical and imaging staff required for synchronous or asynchronous care?

They may be required for both to assist in collecting data and performing components of the exam

What is an originating site?

the location where the patient receives healthcare services through a telecommunication system

What is DICOM?

Digital Imaging and Communications in Medicine; international standard for medical images allowing for a standardized storage format ensuring image equality and compatibility between systems (ex: Zeiss Forum)

What occurred in March of 1905 for telehealth history?

Willem Einthoven transmits the first tele-electrocardiogram

What occurred in 1959 for telehealth history?

University of Nebraska uses a two way television communication system to share information with medical students (leads to video consults with local hospitals)

What occurred in 1970s-1980s for telehealth history?

NASA in combo with the military, STARPAHC used for remote dx in southern arizona for a native american tribe

what were the issues with STARPAHC?

expensive

What occurred in 2005 for telehealth history?

SUNDROP: done on retinopathy of prematurity

What occurred in 2020 for telehealth history?

SARS Cov-2 pandemic sees a surge in telehealth patient visits by 250-700% in different areas

T or F: Telehealth is healthcare's natural evolution into the digital age.

True; not just another type of care. It can be a critical tool in advancing a well coordinated patient centered value optimized healthcare system

What is home monitoring?

device used by patient, information transmitted to the doctor

What are video chat services?

synchronous doctor/patient encounter via phone or computer

What are remote optometrist lanes?

synchronous doctor/patient encounter with access to additional equipment and more diagnostic tools

What are examples of ocular telehealth veteran's affairs progrmas?

-tele-retina
-technology based eye care services (TECS)

What is tele-retina?

asynchronous service, modeled after the joslin vision netwok

What is TECS?

asynchronous service; builds upon the well established tele-retinal program, while incorporation of mydriatic fundus photos, refraction etc

can you give an exam in another state if practicing in TN?

you and the patient must be in the same state unless you are employed by the federal government

What are implementation barriers of synchronous telehealth?

-maintaining high standard of care
-platform for communication (fees, HIPAA)
-limited ability to collect data; some EMR systems may not be compatible
-internet access
-information security

What are implementation barriers of asynchronous telehealth?

-maintaining high standard of care

-equipment needs

-space

-personnel

-increased cost

What equipment is needed for asynchronous telehealth?

-depends on degree of care offered
-anterior and posterior segment imaging
-visual acuity measure
-refraction by a technician
-IOP measurements
-OCT/VF

is every patient a good candidate for telehealth?

no, it is very dependent on the patient case

For billing and coding, does Z code need to match the provider code?

No; testing and exam portion on the patient side are coded sequentially as they perform testing then the provider bills the interpretation code

What are legal considerations for telehealth?

-licensing by state: provider should be licensed in the state where the patient receives care
-HIPAA: standard of compliance are the same for telehealth as in a normal office
-data security: IT staff required to oversee proper security of data and transmission
-tort liability (negligence due to a breach of duty within the provider patient relationship)
-malpractice insurance

What goes into telehealth ethics?

-quality of care
-safety
-patient education

What is coming for the future of telehealth?

AI and machine learning (retinal imaging, OCT interpretation)

What is supervised learning?

prediction of values, observation with labels

What is unsupervised learning?

data organization, observations do not have labels

What is semi supervised learning?

prediction of values, some of the data has labels

What is reinforcement learning?

interaction with the environment (online open AI)

What is deep learning?

uses multiple layers to progress, can be combined