Comprehensive Guide to Telemedicine and Telerehabilitation in Physical Therapy
Introduction to Healthcare Informatics and Telehealth
The healthcare market in the century is continually evolving, making it pivotal for healthcare professionals to remain current with changes in care delivery and the media formats used. A significant component of this evolution is healthcare informatics and the role of Telehealth.
Core Definitions and Concepts
Health Informatics: This field involves the process of acquiring, storing, retrieving, and using healthcare information. Its primary purpose is to foster improved collaboration among a patient's various healthcare providers. Informatics is considered a critical element in the ongoing push toward comprehensive healthcare reform.
Telehealth: This refers to the use of electronic communications to provide healthcare services and information to patients and clients. These services can be delivered through two primary methods:
Synchronous Service: Delivery in real time using audio and video technology.
Asynchronous Service (Store and Forward): Information or services distributed over a period of time using store and forward technology.
Clinical Application: Physical therapists (PTs) and physical therapist assistants (PTAs) utilize both synchronous and asynchronous methods to increase collaborative abilities and bridge tangible gaps to address patient needs effectively.
Standardized Terminology
Standardized definitions provided by the American Telemedicine Association (ATA) help clarify the various aspects of electronic healthcare delivery:
Telemedicine: The use of medical information exchanged from one site to another via electronic communications specifically to improve a patient's clinical health status. This encompasses a variety of tools, including two-way video, email, smartphones, and wireless technologies.
Telerehabilitation: The delivery of rehabilitation services via information and communication technologies. This term covers a broad range of clinical services, such as:
Assessment
Monitoring
Prevention
Intervention
Supervision
Education
Consultation and counseling
Synchronous: Interactive video connections that transmit information in both directions simultaneously during the same period of time.
Asynchronous: The store and forward transmission of medical images or data. Unlike synchronous communication, the data transfer usually takes place over a period of time and in separate time frames; the transmission does not occur simultaneously.
Distant or Hub Site: The site where the physician or licensed practitioner (such as a physical therapist) is located while providing services via a telecommunication system.
Originating or Spoke Site: The location of the patient at the time the service is being furnished via a telecommunication system.
Telepresenters: Individuals who may be required to facilitate the delivery of services at the originating site.
The Shift Toward Telehealth in Physical Therapy
The move toward Telehealth services is driven by a need for greater efficiency in the healthcare world. Patients, providers, and third-party payers are increasingly adopting these models due to several factors:
Aging Population: The growing population of older adults places an incredible amount of stress on the healthcare system and increases demand on unfulfilled healthcare staff.
Patient Preference: Patients are seeking more efficient models of care that move away from traditional, clinic-based appointments.
Geographical Expansion: Traditionally used in rural areas, Telehealth is now being pushed into other areas such as densely populated cities. In these environments, patients utilize Telehealth to avoid traffic and save time compared to traditional clinical visits.
Professional Alignment: The American Physical Therapy Association (APTA) facilitates Telehealth through its Frontiers in Research, Science and Technology (FRIST) council. This council focuses on technology and science that will drive the profession into the future.
Analysis of Telehealth Implementation
Advantages (Pros)
Improved Efficiency: Better management of provider and patient time.
Home-Based Management: Ability to manage care from the home rather than a clinic or hospital setting.
Cost Reduction: Once a program is established, the overall cost of delivering care decreases.
Increased Access: Improved reach to rural populations.
Reduced Wait Times: More immediate access to care.
Decreased Travel Costs: Financial savings for both patients and providers regarding transportation.
Disadvantages and Barriers (Cons)
Technology Access: Not all patients have the necessary hardware or tools.
Connectivity Issues: Variations in overall connectivity speeds for patients.
Start-Up Costs: Initial investment required for both patients and providers to integrate appropriate systems.
Traditional Preference: Some patients still prefer the traditional clinical system.
Reimbursement: Presently, there is limited reimbursement specifically for physical therapists.
Practical Implementation Examples in Physical Therapy
Supervisory Visits: A physical therapist can communicate with a patient via Telehealth while a physical therapist assistant (PTA) provides ongoing care in a home health setting.
Teleconsultation: This allows for the mentoring of less experienced PT and PTA staff and provides a platform for consulting with patients.
Outcome Assessment: Using wearable technology, such as a Fitbit, allows for remote monitoring. Pedometers in these devices can be used to assess:
Endurance
Functional capacity
Gait speed
Overall physical capacity
Clinical Education: Practitioners can be educated through media formats outside of direct one-to-one education.
Requirements for Successful Implementation
Physicians and practitioners must follow specific steps to legally and effectively implement a Telehealth program:
State Board Assessment: Contact the state board of physical therapy practice. While Telehealth is an additional delivery method, states may require specific legislation or board regulations before practice can begin.
Licensure Awareness: Providers must be aware of licensure requirements, especially when managing patients remotely across state lines.
State Practice Act: Determine if Telehealth is addressed in the specific state practice act to ensure care is provided within the legal scope of practice.
Advocacy: If Telehealth is not in the practice act, practitioners should engage with state boards and local chapters or legislators to facilitate professional change and meet community needs.
Medicare and Payer Status: Currently, physical therapists are not approved Medicare providers for Telehealth services. However, some commercial payers encourage its use, providing an opportunity for practitioners to expand their practice.
Billing Procedures: Billing for physical therapy services does not change when using Telehealth. Commonly used Current Procedural Terminology (CPT) codes for physical therapy remain the same, including: