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US and territory telemedicine policies: identifying gaps in perinatal careBACKGROUND: Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories). OBJECTIVE: We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified. STUDY DESIGN: We conducted a 2014 systematic World Wide Webebased review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N=59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis. RESULTS: Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care. CONCLUSION: The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource-challenged jurisdictions.
Defining evaluation indicators for telemedicine as a tool for reducing health inequities: Study and results of a community of practiceThis report presents the opinion of participants in a discussion forum on “Defining Evaluation
Indicators for Telemedicine Projects,” convened by the Pan American Health Organization, and held in
April and May 2015. In all, 52 people from at least 13 countries in Latin America were registered in the
introductory forum. The participants were very clear on the variety of definitions of telemedicine and
on the implications of its inclusion in the term “telehealth”. The greatest benefit discussed was “access
and timeliness”. They thought that telemedicine projects were not and should not be understood simply
as technology projects, but rather were health interventions that relied on and/or used information
and communications technologies (ICTs) for service delivery. For the participants, the differences and
similarities between telemedicine and health services not provided through ICTs were that, while both
basically were health services, the interface created a new paradigm both for the user and the beneficiary.
They found that the greatest challenge in terms of evaluation was the lack of knowledge on use
of telemedicine, which hindered the development of reliable evaluation indicators. Another challenge
was that evaluation should occur in every phase of the project, both comprehensively and in individual
processes. The participants thought that early phases of telemedicine projects should be evaluated systematically,
mainly with regard to feasibility and acceptability. They considered it important to measure
the health impact of telemedicine projects despite the difficulties inherent in the complex multicausal
processes typical of this type of project.
Framework for the Implementation of a Telemedicine Service[Introduction]. This document aims to provide solutions for the successful implementation of telemedicine services
(and eHealth, in general) in the health care setting. Following a literature review that identifies
key theories, models, and frameworks used in the science of implementation, we introduce a theoretical
framework that addresses the obstacles to incorporating and standardizing the use of telemedicine in
health care institutions. This narrative review gathers qualitative information from different sources on
a particular topic, and summarizes and synthesizes the literature in order to determine “what is known”
about a topic (3).
This theoretical framework is based on understanding the context within its broader structure,
together with existing challenges and opportunities. The document introduces the reader to the reality
of implementing telemedicine services in actual health care settings; analyzes interactions that occur
during the process of ICT implementation and changes that occur in organizations, management
models, culture, and medical care services; and, finally, reflects on key aspects related to prioritization,
design, deployment, integration, and assessment. Analysis of this theoretical framework should allow
for the creation of a research program that focuses on major aspects in the successful development of
telemedicine, and generate proposed actions to overcome difficulties.
Bearing in mind its cross-cutting nature, this report is aimed at the community of professionals
(in its broadest sense) willing to work in any field related to the advancement of the health care sector,
both in health and social settings, with the implementation and intensive use of ICTs.
This publication consists of eight chapters. Chapter 2 provides a context for information presented
later in the report, with a special emphasis on terminology and key concepts and their relationship
with the subject under study. With that aim, it provides a brief summary of “state of the art” scientific
publications on telemedicine and introduces the main obstacles and facilitators that should be kept in
mind during implementation.