An Overview of Telehealth and Digital Practice

Edward Dobrzykowski, PT, DPT, MHS, AT, Ret.

June 2, 2020



What is telehealth and why the change to digital health terminology?   


One definition by the Health Resources Services Administration defines telehealth as the use of electronic communication and technologies to support long-distance clinical healthcare, patient, and professional health-related education, public health, and health administration. The technologies include video conferencing, the internet for which we could not do it without the internet obviously, store and forward imaging, streaming media, and the wireless, and both ground communications. So telehealth is a very large area of how we deliver care, you know remotely from our in-person sort of visits.

Digital health is a convergence of digital technologies with health, healthcare, living, and society to improve the efficiency of healthcare delivery. I think the big point about moving to this new terminology over the last couple of years is that it's more encompassing.  It is beyond just the clinical practice of delivering care and billing insurance companies for it. It provides us with a space to communicate as consumers and learn more about our health. It connects devices that allow us to track some of our healthcare needs, particularly those that have chronic kind of condition.

So, along with self-management and adherence, digital health provides us with the potential for connecting more closely and appropriately with our healthcare providers, particularly when there is a sign that indicates we might have a problem. Digital health connects and empowers people to manage their own health and wellness, augmented by accessible and supportive provider teams working within flexible, integrated, interoperable, and digitally-enabled care environments. This is where we get into that term of artificial intelligence, and how is that intelligence going to aid us in recognizing early where we might have a deviation in our healthcare, vital signs or other things that are being tracked and get us into prevention in the system earlier for a remedy.

There are four types of digital practice or telehealth.  You may have heard of the first three.  Synchronous is the real-time on-demand healthcare delivery with a patient and client. As therapists, this type is the one that we'll probably be doing most of the time. It's usually scheduled visits and it's most similar to an in-person visit. You'll likely have a camera there so that you can view the patient during their care during the visit time.  Asynchronous is not real-time healthcare delivery. In the medicine space, this is where for example, radiologists could read and review patient's scans or images and provide feedback. It could be your review of patient assessments prior to the visit. Your dialog maybe post synchronous with a patient to clarify exercises, for example. So it may not be a real-time visit but more of a non-real time but that allows you then some fashion potentially to bill for that visit.

Remote patient monitoring is the desire to improve the quality of chronic disease management. An example of this would be using an assistive device or technology outside the conventional clinic setting to monitor a patient.  All of the wearables for vital signs such as blood pressure, oxygen saturation, and pulse rate would fall under this category.   It could be a home compliance monitor, which is common in use in home healthcare today, or a device measuring exercise completion, which is becoming more and more prevalent. For example, there would be some sort of tracking device that is worn or some kind of computer that you're logging into, that measures the completion of exercises, the type of exercise and the quality of the exercise performed.  It also could be a trigger to cause someone to intervene from the data provided by the device. So for example, for a  total joint patient, you might have a therapist monitoring the patient's completion of their home exercise, their adherence to their program repetitions, quality, and quantity of exercises needed. That may cause us then to intervene seeing that that exercise is not happening.

The last type is mobile health or mHealth.  It refers to the concept of mobile self-care. These are consumer technologies using smartphones, tablet apps, and apps that enable consumers to capture their own health data. Likely most of us are doing that today with our step counts and heart rates. You could also use it to seek out valid information on a specific health questionnaire. So for example, in the behavioral health space, there's a lot of use of digital practice today, where patients fill out a variety of screening assessment tools to then check in with their healthcare provider to provide some indication about how they're feeling.


This Ask The Expert is an excerpt from the webinar, Telehealth (Digital Practice) Implementation: Considerations and Road Map

edward dobrzykowski

Edward Dobrzykowski, PT, DPT, MHS, AT, Ret.

ED DOBRZYKOWSKI, PT, DPT, MHS, AT, Ret., has been engaged in healthcare administration, management, education, and consulting for more than 30 years. He is presently an Independent Contractor/Sole Proprietor for Rehabilitation Services and Education, and Chair-Elect of the Kentucky Physical Therapy License Board. Since 2003, he has provided over 200 workshops/webinars/continuing education events. Topics have included leadership and management development, productivity/efficiency improvement, healthcare transition to value, and telehealth.

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