Telemedicine is defined as “the use of medical information exchanged from one site to another via electronic communications for the health and education of the
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patient or healthcare provider and for the purpose of patient care” by the Ameri-can Telemedicine Association (www.ameriAmeri-cantelemed.org). A willingness and ability of clinicians to develop new ways of interacting and communicating with patients are required, as well as an adjustment of roles and identities among clini-cians and professionals. At this point, telemedicine seems to be the best solution.
Telemedicine is video and audio traveling as a high definition digital signal from one computer to another for the purposes of direct patient care. Telemedicine is supported by the wide availability of wireless internet infrastructure to transport digital data quickly and easily from device to device (Brooks, 2016: 2–4).
Telemedicine was developed as a solution to provide healthcare to under-privileged inaccessible regions and aims to provide equal access to medical care irrespective of geographic location (Sood et al., 2007: 574). The functions of tel-emedicine include: remote physician consultations, intensive care services, mental health monitoring, chronic disease management, and serving as a supplement or an alternative to traditional physician office visits. Telemedicine increases the level of choice available to patients to choose between service providers in a wide range of locations (MacFarlane et al., 2006: 246).
Telemedicine technology can be used on the basis of two concepts: synchro-nous and asynchroconcepts: synchro-nous methods. The synchroconcepts: synchro-nous method requires a real time communication link between groups allowing for live interaction. Remote com-munication devices or video conference equipment are widely used for the syn-chronous telemedicine concept. Both groups can see each other, access related electronic medical data, share opinions on diagnosis, and write reports together.
The asynchronous telemedicine method does not require the presence of both groups at the same time. They can share electronic medical data or images but the assessment is done offline. Telemedical services may be divided into primary and premium services. When considering interactive premium services, only teleconsultation and remote diagnosis in radiology have officially been accepted by health insurances in some countries for reimbursement. Other premium ser-vices such as remote image processing, remote image fusion, or remote three-dimensional surgery need more time to become widespread all over the world (Ricke & Bartelink, 2000: 827).
The use of telemedicine systems reduces the high-cost of patient transfers for emergencies. Similarly, home monitoring telemedicine systems can decrease high-cost hospital visits. Telemedicine enhances doctor-patient communication and helps to create a better network of healthcare providers, allowing doctors around the world to exchange opinions and patient information. Telemedicine can also reduce the need for hospital readmissions, which can be an inconvenience for
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patients and are a significant expense to healthcare facilities. It provides greater and faster access to a patient’s medical history, reducing the risk of negative drug interactions or a poor response to treatment, while also improving administrative efficiency and coordination. Telemedicine adds a dimension of clinical protection for users by eliminating the possibility of transmitting infectious diseases between healthcare professionals and patients.
Healthcare organizations providing telemedicine services should have system-atic performance management and quality improvement processes. They should ensure compliance with legislation and regulations including the protection of patient health records and telemedicine services should be integrated with HIMSs.
Finally, telemedicine increases access to healthcare; improves health outcomes;
reduces healthcare, management, and transportation costs; assists in addressing shortages; and supports clinical education programs. It decreases costs by reduc-ing long travel times and uses idle times of specialist effectively, increasreduc-ing the availability of healthcare services and the overall quality of care especially in rural areas. It also reduces waiting lists and speeds up referral processes.
E-Prescribing Mechanism in Digital Health
E-prescribing is a technology framework that allows physicians to write and send prescriptions to pharmacies electronically instead of using handwritten prescrip-tions. E-prescriptions are computer generated prescriptions created by physicians using a HIMS and are sent directly to an e-pharmacy network by the healthcare provider. Instead of writing the prescription on paper, physicians enter the prescrip-tion directly into his/her computer. The e-prescribing systems work as follows: At first, physicians sign into the system through a verification process authenticating their identity. Standard authentication requires a username and password, although other technologies such as random-number cards, digital certificates, or fingerprint readers are available. Once authenticated, the system provides functionality specific to a user’s role and authorization level. Different user types (e.g. clinicians and office staff) have different legal permissions to enter, review, or modify prescrip-tions. Digitally written prescriptions travel from the healthcare providers’ HIMS to the electronic pharmacy network. E-prescriptions are usually sent electronically through a private and secure network. It is suggested that the basic documentation functions of e-prescribing systems that allow physicians to enter and store patient prescriptions have the potential to increase patient safety and reduce costs through improved legibility and practice efficiency (Teich et al., 2005: 366).
Beneficial features of e-prescribing include: (1) the ability to maintain a com-plete medication list and a recent medication history for each patient; (2) clinical
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decision-support tools, including alerts and reminders which can incorporate patient-specific medical information such as patients’ chronic conditions or medi-cation allergies; (3) access to patient-specific formulary data; and (4) capacity for two-way electronic communication between the computer systems of the medical practice and the pharmacy for sending prescriptions, clarifications, and renewal requests. Together, these advanced features have the potential to improve patient safety and reduce costs by providing better patient information and clinical advice at the point of care and remove additional sources of human error in communica-tion between practices and pharmacies (Grossman et al., 2007: 394).
Medical errors have a number of subcategories; one of these is medication er-rors, which are considered to be the main reason for approximately 7000 deaths annually. The occurrence of some unintended e-prescribing errors is inevitable;
however, evidence shows that 9% of e-prescriptions contain medication errors (www.surescripts.com). E-prescribing enables direct communication between physicians and pharmacies over an electronic pharmacy network to increase ef-ficiency and reduce errors (Lawrence, 2010: 24–26).
The risks and disadvantages of using e-prescribing include: failure to properly implement e-prescribing, cost of e-prescribing implementation and maintenance, emergence of e-prescribing errors (such as wrong strength, wrong quantity, dose and drug selection, direction, duplicate e-prescriptions), lack of standardized e-prescribing software, threats to patient safety due to inappropriate drug therapy, increased medication costs, increased work responsibilities and imposing an ex-cessive burden for pharmacy personnel (such as performing additional checks involved in error recovery), reduced pharmacy workflow efficiency due to addi-tional transaction costs, extra time required to integrate e-prescribing into work-flow, possible lack of computer support services, distracting e-prescribing system design features (such as poor drop-down menus, screen design, and inaccurate patient medication), heterogeneous e-prescribing database management systems, unclaimed e-prescriptions, complicated electronic health record systems with ro-bust clinical decision support (CDS) for e-prescribing systems, the cost of training for medical staff, and the restrictions placed on prescribing controlled substances electronically (Zadeh and Tremblay, 2016: 6).
E-prescribing offers clinicians a powerful tool to safely and efficiently manage their patient’s medications. Compared to paper-based prescribing, e-prescribing can enhance patient safety and medication compliance, improve prescribing ac-curacy and efficiency, and reduce healthcare costs through averted adverse drug events and the substitution of less expensive drug alternatives (AMA, 2011).
More sophisticated e-prescribing systems can function as automated prescription
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systems. They can create and refill prescriptions for individual patients, manage medications, connect to a pharmacy, and integrate with a HIMS.