The following issues should be also be taken into consideration in the design
and implementation of telehealth services to rural communities.
Access to Services and Service Delivery
The introduction of telehealth services should not have an adverse impact on
access to health services by rural communities. Planning for telehealth services
must never be intended to replace local health care services delivered by rural
health workers to their community at the local level.
However, any service delivery based on telehealth must acknowledge existing
referral and access patterns between rural communities and secondary/tertiary
providers of health care. If not, then both the community and the health workers
may bypass the telehealth services, which would have a significant impact on
the viability of the telehealth service. Any variation of existing referral
and access patterns for telehealth services must be fully justified and explained
to the rural community.
Recommendation 16
Telehealth services must be used to support and improve, but not to replace
the local delivery of health care services for rural communities.
Recommendation 17
Telehealth service patterns should wherever possible reflect and support
existing referral and access patterns of rural communities to secondary and
tertiary services.
Recruitment and Retention
The introduction of telehealth services, with the associated information and
telecommunication technologies, has the potential to improve recruitment and
retention of rural health workers by reducing the sense of professional isolation
experienced by many of these workers. However, this potential has not yet been
clearly established, and needs to be carefully evaluated and researched.
Recommendation 18
Programs addressing the recruitment and retention of health workers to
rural communities should place a high priority on information and communication
technologies where it is planned to introduce telehealth services.
Continuing Education
The installation of information and communication technologies to support telehealth
provides rural health workers with the opportunity to access a wide range of
continuing education services remotely. The opportunities for distance education
will be limited by the technical performance of the system installed. However,
the equipment should be made available to rural health workers as part of an
overall strategy to reduce professional isolation.
Recommendation 19
The information and communication technologies installed to provide telehealth
services should be made available to the rural health workers to access continuing
education and training.
Rural health workers may develop the perception that telehealth simply represents
an opportunity for specialists to extend their influence. A criticism of telehealth
is that it has potential for encouraging dependency on specialist input, and
not fostering a problem-solving attitude amongst rural health workers. The WONCA
Policy Document on Rural Training stresses the need to avoid creating such an
environment of Learned Helplessness.
This attitude shift also extends to the patients. Experiences of specialist
input on management of complex problems tends to raise expectations that same
degree of consultation should be available in cases that are well within the
capabilities of the rural health worker. This has the potential to reduce the
skills and motivation of the rural health worker
Telehealth consultations should not be a forum for displaying the skills of
the specialist, with little benefit from the consultation process for the referring
physician. To ensure that there is mutual benefit from the telehealth process
for all parties involved, it is necessary to ensure that the dynamics of a telehealth
consultation:
* foster a strong collegial atmosphere between the referring community and consulting
specialist. Mutual respect for the abilities of each party greatly increases
the acceptance of input into the consultation and the acceptance of the recommendations
that arise from the consultation.
* ensure that all parties involved in a telehealth consultation recognise the
potential for education in the process.
* the referring parties benefit from the experience of the consulting physician,
with the likelihood of being able to handle similar future cases with less need
for consultation.
* the consulting specialist benefits from the local knowledge of the referring
physician about the patient, local expectations, conditions and customs. The
specialist also develops a greater level of familiarity with the abilities and
uncertainties of the referring physician, and the capabilities of the local
resources.
Recommendation 20
Telehealth programs have the potential to play a crucial role by providing
continuing education as an integral part of the consultation process. This should
be actively encouraged by:
fostering a high degree of collegiality in the consultation process,
allowing for the educational aspect in the budget and time management process
and
actively encouraging the participation of the referring health worker in the
consultation process.