Question 1

Which of the following terms is preferred to describe the provision of services at a location that is physically distant from the client, thereby allowing for services to occur where the client lives, works, and plays?

A) Telemedicine
B) Telerehabilitation
C) Telehealth
D) Artificial intelligence

Telehealth

Accepted Answer

Information and communication technologies (ICTs) include technology that allows for the "transfer of information and various types of electronically mediated communication" (Zuppo, 2012, p. 19). This may include technology such as online video conferencing, telephone, e-mail, text messages, or remote monitoring systems (Center for Connected Health Policy, 2014; LeadingAge Center for Aging Services Technologies [LACAST], 2015). Professions such as education, business, and economics utilize ICTs to enhance workflow. Health care utilizes ICTs as a means to deliver services under the umbrella of telehealth. The American Occupational Therapy Association (AOTA, 2013) defines telehealth as "an emerging model of health care delivery . . . which involves health care services, health information, and health education" and "a mechanism to provide services at a location that is physically distant from the client, thereby allowing for services to occur where the client lives, works, and plays" (2013, p. S69). Within the context of telehealth, telerehabilitation is a term used to identify the use of ICTs for the delivery of rehabilitative and habilitative services (American Telemedicine Association [ATA], 2010). In addition, various professional organizations use the term telemedicine. Some organizations differentiate the two terms of telehealth and telemedicine, but for the purpose of this chapter, telehealth and telemedicine are used interchangeably. The term telehealth is preferred because of the broader scope across all health-care disciplines and the scope of services provided implied by the term. It is important to note that telehealth only refers to the format of service delivery; the practice principles remain the same as practice using other formats.

Question 2

Mr. Greg is a 78-year-old male with congestive heart failure who has had a recent fall due to his new blood pressure medication. In order to monitor his blood pressure, which type of telehealth would be recommended?

A) Telemedicine
B) Remote patient monitoring
C) Videophone
D) Artificial intelligence

Remote patient monitoring

Accepted Answer

Remote patient monitoring (RPM) is the use of technology to collect and monitor a client's health data (Center for Connected Health Policy, 2014). RPM systems include use of devices that the client can use to record health data, such as blood pressure, heart rate, and weight, to transmit to an off-site monitoring location for interpretation by a health-care professional. Other types of RPM systems can track safety indicators of the person and environment, such as falls, carbon monoxide levels, or behavioral indicators of daily performance patterns (LACAST, 2015). Use of these systems is beneficial for older adults who are living alone but need additional supervision to track their safety and health. Systems can be set up in the client's home to provide continuous monitoring through the use of motion detection equipment or devices worn by the client to activate during an emergency. These systems can track the client's normal pattern of movement in the home, use of appliances, bathing patterns, and sleep. This information can identify when a normal pattern of behavior is disrupted by illness, declining health, or other concerns. Use of these monitoring systems can prevent hospitalization and allow the client to age in place (see Chapter 12).

Question 3

Mr. Greg's wife is concerned about the home environment related to his recent fall. She offers to take a video on her smartphone of the home environment and share it with the health-care team. This is an example of which type of delivery of telehealth?

A) Synchronous
B) Remote patient monitoring
C) Asynchronous
D) Artificial intelligence

Asynchronous

Accepted Answer

In certain contexts of service, asynchronous delivery of services may be a better fit to meet the client's needs. Asynchronous delivery does not require both parties to be present at the same time. For example, a client's caregiver may make a video recording of a walkthrough of the client's home and then upload the recording for the therapist. The therapist then views the recording and makes recommendations for safety and home modification that support aging in place. The practitioner may send documents and resources electronically to the client and caregiver to review at their convenience. A hybrid approach using synchronous video may be used for additional discussion, clarifications, and observation of the client in the home following implementation of the recommendations. Furthermore, the team may collaborate asynchronously through the client's electronic medical record.

Question 4

Telehealth is considered a health care:&#10;A) Delivery service&#10;B) Distinct service&#10;C) Synchronous&#10;D) Asynchronous

Accepted Answer

Telehealth is a delivery method and not a distinct service; the service is still occupational therapy. The practitioner collaborates with the client to determine the desired goals and uses clinical judgment to determine the best means to meet those goals. Telehealth may be the best alternative when in-person services are not feasible. The client and practitioner can determine if this means 100% telehealth delivery or a mix of telehealth and in-person services. Telehealth may be feasible for some types of services, while in-person services might be the best means to provide other types of services.

Question 5

One benefit of telehealth models is that the occupational therapy practitioner can access the following during the OT evaluation:&#10;A) Occupational profile&#10;B) Caregiver as part of evaluation&#10;C) Synchronous evaluation&#10;D) Asynchronous evaluation

Accepted Answer

Evaluation of a group of individuals that may include the family or a population of individuals is also possible through telehealth. For example, if a client has a family member who is a caregiver to the client, but that caregiver is not available to be physically present during the time of the evaluation, the use of telehealth provides an opportunity for the caregiver to connect through videoconferencing to participate in the session. If the client group is together in a space, then it is important to ensure that all individuals are in the view of the camera or able to access a microphone when speaking. If the client group is separated by physical distance, telehealth can bring them all together for the evaluation process through the use of a conference system with video and/or audio. In this situation, telehealth may hold an advantage over the traditional in-person evaluation process because of the ability to bring together the entire client group for increased collaboration in the health-care process.

Question 6

Esther is an occupational therapist practicing in a rural area. She approaches her critical access hospital about expanding to telehealth, which she feels could increase her productivity. One important consideration Esther must understand before approaching hospital leadership is:

A) Internet connectivity
B) Current state licensure laws
C) Reimbursement
D) The Health Insurance Portability and Accountability Act

Accepted Answer

Access to clients in rural settings may include extensive amounts of travel for the practitioner. The clients may also need to travel to access services in a community center or other site. Telehealth can reduce the cost and time of travel for the clients and practitioner. The clients may get back to their meaningful daily activities if they do not need to spend excessive time traveling. The practitioners may be able to provide services to more clients during the time they would normally be traveling between locations. The cost of the equipment to utilize telehealth does not significantly increase the overall costs of the services. Depending on the type of technology and the distance needed to travel, the cost can be offset or reduced by using telehealth (Kairy et al., 2009; Pramuka & van Roosmalen, 2009).

Question 7

Mrs. Smith is a 92-year-old woman living in a rural area who has experienced a recent fall. Access to care is difficult for her due to living a long distance from any health-care services. Mrs. Smith is offered telehealth as an option for occupational therapy. She has had negative experiences with technology in the past. Mrs. Smith tries it and calls to complain. The barrier in telehealth described here can be due to all but:

A) Access to training
B) Client knowledge of technology
C) Client perception of telehealth
D) Poor Internet connectivity

Accepted Answer

Perceptions of technology and the use of telehealth to receive health-care services can vary based on each person's prior experience. If the clients or practitioners had a negative experience with technology in the past, they may be less open to using technology for health-care services. In addition, limited experience with technology or the use of telehealth may make people more skeptical about its effectiveness when they compare it to their experience of receiving services in the traditional in-person model. Furthermore, clients and practitioners may be hesitant to use telehealth because of the perceived lack of a personal connection to build positive rapport, or the risk to one's privacy (Cimperman, Brencic, Trkman, & Stanonik, 2013; Levy & Strachan, 2013). Building a telehealth program that incorporates user-centered design (e.g., the use of technology familiar to the client, intuitive software, etc.) with procedures in place to provide training and ongoing assessment can increase the overall success of the telehealth program by improving user perception (Demiris et al., 2010).

Question 8

Telehealth can promote equal access to health care. This demonstrates which ethical value in the profession of occupational therapy?&#10;A) Beneficence&#10;B) Nonmaleficence&#10;C) Autonomy&#10;D) Justice

Accepted Answer

A third principle relevant to the use of telehealth is justice. Justice is "the fair, equitable, and appropriate treatment of persons" (AOTA, 2015a, p. 5). The practitioner must advocate for equal access to services for clients who may experience barriers to access. Telehealth may be the best option for health-care access for clients who would otherwise not have access to services. The Code of Ethics also calls upon the practitioner to utilize standards of practice (AOTA, 2010). The practitioner must uphold the same standards of practice in the virtual context as in the in-person context.

Question 9

Esther is an occupational therapist practicing in a rural area. She approaches her critical access hospital about expanding to telehealth, which she feels could increase her productivity. One important consideration Esther must understand before approaching hospital leadership is:

A) Internet connectivity
B) Current state licensure laws
C) Reimbursement
D) The Health Insurance Portability and Accountability Act

Accepted Answer

State licensure regulations have not caught up with the expanding use of telehealth in each state. Currently, state licensure regarding the use of telehealth to provide occupational therapy services varies greatly. Most state licensure boards either take no position, deem it out of their authority, or directly regulate the use of telehealth by occupational therapy practitioners. Direct regulation may include items of parity between traditional in-person services and those provided by telehealth, the physical location of the practitioner, and the requirement of state licensure in the state where the client is located (AOTA State Affairs, 2018). Before implementing the use of telehealth in any state, occupational therapy practitioners should review the current state licensure laws related to their own state as well as the state where the client is located. If the licensure laws are unclear, the practitioner should consult the professional licensing board(s).

Question 10

Mr. Sawaztki is a 64-year-old male who has recently retired and has had a mild stroke. He wants to receive occupational therapy services, but is not interested in outpatient care and does not qualify for home health. He inquires about the evidence regarding telehealth. As an occupational therapy practitioner, you are able to say telehealth OT intervention is:

A) Ineffective
B) Effective
C) Neither effective nor ineffective
D) Has not been researched

Accepted Answer

Current available evidence supports the use of telehealth as an effective means to provide services to community-based clients. Multiple studies demonstrate how services provided through telehealth are as effective or more effective than services provided in person (Bendixen, Horn, & Levy, 2007; Bendixen et al., 2007; Chumbler et al., 2012; Crotty et al., 2014; Dallolio et al., 2008; Hoenig et al., 2006; Kairy et al., 2009; Little et al., 2018; Ng et al., 2013; Sundsli et al., 2014). Telehealth offers a means to be client-centered by allowing clients to remain in their homes to receive services. Maintaining a client-centered approach to services in the client's natural context is also the focus of community-based service. In addition, telehealth can be a cost-effective approach, especially in rural areas where access to health-care services may be limited or unavailable.

Question 11

Which of the following is a population health example of occupational therapy in telehealth?&#10;A) Home safety assessment for an older adult&#10;B) School-based assessment&#10;C) Remote monitoring of an older adult with congestive heart failure&#10;D) Occupation-based coaching to families with children who have autism spectrum disorder

Accepted Answer

The answer of Which of the following is a population...

Question 12

One current effective way to charge clients for use of telehealth occupational therapy is:&#10;A) Direct pay&#10;B) Medicare&#10;C) Medicaid&#10;D) Private insurance

Accepted Answer

The answer of One current effective way to charge clients...

Deck 23: Telehealth Introduction