Population Stakeholders and Current Practices

 Telepresence is able to  address current social issues in healthcare with limited care to rural areas and underserved populations remotely. Telepresence utilization occurs in both episodic and chronic patient conditions. Patients who have experienced acute medical issues such as trauma or stroke and also those with chronic conditions can benefit from telepresence in various settings. Mental health assessments can occur in real-time in both inpatient and outpatient settings. Patients of any age or race with  physical and/or cognitive impairments can utilize the telepresence as mentioned earlier in services. Telepresence allows patients to feel as though the clinical provider is present and engaged while the patient is able to remain in their environment. The patient can interact in real-time with family and providers when it is convenient for both parties, which leads to an increased level of compliance. 

            Telepresence devices can be controlled at any location and can help students learn through clinical simulation scenarios to orient allied health students to telehealth experiences and real-life clinical scenarios (Shaw et al., 2018). There is an educational benefit of allowing students to practice new clinical settings in a safe environment for both them and the patient population. Clinical simulation scenarios permit the students and educators to communicate in real-time through audio and video modalities with the ability to drive and position the device remotely while also participating in simulations and post-event debriefings. Students that are both distance and local learners have the opportunity to engage in evidence-based practice, utilize informatics tools, and participate in caring for a simulated patient in a multidisciplinary setting (Shaw et al., 2018).

Telepresence can provide entertainment, education, motivational coaching, and an increase in communication skills through the use of home assistance robotics for patients and their families (Dahl & Boulos, 2013). One of the first telepresence robot systems used in care for the elderly was the Physician-Robot system, developed by InTouch Health Company and the Johns Hopkins University (Koceski & Koceska, 2016).  The Physician-Robot system enables physicians to virtually visit their hospitalized patients frequently. Telepresence was initially researched by Koceski and colleagues to develop a telepresence robot system, that would lead to improving the well-being of the elderly by supporting their daily activities while facilitating social interactions. 

     In home care, telepresence robotics can improve access and frequency of home care services as telehealth services can occur in between face-to-face visits (Vaughn, Shaw, & Molloy, 2015). “Socially assistive robotics (SAR) is a subfield of robotics they include; social, service, rehabilitative robotics that can create human and human to human interaction” (Moyle, Arnautovska, Ownsworth, & Jones, 2017). SAR devices can assist humans with various tasks, create engagement in the community for the patient, and mimic social behaviors that assist humans with social interactions. There are several types of SAR robots; Social robots can care for patients who are socially isolated, such as dementia patients, where there is a concern of decreasing social connections, and they function to elicit therapeutic emotional responses from the patient. The Giraff robot is an example of a social robot, and it can decrease social isolation while improving family connections through interactive wheeled telepresence (Niemelä, Van Aerschot, Tammela, Aaltonen, & Lammi, 2019). The telepresence device is more appealing for communication rather than the use of a telephone as it can move about the environment with a video feed played on a screen to increase engagement. Family and caretakers can ensure that their family member is being taken care of while having the enjoyment of feeling that they are more engaged in the patient’s daily life. The collaboration of patient support increases as a family, and the health care providers can discuss care in real-time through the device. 

Telerehabilitation is a multidisciplinary collaboration to provide care to patients, used by physical therapists, occupational therapists, audiologists, and speech-language pathologists through the use of videophones or telepresence devices. Remote therapy occurs through tools such as EMG controlled games for treatment or remote telepresence devices that create interactive story retelling for a patient with brain injuries (Schmeler, Schein, McCue, & Betz, 2009). Rehabilitative robotics perform physical tasks to create ease for a patient with a physical functional disability. Virtual reality telepresence devices can create and control three-dimensional environments that allow the provider to perform a clinical assessment and recommend rehabilitative treatment through the assessment of patient movements, exercise progress, and evaluation of meeting program goals. A speech-language pathologist can assess and treat a patient remotely through the use of augmented therapeutic interactions through virtual desktop applications that can record real-time interaction to provide assessment, remediation of executive deficits, and measurement of mental capacity (Schmeler, Schein, McCue, & Betz, 2009). 

Service robots help with patient mobility and household tasks and can also perform health monitoring. The nurse can create integrated care by moving a telepresence device in the patient’s environment. Robotic systems are able to treat wound victims, where specialists can connect and assess/treat burns from remote locations. Wound care can be observed by the nurse as the patient or family member assists the individual. The nurse can observe for accuracy, completeness, and provide education along with an assessment of the wound through a wheeled remote-control device. Companion robotics act as a companion for the patient, focusing on patient engagement rather than completing certain tasks. An example of this form of telepresence is the Robo-Dog; it interacts with a patient just as a real dog would.

     Telehealth in future and current practice includes telerobotic surgery. The machine is operated by a "master," which is the console that the surgeon uses, and a "slave," which is the robot. An example of this is the Da Vinci Telerobotic Surgical System, which was developed by the U.S. Department of Defense for combat surgeons to operate from secure locations on injured soldiers fighting in battle (Ballantyne & Moll, 2003). Surgical care can be provided to isolated patients in rural areas. The system utilizes a force feedback that allows the user to feel the actions occurring such as soft objects feeling soft or actions from probing the tissue bed. In the state of New Hampshire, Wentworth Douglas Hospital utilizes the Da Vinci Surgical System in surgical procedures as the instrumentation rotates beyond the surgeon’s natural range of motion while also eliminating hand tremors. The system has a highly-magnified HD camera which provides a clear 3D view of the surgical site while integrating a table motion, creating an environment that rotates patients into an optimal position during surgery (Wentworth Douglas Hospital, 2019). 

Telepresence use for the aging population is becoming increasingly popular as well since there is an increase in social, economic, and cultural challenges that are presenting to individuals, families, and the community as a whole. In some literature, telepresence can engage individuals in a social manner who may have otherwise been isolated, and remind them to take their medication and perform their activities of daily living (ADL) (Hills & Jensen, 1998). Telepresence can provide entertainment, education, motivational coaching, and an increase in communication skills through the use of home assistance robotics (Dahl & Boulos, 2013).