Discussion/Conclusion

Impact on the current healthcare system

There is a fundamental aim to increase services through the use of telepresence devices, and as there has been a recent increase in access to internet access across the world, which has led to improved convenience for the health care delivery system (Dorsey & Topol, 2016). An increase in access to services from centralized specialists is achieved through the remote use of telepresence by the provider. Telepresence can engage individuals in a social manner who may have otherwise been isolated, and remind them to take their medication and complete their ADLs and provide additional assistance to reduce the strain on professional caregivers (Koceski & Koceska, 2016). Minimally invasive surgeries, as well as rare and complicated operations, can also be performed due to the steady and meticulous controls of the robotic system.

Challenges

For telepresence to be useful, there must be a perceived ease-of-use and recognized usefulness by caregivers and the patient, and extensive training is required for the patients as well as the caregivers. The devices still require human assistance to move around without bumping into doorways and running into obstacles which may not be a sense of a significant perception of the usefulness of telepresence (Koceski & Koceska, 2016). Due to rigorous and lengthy research in the use of telepresence devices, published studies are often on outdated technology (Dorsey & Topol, 2016). Overall, many clinicians have had limited exposure to the actual care delivery system through telehealth and telepresence services. There are also legal barriers such as state licensure, practice laws, credentialing, and liability issues, leaving many patients unable to access readily available services. 58% of licensed mental health care professionals reported being unaware of state and federal regulations governing telehealth services (Glueckauf et al., 2018).  

Benefits

Telepresence is becoming a useful resource in healthcare settings, allowing for educational opportunities and assistance to various populations across the lifespan. University hospitals are utilizing telepresence to teach healthcare students how to care for patients via simulation, giving them the opportunity to learn how to properly care for their patients in different scenarios. Telepresence allows for three-dimensional human interaction through mobile conferencing, offering medical assessment of a patient by a specialist from anywhere in the world. Specialists of numerous disciplines are incorporating this method of practice into their services, which has the potential to reduce costs to patients and provide care to individuals in remote locations. As telepresence becomes more prominent in working with individuals, specialists need to be appropriately trained in providing services to protect the privacy of their patients. Implementing the use of telepresence devices can create a positive impact on the current health care shortage because it can increase the number of patients seen by health care providers. Patients are seen remotely in an observational setting, and this saves the health professional time, allowing for an increased number of patients who can be treated in the day (Moyle, Jones, Dwan, Ownsworth, & Sung, 2018). 

Future Implementations

As the older population continues to grow, social, economic, and cultural challenges are becoming apparent to individuals, families, and the community as a whole. Solutions to improve access to health care are readily available such as the Da Vinci telerobotic system, as it can provide services to third world countries and improve clinical outcomes for rare and complicated operations. The advancement of telerobotics will be achieved through the use of smaller and more diverse tools for operating, allowing for smoother movements with an expanded range of motion (Ballantyne & Moll, 2003). As a solution to the chronic clinical workforce shortage in the health care system, telepresence is able to decrease the burden of the current workforce. There is an increasing number of individuals who are acutely ill, and for those who have chronic illnesses the future goal of telepresence is to shift care from acute hospitals, clinics, and health care centers to the home setting. The shift of care from the patient to the provider, to remote visits in the patient’s home creates a level of responsibility for the patient to manage their own care more effectively (Dahl & Boulos, 2013). As the use of telepresence increases, the overall cost can decrease over time, with reimbursement increasing. The American Psychiatric Association has endorsed a proposal that would coordinate state licensing boards to create a model act for inter-jurisdictional practice along with professional training in the use of telehealth and telepresence services (Glueckauf et al., 2018). 

Conclusion

According to Woods “We are on the edge of a crisis,” said William Dombi, president of the National Association for Home Care & Hospice. “We are not prepared for what’s coming. Our concern is that the demand is going to outstrip the supply unless we see some dynamic changes occur.” (2019). Overall there is a justification in the use of telepresence as it reduces the overall cost of health care delivery while improving patient clinical outcomes as well as increasing the patient and their families' quality of life (Dahl & Boulos, 2013). Reimbursement rates, and how to reduce the overall cost is an area requiring further research. To combat the high cost of utilizing telepresence, a bundled payment system can be used. This can allow for the widespread adoption of telepresence services. As telepresence demonstrates strong empirical evidence for use to improve patient outcomes, patients can stay safely in their homes while having access to services and have a positive impact on the current healthcare worker shortage (Dorsey & Topol, 2016). Telepresence devices have the ability to help maintain patients within the community setting longer with impaired cognition as long as face to face visits still occur, and the device is not over prescribed (Moyle, Arnautovska, Ownsworth, & Jones, 2017). Further research is still required in how to create and maintain therapeutic relationships between the patient and the provider through the use of telepresence as this is an area of controversy. 

telepresence in healthcare