The terms medical record , health record and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient 's medical history and care across time within one particular health care provider's jurisdiction. A medical record includes a variety of types of "notes" entered over time by healthcare professionals , recording observations and administration of drugs and therapies, orders for the administration of drugs and therapies, test results, X-rays , reports, etc. The maintenance of complete and accurate medical records is a requirement of health care providers and is generally enforced as a licensing or certification prerequisite.
127-475: Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies . It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport,
254-442: A clinic because the patient has a disability or because of travel time. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance. Most telerehabilitation is highly visual. As of 2014, the most commonly used mediums are webcams , videoconferencing , phone lines , videophones and webpages containing rich web applications. The visual nature of telerehabilitation technology limits
381-751: A disease specific approach, but today the World Health Organization (WHO) takes a broader approach suggesting that palliative care should be applied as early as possible to any chronic and fatal illness. As in many aspects of healthcare , telehealth is increasingly being used in palliative care and is often referred to as telepalliative care. The types of technology applied in telepalliative care are typically telecommunication technologies, such as video conferencing or messaging for follow-up, or digital symptom assessments through digital questionnaires generating alerts to health care professionals. Telepalliative care has been shown to be
508-545: A teletherapy application for cognitive skills enhancement programs for school children. Tele-audiology (hearing assessments) is a growing application. Physical therapy and psychology interventions delivered via telehealth may result in similar outcomes as those delivered in-person for a range of health conditions. Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy, and (2) building new data collection systems to digitize information that
635-649: A basic framework for defining the sector, the United Nations' International Standard Industrial Classification categorizes health care as generally consisting of hospital activities, medical and dental practice activities, and "other human health activities." The last class involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, patient advocates or other allied health professions . In addition, according to industry and market classifications, such as
762-414: A case over video conference ; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during
889-569: A challenge for the design of ICT (information and communication technology) for home care. Because statistics show that over 80 million Americans have taken time off of their primary employment to care for a loved one, many countries have begun offering programs such as the Consumer Directed Personal Assistant Program to allow family members to take care of their loved ones without giving up their entire income. With obesity in children rapidly becoming
1016-612: A clear correlation between worse quality and higher spending. Expand the OECD charts below to see the breakdown: The management and administration of health care is vital to the delivery of health care services. In particular, the practice of health professionals and the operation of health care institutions is typically regulated by national or state/provincial authorities through appropriate regulatory bodies for purposes of quality assurance . Most countries have credentialing staff in regulatory boards or health departments who document
1143-431: A consult. Telehealth is sometimes discussed interchangeably with telemedicine, the latter being more common than the former. The Health Resources and Services Administration distinguishes telehealth from telemedicine in its scope, defining telemedicine only as describing remote clinical services, such as diagnosis and monitoring, while telehealth includes preventative , promotive, and curative care delivery. This includes
1270-825: A feasible approach to deliver palliative care among patients , caregivers and health care professionals. Telepalliative care can provide an added support system that enable patients to remain at home through self-reporting of symptoms and tailoring care to specific patients. Studies have shown that the use of telehealth in palliative care is mostly well received by patients, and that telepalliative care may improve access to health care professionals at home and enhance feelings of security and safety among patients receiving palliative care. Further, telepalliative care may enable more efficient utilization of healthcare resources , promotes collaboration between different levels of healthcare and makes healthcare professionals more responsive to changes in patients' condition. Challenging aspects of
1397-993: A frequency varying from 500 Hz to 2500 Hz with 1500 Hz at baseline. Health care Health care , or healthcare , is the improvement of health via the prevention , diagnosis , treatment , amelioration or cure of disease , illness , injury , and other physical and mental impairments in people. Health care is delivered by health professionals and allied health fields . Medicine , dentistry , pharmacy , midwifery , nursing , optometry , audiology , psychology , occupational therapy , physical therapy , athletic training , and other health professions all constitute health care. The term includes work done in providing primary care , secondary care , tertiary care , and public health . Access to healthcare may vary across countries, communities, and individuals, influenced by social and economic conditions and health policies . Providing health care services means "the timely use of personal health services to achieve
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#17327718922221524-609: A gain of 10 years since 1970. The US (78.7 years) ranges only on place 26 among the 34 OECD member countries, but has the highest costs by far. All OECD countries have achieved universal (or almost universal) health coverage, except the US and Mexico . (see also international comparisons .) In the United States , where around 18% of GDP is spent on health care, the Commonwealth Fund analysis of spend and quality shows
1651-520: A given period. In the United Kingdom , medical records are required for the lifetime of a patient and legally for as long as that complaint action can be brought. Generally in the UK, any recorded information should be kept legally for 7 years, but for medical records additional time must be allowed for any child to reach the age of responsibility (20 years). Medical records are required many years after
1778-403: A lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. Telehealth could include two clinicians discussing
1905-441: A licensed independent practitioner such as a physiotherapist , or a non-physician primary care provider such as a physician assistant or nurse practitioner . Depending on the locality and health system organization, the patient may see another health care professional first, such as a pharmacist or nurse . Depending on the nature of the health condition, patients may be referred for secondary or tertiary care. Primary care
2032-419: A major concern, health services often set up programs in schools aimed at educating children about nutritional eating habits, making physical education a requirement and teaching young adolescents to have a positive self-image. Health care ratings are ratings or evaluations of health care used to evaluate the process of care and health care structures and/or outcomes of health care services. This information
2159-441: A medical record by a medical professional is a felony in most United States jurisdictions. Governments have often refused to disclose medical records of military personnel who have been used as experimental subjects. Given the series of medical data breaches and the lack of public trust, some countries have enacted laws requiring safeguards to be put in place to protect the security and confidentiality of medical information as it
2286-507: A patient's death to investigate illnesses within a community (e.g., industrial or environmental disease or even deaths at the hands of doctors committing murders, as in the Harold Shipman case). The outsourcing of medical record transcription and storage has the potential to violate patient–physician confidentiality by possibly allowing unaccountable persons access to patient data. With the increase of clinical notes being shared as
2413-411: A patient's medical history by a physician, nurse practitioner, or physician assistant and can take several forms. Hospital admission documentation (i.e., when a patient requires hospitalization) or consultation by a specialist often take an exhaustive form, detailing the entirety of prior health and health care. Routine visits by a provider familiar to the patient, however, may take a shorter form such as
2540-753: A physical examination. Remote monitoring, also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective. Examples include home-based nocturnal dialysis and improved joint management. Electronic consultations are possible through interactive telemedicine services which provide real-time interactions between patient and provider. Videoconferencing has been used in
2667-518: A physician, Dr. Elizabeth McInerney, challenging a patient's access to their own medical record was denied. The patient, Margaret MacDonald, won a court order granting her full access to her own medical record. The case was complicated by the fact that the records were in electronic form and contained information supplied by other providers. McInerney maintained that she didn't have the right to release records she herself did not author. The courts ruled otherwise. Legislation followed, codifying into law
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#17327718922222794-400: A primary care practitioner must possess a wide breadth of knowledge in many areas. Continuity is a key characteristic of primary care, as patients usually prefer to consult the same practitioner for routine check-ups and preventive care , health education , and every time they require an initial consultation about a new health problem. The International Classification of Primary Care (ICPC)
2921-401: A remote specialist to their local clinician. Such home care is convenient but requires access to and familiarity with internet. A 2017 randomized controlled trial of "virtual house calls" or video visits with individuals diagnosed with Parkinson disease evidences patient preference for the remote specialist vs their local clinician after one year. Teleneurology for patients with Parkison's disease
3048-545: A result of the 21st Century Cures Act , the increase in sensitive terms used in the records of all patients, including minors, are increasingly shared amongst care teams making privacy more complicated. Intersex people have historically had their medical records intentionally falsified/concealed , to hide birth sex , and intersex medical procedures . Christiane Völling became the first intersex person in Europe to successfully sue for medical malpractice . Falsification of
3175-633: A short period of time for a brief but serious illness, injury, or other health condition. This care is often found in a hospital emergency department . Secondary care also includes skilled attendance during childbirth , intensive care , and medical imaging services. The term "secondary care" is sometimes used synonymously with "hospital care". However, many secondary care providers, such as psychiatrists , clinical psychologists , occupational therapists , most dental specialties or physiotherapists , do not necessarily work in hospitals. Some primary care services are delivered within hospitals. Depending on
3302-989: A significant part of a country's economy , development, and industrialization . Health care is an important determinant in promoting the general physical and mental health and well-being of people around the world. An example of this was the worldwide eradication of smallpox in 1980, declared by the WHO, as the first disease in human history to be eliminated by deliberate healthcare interventions. The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams . This includes professionals in medicine , psychology , physiotherapy , nursing , dentistry , midwifery and allied health , along with many others such as public health practitioners , community health workers and assistive personnel , who systematically provide personal and population-based preventive, curative and rehabilitative care services. While
3429-565: A therapist can use in practice. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice, in the future. In the United States, the National Institute on Disability and Rehabilitation Research 's (NIDRR) supports research and the development of telerehabilitation. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at
3556-526: A wide range of clinical disciplines and settings for various purposes including management, diagnosis, counseling and monitoring of patients. Videotelephony comprises the technologies for the reception and transmission of audio-video signals by users at different locations, for communication between people in real-time. At the dawn of the technology, videotelephony also included image phones which would exchange still images between units every few seconds over conventional POTS -type telephone lines, essentially
3683-410: Is a United States federal law pertaining to medical privacy that went into effect in 2003. This law established standards for patient privacy in all 50 states, including the right of patients to access to their own records. HIPAA provides some protection, but does not resolve the issues involving medical records privacy. Medical and health care providers experienced 767 security breaches resulting in
3810-494: Is a standardized tool for understanding and analyzing information on interventions in primary care based on the reason for the patient's visit. Common chronic illnesses usually treated in primary care may include, for example, hypertension , diabetes , asthma , COPD , depression and anxiety , back pain , arthritis or thyroid dysfunction . Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations . In
3937-641: Is achieving significant growth rates in many countries due to several factors: the preoccupation in reducing the costs of health care, an increase in the number of aging and chronically ill population, and the increase in coverage of health care to distant, rural, small or sparsely populated regions. Among its benefits, telenursing may help solve increasing shortages of nurses; to reduce distances and save travel time, and to keep patients out of hospital. A greater degree of job satisfaction has been registered among telenurses. In Australia , during January 2014, Melbourne tech startup Small World Social collaborated with
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4064-404: Is also being used in some trauma ICUs to reduce the spread of infections. Rounds are usually conducted at hospitals across the country by a team of approximately ten or more people to include attending physicians, fellows, residents and other clinicians. This group usually moves from bed to bed in a unit discussing each patient. This aids in the transition of care for patients from the night shift to
4191-423: Is also gaining acceptance in the United States. There are several modalities currently being practiced that include but are not limited to TeleTriage, TeleMSE and ePPE. An example of telehealth in the field is when EMS arrives on scene of an incident and is able to take an EKG that is then sent directly to a physician at the hospital to be read. Therefore, allowing instant care and management. Telenursing refers to
4318-600: Is conducted in Australia and Europe. Only a few health insurers in the United States, and about half of Medicaid programs, reimburse for telerehabilitation services. If the research shows that teleassessments and teletherapy are equivalent to clinical encounters, it is more likely that insurers and Medicare will cover telerehabilitation services. In India, the Indian Association of Chartered Physiotherapists (IACP) provides telerehabilitation facilities. With
4445-417: Is considered necessary, regardless of whether the funding is from private insurance schemes or national health insurance . Allied health professionals , such as physical therapists , respiratory therapists , occupational therapists , speech therapists , and dietitians , also generally work in secondary care, accessed through either patient self-referral or through physician referral. Tertiary care
4572-473: Is found to be cheaper than in person visits by reducing transportation and travel time A recent systematic review by Ray Dorsey et al. describes both the limitations and potential benefits of teleneurology to improve care for patients with chronic neurological conditions, especially in low-income countries. White, well educated and technologically savvy people are the biggest consumers of telehealth services for Parkinson's disease. as compared to ethnic minorities in
4699-636: Is maintained. A patient's individual medical record identifies the patient and contains information regarding the patient's case history at a particular provider. The health record as well as any electronically stored variant of the traditional paper files contain proper identification of the patient. Further information varies with the individual medical history of the patient. The contents are generally written with other healthcare professionals in mind. This can result in confusion and hurt feelings when patients read these notes. For example, some abbreviations, such as for shortness of breath , are similar to
4826-422: Is no consensus regarding medical record ownership in the United States . Factors complicating questions of ownership include the form and source of the information, custody of the information, contract rights, and variation in state law. There is no federal law regarding ownership of medical records. HIPAA gives patients the right to access and amend their own records, but it has no language regarding ownership of
4953-417: Is not medical in nature. It is often information to locate the patient, including identifying numbers, addresses, and contact numbers. It may contain information about race and religion as well as workplace and type of occupation . It also contains information regarding the patient's health insurance . It is common to also find emergency contact information located in this section of the medical chart. In
5080-574: Is often used as the term for the health care services that play a role in the local community. It can be provided in different settings, such as Urgent care centers that provide same-day appointments or services on a walk-in basis. Primary care involves the widest scope of health care, including all ages of patients, patients of all socioeconomic and geographic origins, patients seeking to maintain optimal health , and patients with all types of acute and chronic physical, mental and social health issues, including multiple chronic diseases . Consequently,
5207-505: Is seen from the analysis carried out each year by Bloomberg. Clearly this kind of analysis is flawed in that life expectancy is only one measure of a health system's performance, but equally, the notion that more funding is better is not supported. In 2011, the health care industry consumed an average of 9.3 percent of the GDP or US$ 3,322 ( PPP-adjusted ) per capita across the 34 members of OECD countries. The US (17.7%, or US$ PPP 8,508),
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5334-502: Is shared electronically and to give patients some important rights to monitor their medical records and receive notification for loss and unauthorized acquisition of health information. The United States and the EU have imposed mandatory medical data breach notifications. Patients' medical information can be shared by a number of people both within the health care industry and beyond. The Health Insurance Portability and Accessibility Act (HIPAA)
5461-622: Is sometimes used as an extension of tertiary care in reference to advanced levels of medicine which are highly specialized and not widely accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are considered quaternary care. These services are usually only offered in a limited number of regional or national health care centers. Many types of health care interventions are delivered outside of health facilities. They include many interventions of public health interest, such as food safety surveillance, distribution of condoms and needle-exchange programs for
5588-545: Is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital . Examples of tertiary care services are cancer management, neurosurgery , cardiac surgery , plastic surgery , treatment for severe burns , advanced neonatology services, palliative, and other complex medical and surgical interventions. The term quaternary care
5715-539: Is still some variance in laws depending on the province. There is also some confusion among providers as to the scope of the patient information they have to give access to, but the language in the supreme court ruling gives patient access rights to their entire record. In the United Kingdom , the Data Protection Acts and later the Freedom of Information Act 2000 gave patients or their representatives
5842-523: Is supported by US national health administration entities and by AHIMA , the American Health Information Management Association. Because many consider the information in medical records to be sensitive private information covered by expectations of privacy , many ethical and legal issues are implicated in their maintenance, such as third-party access and appropriate storage and disposal. Although
5969-552: Is the use of information technology and telecommunications for dental care, consultation, education, and public awareness in the same manner as telehealth and telemedicine. Tele-audiology is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice. This term was first used by Gregg Givens in 1999 in reference to a system being developed at East Carolina University in North Carolina, US. Teleneurology describes
6096-565: Is the use of telehealth/videoconference technology for the remote administration of neuropsychological tests. Neuropsychological tests are used to evaluate the cognitive status of individuals with known or suspected brain disorders and provide a profile of cognitive strengths and weaknesses. Through a series of studies, there is growing support in the literature showing that remote videoconference-based administration of many standard neuropsychological tests results in test findings that are similar to traditional in-person evaluations, thereby establishing
6223-414: Is translated into report cards that are generated by quality organizations, nonprofit, consumer groups and media. This evaluation of quality is based on measures of: Access to healthcare may vary across countries, communities, and individuals, influenced by social and economic conditions as well as health policies . Providing health care services means "the timely use of personal health services to achieve
6350-501: The Australian Breastfeeding Association to create the first hands-free breastfeeding Google Glass application for new mothers. The application, named Google Glass Breastfeeding app trial , allows mothers to nurse their baby while viewing instructions about common breastfeeding issues (latching on, posture etc.) or call a lactation consultant via a secure Google Hangout, who can view the issue through
6477-619: The Global Industry Classification Standard and the Industry Classification Benchmark , health care includes many categories of medical equipment, instruments and services including biotechnology , diagnostic laboratories and substances, drug manufacturing and delivery. For example, pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States. The United States dominates
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#17327718922226604-556: The Netherlands (11.9%, 5,099), France (11.6%, 4,118), Germany (11.3%, 4,495), Canada (11.2%, 5669), and Switzerland (11%, 5,634) were the top spenders, however life expectancy in total population at birth was highest in Switzerland (82.8 years), Japan and Italy (82.7), Spain and Iceland (82.4), France (82.2) and Australia (82.0), while OECD's average exceeds 80 years for the first time ever in 2011: 80.1 years,
6731-545: The United States , the data contained within the medical record belongs to the patient, whereas the physical form the data takes belongs to the entity responsible for maintaining the record per the Health Insurance Portability and Accountability Act . Patients have the right to ensure that the information contained in their record is accurate, and can petition their health care provider to amend factually incorrect information in their records. There
6858-458: The United States , written records must be marked with the date and time and scribed with indelible pens without use of corrective paper. Errors in the record should be struck out with a single line (so that the initial entry remains legible) and initialed by the author. Orders and notes must be signed by the author. Electronic versions require an electronic signature . Ownership and keeping of patient's records varies from country to country. In
6985-1081: The University of Pittsburgh , the Rehabilitation Institute of Chicago , the State University of New York at Buffalo, and the National Rehabilitation Hospital in Washington DC. Other federal funders of research are the Veterans Health Administration , the Health Services Research Administration in the US Department of Health and Human Services, and the Department of Defense. Outside the United States, excellent research
7112-481: The biopharmaceutical field, accounting for three-quarters of the world's biotechnology revenues. The quantity and quality of many health care interventions are improved through the results of science, such as advanced through the medical model of health which focuses on the eradication of illness through diagnosis and effective treatment. Many important advances have been made through health research, biomedical research and pharmaceutical research , which form
7239-444: The certification or licensing of health workers and their work history. Health information technology (HIT) is "the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making." Health information technology components: Medical record The terms are used for
7366-441: The problem-oriented medical record (POMR), which includes a problem list of diagnoses or a " SOAP " method of documentation for each visit. Each encounter will generally contain the aspects below: Written orders by medical providers are included in the medical record. These detail the instructions given to other members of the health care team by the primary providers. When a patient is hospitalized, daily updates are entered into
7493-536: The social model of health and disability , which emphasizes the societal changes that can be made to make populations healthier. Results from health services research often form the basis of evidence-based policy in health care systems. Health services research is also aided by initiatives in the field of artificial intelligence for the development of systems of health assessment that are clinically useful, timely, sensitive to change, culturally sensitive , low-burden, low-cost, built into standard procedures, and involve
7620-566: The 1992 Canadian Supreme Court ruling in McInerney v. MacDonald gave patients the right to copy and examine all information in their medical records, while the records themselves remained the property of the healthcare provider . The 2004 Personal Health Information Protection Act (PHIPA) contains regulatory guidelines to protect the confidentiality of patient information for healthcare organizations acting as stewards of their medical records. Despite legal precedent for access nationwide, there
7747-462: The US. Telemedicine in neurosurgery was historically primarily used for follow-up visits by patients that had to travel far to undergo surgery. In the last decade, telemedicine was also used for remote ICU rounding as well as prompt evaluation for acute ischemic stroke and administration of IV alteplase in conjunction with Neurology. From the onset of the COVID-19 pandemic, there was a rapid surge in
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#17327718922227874-416: The United States, the 2013 National Health Interview Survey found that skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%, excluding asthma) were the most common reasons for accessing a physician. In the United States, primary care physicians have begun to deliver primary care outside of
8001-429: The abbreviations for profanities, and taking "time out" to follow a surgical safety protocol might be misunderstood as a disciplinary technique for children . Traditionally, medical records were written on paper and maintained in folders often divided into sections for each type of note (progress note, order, test results), with new information added to each section chronologically. Active records are usually housed at
8128-568: The above features with portability, thus allowing a patient to share medical records across providers and health care systems. Electronic medical records could also be studied to quantify disease burdens – such as the number of deaths from antimicrobial resistance – or help identify causes of, factors of and contributors to diseases, especially when combined with genome-wide association studies . For such purposes, electronic medical records could potentially be made available in securely anonymized or pseudonymized forms to ensure patients' privacy
8255-528: The above-mentioned non-clinical applications, like administration and provider education. The United States Department of Health and Human Services states that the term telehealth includes "non-clinical services, such as provider training, administrative meetings, and continuing medical education", and that the term telemedicine means "remote clinical services". The World Health Organization uses telemedicine to describe all aspects of health care including preventive care. The American Telemedicine Association uses
8382-687: The aid of teleconferencing or videoconferencing . Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities. This approach allows patients in remote or underserved areas to receive pharmacy services that would otherwise be unavailable to them, enhancing access to care and ensuring continuity in medication management. Health outcomes appear similar when pharmacy services are delivered by telepharmacy compared to traditional service delivery. The term can also refer to
8509-406: The authorities. In Germany, a relatively new law, which has been established in 2013, strengthens the rights of patients. It states, amongst other things, the statutory duty of medical personnel to document the treatment of the patient in either hard copy or within the electronic patient record (EPR). This documentation must happen in a timely manner and encompass each and every form of treatment
8636-620: The barriers to telepalliative care relate to inflexible reporting of complex and fluctuating symptoms and circumstances using electronic questionnaires. Further, palliative care emphasizes a holistic approach that should address existential , spiritual and mental distress related to serious illness. However, few studies have included the self-reporting of existential or spiritual concerns, emotions , and well-being . Healthcare professionals may also be uncomfortable providing emotional or psychological care remotely. Palliative care has been characterized as high-touch rather than high-tech, limiting
8763-662: The basis for evidence-based medicine and evidence-based practice in health care delivery. Health care research frequently engages directly with patients, and as such issues for whom to engage and how to engage with them become important to consider when seeking to actively include them in studies. While single best practice does not exist, the results of a systematic review on patient engagement suggest that research methods for patient selection need to account for both patient availability and willingness to engage. Health services research can lead to greater efficiency and equitable delivery of health care interventions, as advanced through
8890-829: The basis for the reliability and validity of teleneuropsychological assessment. Telenutrition refers to the use of video conferencing/ telephony to provide online consultation by a nutritionist or dietician . Patient or clients upload their vital statistics, diet logs, food pictures etc. on a telenutrition portal which are then used by nutritionist or dietician to analyze their current health condition. Nutritionist or dietician can then set goals for their respective client/ patients and monitor their progress regularly by follow-up consultations. Telenutrition portals can help people seek remote consultation for themselves and/or their family. This can be extremely helpful for elderly or bed ridden patients who can consult their dietician from comfort of their homes. Telenutrition showed to be feasible and
9017-501: The best possible health outcomes". Factors to consider in terms of healthcare access include financial limitations (such as insurance coverage), geographical and logistical barriers (such as additional transportation costs and the ability to take paid time off work to use such services), sociocultural expectations, and personal limitations (lack of ability to communicate with health care providers, poor health literacy , low income). Limitations to health care services affect negatively
9144-502: The best possible health outcomes". Factors to consider in terms of healthcare access include financial limitations (such as insurance coverage), geographical and logistical barriers (such as additional transportation costs and the ability to take paid time off work to use such services), sociocultural expectations, and personal limitations (lack of ability to communicate with health care providers, poor health literacy , low income). Limitations to health care services affects negatively
9271-425: The case of X-rays, a written report of the findings is included in lieu of the actual film. Many other items are variably kept within the medical record. Digital images of the patient, flowsheets from operations/ intensive care units , informed consent forms, EKG tracings, outputs from medical devices (such as pacemakers ), chemotherapy protocols, and numerous other important pieces of information form part of
9398-641: The central repository for planning patient care and documenting communication among patient and health care provider and professionals contributing to the patient's care. An increasing purpose of the medical record is to ensure documentation of compliance with institutional, professional or governmental regulation. The traditional medical record for inpatient care can include admission notes , on-service notes , progress notes ( SOAP notes ), preoperative notes , operative notes , postoperative notes , procedure notes , delivery notes , postpartum notes , and discharge notes . Personal health records combine many of
9525-607: The clinical site, but older records are often archived offsite. The advent of electronic medical records has not only changed the format of medical records but has increased accessibility of files. The use of an individual dossier style medical record, where records are kept on each patient by name and illness type originated at the Mayo Clinic out of a desire to simplify patient tracking and to allow for medical research. Maintenance of medical records requires security measures to prevent from unauthorized access or tampering with
9652-710: The compromised confidential health information of 23,625,933 patients during the period of 2006–2012. The federal Health Insurance Portability and Accessibility Act (HIPAA) addresses the issue of privacy by providing medical information handling guidelines. Not only is it bound by the Code of Ethics of its profession (in the case of doctors and nurses), but also by the legislation on data protection and criminal law. Professional secrecy applies to practitioners, psychologists, nursing, physiotherapists, occupational therapists, nursing assistants, chiropodists, and administrative personnel, as well as auxiliary hospital staff. The maintenance of
9779-400: The confidentiality and privacy of patients implies first of all in the medical history, which must be adequately guarded, remaining accessible only to the authorized personnel. However, the precepts of privacy must be observed in all fields of hospital life: privacy at the time of the conduct of the anamnesis and physical exploration, the privacy at the time of the information to the relatives,
9906-470: The context of global population aging , with increasing numbers of older adults at greater risk of chronic non-communicable diseases , rapidly increasing demand for primary care services is expected in both developed and developing countries. The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy. Secondary care includes acute care : necessary treatment for
10033-438: The definitions of the various types of health care vary depending on the different cultural , political, organizational, and disciplinary perspectives, there appears to be some consensus that primary care constitutes the first element of a continuing health care process and may also include the provision of secondary and tertiary levels of care. Health care can be defined as either public or private . Primary care refers to
10160-415: The department of Medicine. Transmission using wireless was done using frequency modulation which eliminated noise. Transmission was also done through telephone lines. The ECG output was connected to the telephone input using a modulator which converted ECG into high frequency sound. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. The ECG was converted to sound waves with
10287-584: The facts, or absence of facts in the record, apart from the medical record itself. In 2009, Congress authorized and funded legislation known as the Health Information Technology for Economic and Clinical Health Act to stimulate the conversion of paper medical records into electronic charts. While many hospitals and doctor's offices have since done this successfully, electronic health vendors' proprietary systems are sometimes incompatible. Demographics include patient information that
10414-572: The form of a strong, reliable broadband connection, and broadband mobile communication technology of at least the fourth generation (4G) or long-term evolution (LTE) standard to overcome issues with video stability and bandwidth restrictions. As broadband infrastructure has improved, telehealth usage has become more widely feasible. Healthcare providers often begin telehealth with a needs assessment which assesses hardships which can be improved by telehealth such as travel time, costs or time off work. Collaborators, such as technology companies can ease
10541-561: The hospital directly to his lab. One of the oldest known telecardiology systems for teletransmissions of ECGs was established in Gwalior, India in 1975 at GR Medical college by Ajai Shanker, S. Makhija, P.K. Mantri using an indigenous technique for the first time in India. This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of
10668-428: The interest in applying technological advancements when developing interventions. To optimize the advantages and minimize the challenges with the use of telehealth in home-based palliative care, future research should include users in the design and development process . Understanding the potential of telehealth to support therapeutic relationships between patients and health care professionals and being aware of
10795-782: The majority of patients trusted the nutritional televisits, in place of the scheduled but not provided follow-up visits during the lockdown of the COVID-19 pandemic. Telerehabilitation (or e-rehabilitation ) is the delivery of rehabilitation services over telecommunication networks and the Internet. Most types of services fall into two categories: clinical assessment (the patient's functional abilities in his or her environment), and clinical therapy . Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology , speech–language pathology , audiology , occupational therapy , and physical therapy . Telerehabilitation can deliver therapy to people who cannot travel to
10922-526: The managed care (insurance-billing) system through direct primary care which is a subset of the more familiar concierge medicine . Physicians in this model bill patients directly for services, either on a pre-paid monthly, quarterly, or annual basis, or bill for each service in the office. Examples of direct primary care practices include Foundation Health in Colorado and Qliance in Washington. In
11049-632: The medical record documenting clinical changes, new information, etc. These often take the form of a SOAP note and are entered by all members of the health-care team (doctors, nurses, physical therapists, dietitians, clinical pharmacists, respiratory therapists , etc.). They are kept in chronological order and document the sequence of events leading to the current state of health. The results of testing, such as blood tests (e.g., complete blood count ) radiology examinations (e.g., X-rays ), pathology (e.g., biopsy results), or specialized testing (e.g., pulmonary function testing ) are included. Often, as in
11176-524: The medical report and must be archived by the attending physician for at least 10 years. The law clearly states that these records are not only memory aids for the physicians, but also should be kept for the patient and must be presented on request. In addition, an electronic health insurance card was issued in January 2014 which is applicable in Germany ( Elektronische Gesundheitskarte or eGK), but also in
11303-406: The morning shift, but also serves as an educational experience for new residents to the team. A new approach features the team conducting rounds from a conference room using a video-conferencing system. The trauma attending, residents, fellows, nurses, nurse practitioners, and pharmacists are able to watch a live video stream from the patient's bedside. They can see the vital signs on the monitor, view
11430-509: The mother's Google Glass camera. The trial was successfully concluded in Melbourne in April 2014, and 100% of participants were breastfeeding confidently. Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses . In the past, palliative care was
11557-400: The organization and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care. In countries that operate under a mixed market health care system, some physicians limit their practice to secondary care by requiring patients to see a primary care provider first. This restriction may be imposed under
11684-488: The other member states of the European Union ( European Health Insurance Card ). It contains data such as: the name of the health insurance company, the validity period of the card, and personal information about the patient (name, date of birth, sex, address, health insurance number) as well information about the patient's insurance status and additional charges. Furthermore, it can contain medical data if agreed to by
11811-405: The patient receives, as well as other necessary information, such as the patient's case history, diagnoses, findings, treatment results, therapies and their effects, surgical interventions and their effects, as well as informed consents. The information must include virtually everything that is of functional importance for the actual, but also for future treatment. This documentation must also include
11938-544: The patient. There are generally five primary methods of funding health care systems : In most countries, there is a mix of all five models, but this varies across countries and over time within countries. Aside from financing mechanisms, an important question should always be how much to spend on health care. For the purposes of comparison, this is often expressed as the percentage of GDP spent on health care. In OECD countries for every extra $ 1000 spent on health care, life expectancy falls by 0.4 years. A similar correlation
12065-452: The patient. ECGs, or electrocardiographs , can be transmitted using telephone and wireless. Willem Einthoven , the inventor of the ECG, actually did tests with transmission of ECG via telephone lines. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. In 1906 Einthoven came up with a way to transmit the data from
12192-432: The patient. This data can include information concerning emergency care, prescriptions, an electronic medical record, and electronic physician's letters. However, due to the limited storage space (32kB), some information is deposited on servers. In the United States , the most basic rules governing access to a medical record dictate that only the patient and the health-care providers directly involved in delivering care have
12319-569: The possible difficulties and tensions it may create are critical to its successful and acceptable use. Telepharmacy is the delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist . It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy . Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs , and monitoring of formulary compliance with
12446-419: The presence of both parties at the same time. Dermatology (cf: teledermatology ), radiology , and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured medical record preferably in electronic form should be a component of this transfer. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of
12573-553: The prevention of transmissible diseases. They also include the services of professionals in residential and community settings in support of self-care , home care , long-term care , assisted living , treatment for substance use disorders among other types of health and social care services. Community rehabilitation services can assist with mobility and independence after the loss of limbs or loss of function. This can include prostheses , orthotics , or wheelchairs . Many countries are dealing with aging populations, so one of
12700-510: The principles of the ruling. It is that legislation which deems providers the owner of medical records, but requires that access to the records be granted to the patient themselves. In the United Kingdom , ownership of the NHS 's medical records has in the past generally been described as belonging to the Secretary of State for Health and this is taken by some to mean copyright also belongs to
12827-577: The priorities of the health care system is to help seniors live full, independent lives in the comfort of their own homes. There is an entire section of health care geared to providing seniors with help in day-to-day activities at home such as transportation to and from doctor's appointments along with many other activities that are essential for their health and well-being. Although they provide home care for older adults in cooperation, family members and care workers may harbor diverging attitudes and values towards their joint efforts. This state of affairs presents
12954-423: The record depending on the patient and his or her set of illnesses/treatments. Medical records are legal documents that can be used as evidence via a subpoena duces tecum , and are thus subject to the laws of the country/state in which they are produced. As such, there is great variability in rules governing production, ownership, accessibility, and destruction. There is some controversy regarding proof verifying
13081-433: The records themselves. The same is true for both nursing home and dental records. In cases where the provider is an employee of a clinic or hospital, it is the employer that has ownership of the records. By law, all providers must keep medical records for a period of 15 years beyond the last entry. The precedent for the law is the 1992 Canadian Supreme Court ruling in McInerney v MacDonald. In that ruling, an appeal by
13208-477: The records. The medical history is a longitudinal record of what has happened to the patient since birth. It chronicles diseases , major and minor illnesses , as well as growth landmarks . It gives the clinician a feel for what has happened before to the patient. As a result, it may often give clues to current disease state. It includes several subsets detailed below. Within the medical record, individual medical encounters are marked by discrete summations of
13335-426: The records. Twenty-eight states and Washington, D.C. , have no laws that define ownership of medical records. Twenty-one states have laws stating that the providers are the owners of the records. Only one state, New Hampshire , has a law ascribing ownership of medical records to the patient. Under Canadian federal law , the patient owns the information contained in a medical record, but the healthcare provider owns
13462-534: The right to a copy of their record, except where information breaches confidentiality (e.g., information from another family member or where a patient has asked for information not to be disclosed to third parties) or would be harmful to the patient's wellbeing (e.g., some psychiatric assessments). Also, the legislation gives patients the right to check for any errors in their record and insist that amendments be made if required. In general, entities in possession of medical records are required to maintain those records for
13589-508: The right to view the record. The patient, however, may grant consent for any person or entity to evaluate the record. The full rules regarding access and security for medical records are set forth under the guidelines of the Health Insurance Portability and Accountability Act (HIPAA). The rules become more complicated in special situations. A 2018 study found discrepancies in how major hospitals handle record requests, with forms displaying limited information relative to phone conversations. In
13716-833: The same as slow scan TV systems. Currently, videotelephony is particularly useful to the deaf and speech-impaired who can use them with sign language and also with a video relay service , and well as to those with mobility issues or those who are located in distant places and are in need of telemedical or tele-educational services. Common daily emergency telemedicine is performed by SAMU Regulator Physicians in France , Spain , Chile and Brazil . Aircraft and maritime emergencies are also handled by SAMU centres in Paris, Lisbon and Toulouse. A recent study identified three major barriers to adoption of telemedicine in emergency and critical care units. They include: Emergency Telehealth
13843-464: The scene of a mass casualty or disaster situation, via the internet using mobile devices, to determine the severity of injuries. They can provide clinical assessments and determine whether those injured must be evacuated for necessary care. Remote trauma specialists can provide the same quality of clinical assessment and plan of care as a trauma specialist located physically with the patient. Telemedicine for intensive care unit (ICU) rounds: Telemedicine
13970-705: The settings on the respiratory ventilator, and/or view the patient's wounds. Video-conferencing allows the remote viewers two-way communication with clinicians at the bedside. Telemedicine for trauma education: some trauma centers are delivering trauma education lectures to hospitals and health care providers worldwide using video conferencing technology. Each lecture provides fundamental principles, firsthand knowledge and evidenced-based methods for critical analysis of established clinical practice standards, and comparisons to newer advanced alternatives. The various sites collaborate and share their perspective based on location, available staff, and available resources. Telemedicine in
14097-608: The short-term it can be as acceptable and effective as face-to-face care. Research also suggests comparable therapeutic factors, such as changes in problematic thinking or behaviour. It can improve access to mental health services for some but might also represent a barrier for those lacking access to a suitable device, the internet or the necessary digital skills . Factors such as poverty that are associated with lack of internet access are also associated with greater risk of mental health problems, making digital exclusion an important problem of telemental health services. Teledentistry
14224-402: The storage equipment for medical records generally is the property of the health care provider, the actual record is considered in most jurisdictions to be the property of the patient, who may obtain copies upon request. The information contained in the medical record allows health care providers to determine the patient's medical history and provide informed care. The medical record serves as
14351-576: The support and collaboration of local clinics and private practitioners and the Members IACP, IACP runs the facility, named Telemedicine. IACP has maintained an internet-based list of their members on their website, through which patients can make online appointments. Telemedicine can be utilized to improve the efficiency and effectiveness of the delivery of care in a trauma environment. Examples include: Telemedicine for trauma triage: using telemedicine, trauma specialists can interact with personnel on
14478-410: The terms of the payment agreements in private or group health insurance plans. In other cases, medical specialists may see patients without a referral, and patients may decide whether self-referral is preferred. In other countries patient self-referral to a medical specialist for secondary care is rare as prior referral from another physician (either a primary care physician or another specialist)
14605-469: The terms telemedicine and telehealth interchangeably, although it acknowledges that telehealth is sometimes used more broadly for remote health not involving active clinical treatments. eHealth is another related term, used particularly in the U.K. and Europe, as an umbrella term that includes telehealth, electronic medical records , and other components of health information technology . Telehealth requires good Internet access by participants, usually in
14732-422: The transition. Delivery can come within four distinct domains: live video (synchronous) , store-and-forward (asynchronous) , remote patient monitoring , and mobile health . Store-and-forward telemedicine involves acquiring medical data (like medical images , biosignals etc.) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline . It does not require
14859-414: The trauma operating room: trauma surgeons are able to observe and consult on cases from a remote location using video conferencing. This capability allows the attending to view the residents in real time. The remote surgeon has the capability to control the camera (pan, tilt and zoom) to get the best angle of the procedure while at the same time providing expertise in order to provide the best possible care to
14986-450: The types of rehabilitation services that can be provided. It is most widely used for neuropsychological rehabilitation ; fitting of rehabilitation equipment such as wheelchairs , braces or artificial limbs ; and in speech-language pathology. Rich web applications for neuropsychological rehabilitation (aka cognitive rehabilitation ) of cognitive impairment (from many etiologies) were first introduced in 2001. This endeavor has expanded as
15113-412: The use of telecommunications and information technology in order to provide nursing services in health care whenever a large physical distance exists between patient and nurse, or between any number of nurses. As a field it is part of telehealth, and has many points of contacts with other medical and non-medical applications, such as telediagnosis , teleconsultation, telemonitoring, etc. Telenursing
15240-626: The use of medical services, the efficacy of treatments, and overall outcome (well-being, mortality rates). Health care extends beyond the delivery of services to patients, encompassing many related sectors, and is set within a bigger picture of financing and governance structures. A health system , also sometimes referred to as health care system or healthcare system , is the organization of people, institutions, and resources that deliver health care services to populations in need. The healthcare industry incorporates several sectors that are dedicated to providing health care services and products. As
15367-583: The use of medical services, the efficacy of treatments, and overall outcome (well-being, mortality rates). Health systems are the organizations established to meet the health needs of targeted populations. According to the World Health Organization (WHO), a well-functioning healthcare system requires a financing mechanism, a well-trained and adequately paid workforce , reliable information on which to base decisions and policies , and well-maintained health facilities to deliver quality medicines and technologies. An efficient healthcare system can contribute to
15494-454: The use of mobile technology to provide neurological care remotely, including care for stroke, movement disorders like Parkinson's disease, seizure disorders (e.g., epilepsy), etc. The use of teleneurology gives us the opportunity to improve health care access for billions around the globe, from those living in urban locations to those in remote, rural locations. Evidence shows that individuals with Parkinson's disease prefer personal connection with
15621-465: The use of telehealth in palliative care have also been described. Generally, palliative care is a diverse medical specialty, involving interdisciplinary professionals from different professional traditions and cultures , delivering care to a heterogenous cohort of patients with diverse diseases, conditions and symptoms. This makes it a challenge to develop telehealth that is suitable for all patients and in all contexts of palliative care. Some of
15748-515: The use of telemedicine across all divisions of neurosurgery: vascular, oncology, spine, and functional neurosurgery. Not only for follow-up visits, but it has gained popularity for seeing new patients or following established patients regardless of whether they underwent surgery. Telemedicine is not limited to direct patient care only; there are a number of new research groups and companies focused on using telemedicine for clinical trials involving patients with neurosurgical diagnoses. Teleneuropsychology
15875-507: The use of videoconferencing in pharmacy for other purposes, such as providing education, training, and management services to pharmacists and pharmacy staff remotely. Telepsychiatry or telemental health refers to the use of telecommunications technology (mostly videoconferencing and phone calls) to deliver psychiatric care remotely for people with mental health conditions . It is a branch of telemedicine. Telepsychiatry can be effective in treating people with mental health conditions. In
16002-401: The work of health professionals who act as a first point of consultation for all patients within the health care system . The primary care model supports first-contact, accessible, continuous, comprehensive and coordinated person-focused care. Such a professional would usually be a primary care physician , such as a general practitioner or family physician . Another professional would be
16129-435: The written (paper notes), physical (image films) and digital records that exist for each individual patient and for the body of information found therein. Medical records have traditionally been compiled and maintained by health care providers, but advances in online data storage have led to the development of personal health records (PHR) that are maintained by patients themselves, often on third-party websites. This concept
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