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Using Telehealth Technologies to Improve Oral Health for Vulnerable

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Using Telehealth Technologies to Improve Oral Health for Vulnerable $%&%'%(&$' $%)'*+&+,-%. !"# $%&'(#), *%) +,, ( - . D Using Telehealth .v h Technologies to Improve Oral Health for Vulnerable and Underserved Populations )*"# +#*,,-*., //,, -*, -0*; -123*4# 34#+4,5., //,; *./ !4..$ 6*77#584 (/.$0()$ Telehealth refers to the use of technology to provide health care at a distance. The important and increasing role of telehealth in the delivery of health care has been recognized for several decades. Although there are fewer reports on the use of telehealth to deliver oral health services, evidence is emerging that these technologies can enhance the ability of the oral health delivery system to reach vulnerable and underserved populations. *"7359, Paul Glassman, 11., 2(, Michael Helgeson, 11., everal terms have been used to Opportunities,” reviewed the history and 2/(, is a professor of is chief executive officer, describe the use of technologies use of telemedicine nationally and in Dental Practice, director Apple Tree Dental, in that facilitate interaction among California. !e report described the use of Community Oral Health, Minneapolis, Minn. and director of the Pacific Conflict of Interest patients and health care provid- of telemedicine technologies to deliver Center for Special Care, Disclosure: None reported. ers in geographically separated health services in state prisons through Arthur A. Dugoni School of Slocations. Much of the literature uses the regional service delivery mechanisms Dentistry in San Francisco. Jenny Ka3love, is terms “telemedicine” to describe these centered at the University of California, Conflict of Interest director, Strategic Health interactions. In the last decade, the use of Davis, in outreach systems managed by Disclosure: None reported. Initiatives, The Childrens Partnership, in Los these technologies in dentistry has been the Veterans Administration, in out- Angeles. referred to as “teledentistry.” More recent- reach managed by rural health centers, Conflict of Interest ly, these terms have been combined and and for use in diagnosis and treatment Disclosure: None reported. referred to collectively as “telehealth.” of a wide variety of health conditions. !e important and increasing role of Delivery of health care using tele- telehealth in the delivery of health care medicine technologies is recognized by has been recognized for several decades. the federal government as a “cost-effective !e California HealthCare Founda- alternative to the more traditional face- tion in a report, “Telemedicine in to-face way of providing medical care” due California: Progress, Challenges, and to the ability to provide earlier diagnos- !"#$ %&'% !"# 0/'/1/&'01 0/%1,*'*2(/. !"# $%&'(#), *%) +,, ( - . tic and preventive services and savings as a legitimate means of providing health videoconferencing equipment; digital in transportation and other associated care. !e stated intent of the law was to cameras; electronic clinical devices, such costs. !e Center for Medicare and Med- support the idea that “!e use of telecom- as digital stethoscopes; and disease man- icaid Services (CMS) has indicated that munications to deliver health services agement and health education software. “for purposes of Medicaid, telemedicine has the potential to reduce costs, improve Telehealth has been used in many ap- seeks to improve a patient’s health by quality, change the conditions of practice, plications including emergency and criti- permitting two-way, real-time interac- and improve access to health care in rural cal care, vision screening, mental health tive communication between the patient and other medically underserved areas.” evaluation and treatment, telepharmacy, and the physician or practitioner at the Common applications of telehealth child abuse evaluations, and diagnosis and distant site. !is electronic communica- include videoconferencing between a treatment of a variety of other health con- tion means the use of interactive telecom- patient and health care provider for a ditions.- A recent study demonstrated a munications equipment that includes, at consultation or among groups of patients percent lower rate of rehospitalization a minimum, audio and video equipment.” or providers for education, support, and for patients on home health care regi- CMS further stated that “states may reim- mens who were followed using telehealth burse the physician or other licensed prac- technologies versus those in a nontele- titioner at the distant site and reimburse %&'()*+,(& -&. *,/ health group. !e savings from this a facility fee to the originating site. States of the leading states intervention were substantial given an can also reimburse any additional costs average cost of readmission of , per such as technical support, transmission in adopting legislation person for the group of patients studied. charges, and equipment. !ese add-on to define and support the It has been argued that telehealth is costs can be incorporated into the fee- a critical modality to address the severe for-service rates or separately reimbursed role of telemedicine in shortages of health care available for as an administrative cost by the state.” health care delivery. large numbers of people in our society. In A report, “Meeting the Health California, Medi-Cal has recognized the Care Needs of California’s Children: value of telehealth and reimburses provid- !e Role of Telemedicine,” by !e Chil- ers who use videoconferencing to provide dren’s Partnership, stated that “Quality care coordination; transmission of data, care. Medi-Cal also provides a facility and health care no longer requires a health such as X-rays, photographs, video, and transmission fee to the originating site to care provider and patient to be in the audio files; remote monitoring of vital compensate for the telecommunications same room at the same time. With the signs and other health indicators; and and other costs associated with originating advancement of information and com- Internet applications for patient educa- a telehealth visit. Medi-Cal also reimburses munications technology (ICT), children tion and disease management. Telehealth for store-and-forward applications related and adults can receive high-quality can occur in “real time,” where the patient to teledermatology, teleophthamology, and health care from a distance through and his or her provider are at one site specific types of teleoptometry services.- telemedicine. In fact, telemedicine is communicating with another provider at rapidly becoming a viable solution to another site simultaneously. Videocon- Teledentistry meeting the health care needs of patients ferencing is the most common real-time Application and use of telehealth in in rural and other underserved areas.” telehealth interaction. Telehealth also oc- dentistry are not as well-developed as the California was one of the leading curs using “store-and-forward” methods. use of telehealth technologies in other states in adopting legislation to define and A store-and-forward interaction involves aspects of the health care delivery system. support the role of telemedicine in health the transfer of data, such as an X-ray or a However, telehealth technologies have care delivery. In , California adopted digital image, from an originating site to been available and used in the delivery of the Telemedicine Development Act of a distant site for review and consultation oral health services for quite some time. !is law put California in the posi- at a later time. Telehealth also involves the An early report on the use of technology tion of national leadership on telemedi- use of an ever-growing menu of software to allow collaboration between distant cine policy and supported telemedicine and technological devices, including dental providers described a system in use !"# !"#$ %&'% !"# $%&'(#), *%) +,, ( - . by the U.S. Army to transmit still color with dental specialists for temporoman- Access to Oral Health Care for Vulner- images over a modem to allow periodon- dibular disorders, orofacial pain, and oral able and Underserved Populations.”, tists to view healing after periodontal sur- medicine issues. A report described !ese reports emphasize the significant gery without the patient having to travel the use of teledentistry technologies to oral health disparities among a num- long distances. A series of articles in the triage the need for a referral to a re- ber of underserved population groups February issue of the Journal of the mote oral medicine hospital clinic. and call for new methods and systems California Dental Association recognized In , a report described the ability to address these disparities. !ere is the potential for telehealth but expressed of endodontic specialists to remotely specific mention of the role of tele- significant caution about how these tech- locate the canal orifice to assist general health as a component of future oral nologies would develop and be used., In dentists in performing endodontic treat- health delivery systems that can better spite of the widespread use of telehealth ments. A publication described reach and serve these populations. in medicine, there are far fewer reports an initiative developed by the North- in the literature on the application of ern Arizona University (NAU) Dental Teledentistry in the California Virtual telehealth concepts to the delivery of oral Dental Home Project health services. !e emphasis of those !e virtual dental home project, reports that are available on teledentistry $%& '($( directed by the Pacific Center for Spe- has been on the use of these technologies is
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