Section 2 - Distance Learning Communities

The distance learning community that I chose is Health Care - specifically Telemedicine/Telehealth. At Robert Wood Johnson University Hospital, I am responsible for the providorship of continuing education for the nurses. Presently our educational activities that grant CEUs are mostly face to face. This type of offering while extremely informational is very inconvenient in a major institution that is addressing a nursing shortage. The nurses do not have the time to leave the units to attend such a class in the other end of the institution. So it is one of my goals to offer them more on-line offerings.



Telemedicine/Telehealth offers many opportunities. Telemedicine is defined as clinical services where health care providers (physicians, nurses, etc) can bring access to health care to the people in rural or urban areas. Techniques, diagnoses and treatments can be shared and taught from one institution to another anywhere in the world provided the technology and funding is available. Telehealth sometimes referred tp an an umbrella term to encompass both, delivers continuing education such as CME's for physicians and CEU's for nurses and other allied health professionals. These can be generic or related to specialties. Also under this rubric is community education where patient education is given to both patients and families.



There are two basic modes of delivery - Store and Forward, with such examples as radiographic studies stored and sent on to other institutions for further analysis and diagnosis; and Two-way Interactive Television (IATV) which is live and allows participants from many sites to interact at the time of the offering or face to face for consultations. Both modes involve technology and or the use of the internet. The higher the level of technology to allow for the use of peripherals, the capability of bandwidthes, and Use of ISDN or IP the more sophisticated and enhanced the health care and programs can be. Examples of equipment used are electronic stethoscope, electronic otoscope, examination camera and dermascope to aid in long distance assessments and diagnoses.



I found many phenomenal programs in existance:

- KUCTT Kansas University Center for Telemedicine and Telehealth started in 1991 and now considered one of the most active telemedicine programs in the world. The program offers clinical services, continuing education and community education. An example of one of the services is TeleKidCare touted to "Bring the doctor to the school" a health care delivery system where a physician can "exam" and diagnose children in the nurse's office at their school. Since it's beginning approximately 10 years ago - 57% of the cases were mental health issues and 38% were ENT problems. The goal of KUCTT is for the people of Kansas to have access to the best available health care and education and technology. The education and care is to be administered in a professional, timely and convenient manner. http://www2.kumc.edu/telemedicine/2008Technology.htm

-The Idaho State University Institute of Rural Health offers Virtual Grand Rounds (VGR) offering education onf specialty care more accesible to rural and urban health care providers. From 2001-2004 3,910 person-hours continuing education was given over 42 video-conference sessions. The largest group of participants (25%) were nurses. http://tie.telemed.org/

-The University of Wisconsin Medical School - Continuing Medical Education program offers CMEs via conferences, workshop, home study, distance learning by teleconference, PC or PDA.

-MyNursinsingCE Learning Portal - Online continuing education via self-learning modules.

- The University of Wisconsin Collaborative Nursing Program for RN to BSN degree via Distance Learning.



The barriers to Telemedicine/Telehealth include:

Individual states requiring that physicians have licenses in the state that the patient is in, in order to care for those individuals.

Even thought the cost of care can be lest expensive - CMS restricts medicare reimbursement in mant instances, as well as many private insurers placing the same restrictions.