Telehealth: Virtual Appointments & Remote Monitoring

The journey of telehealth began with ancient societies and the early attempts to establish basic communication between settlements when faced with any type of threat and subsequently, to establish a connection between patient and medical providers. The history of telehealth emphasizes the continuing underlying theme of connection between those in need of care and those who provide it. Authors traced the history of long-distance communication beginning with the semaphore, and much later the telegraph and radio to current advanced digital communication and computer processing systems (WHO, 2010). Current technological advances such as virtual appointments and remote monitoring, focus on the deliverance of safe, effective, timely, patient-centered, efficient, and equitable health care. While the telehealth industry is growing with their several advantages, there are a few challenges that have risen up.

Over half of all U.S. hospitals use telehealth and this trend is rising. Surveys found that 90% of these hospitals have already begun developing and implementing a telehealth program into their organizations. The adoption of a program can help achieve numerous benefits such as lowering healthcare costs, improving communication between providers and patients, providing patients better and easier access to healthcare services, and ultimately happier and healthier patients. The American Hospital Association (AHA) states that telehealth plays a critical role in hospitals’ readmission reduction program to help combat high readmission rates (AHA, 2016).

Telehealth enables patients to be monitored remotely on an ambulatory basis, and can avoid the high cost of inpatient services. In addition to remote monitoring, patients are able to receive at- home triage services facilitated by nurses and primary care providers, reducing the unnecessary and expensive use of emergency room visits (AHA, 2016). In today’s healthcare world, convenience is key. Telehealth offers patients simple, on-demand care without the usual wasted time and cost of most in-person visits. Patients who live in remote areas, or who are homebound or not able to take off time from work, can access and manage their care virtually (AHA, 2016). Some clinics that provide virtual appointments enable patients to see their doctor or a nurse via online videoconferencing and receive ongoing care when an in-person visit is not required or possible. Patients are able to ask questions about a medication or their treatment plan more quickly and conveniently, by checking in with their doctor for on-going guidance. With video conferencing, smartphone applications, and online management systems, providers and patients are connected more than ever before. Regardless of location, telehealth can help reach a wider geographic region.

While telehealth promises to grow rapidly over the next decade and has clear benefits, it still poses some technical and practical problems for healthcare providers. Restructuring staff responsibilities and purchasing equipment is time-consuming and costly. The complexity of telehealth equipment can be a challenge and may result in several minutes spent on trying to figure out how to turn on the equipment and use the system’s features, which may take the focus away from the patient. Therefore, proper training upfront and the availability of resources to troubleshoot problems are critical components in building an effective telehealth program. Also, protocols and standards of practice must be well established to define nursing roles and expectations in various telehealth settings. Training is not just focused on how to turn on the

equipment, but more importantly, in how to use it effectively for consultation, education and administrative purposes (WHO, 2010). Training needs to be continual, especially where staff turnover is high, and it should be practical and pitched at different levels. Providing an on-site full-service provider and offering training refreshers are also beneficial for learning and reinforcement. In addition, continuity of care and quality of care suffer since patients are connected with random healthcare providers and patients’ primary care provider may not have access to records from previous visits, and have an incomplete history or notes of the patients’ care routines (WHO, 2010). The discontinuity of care and switching of providers increases the risk for mismanagement and poor quality healthcare. Telehealth also can present challenges relating to privacy and disclosures. Many applications disregard privacy rules specified in the Health Insurance Portability and Accountability Act, or HIPAA. For example, home telehealth tools designed to detect falls may collect and transfer data on certain activities in the household that a patient wishes to keep private, such as alcohol or substance abuse. The main security risk is that of unauthorized access to data during the collection, transmission, or storage of patient information (AMA, 2014). Any data transfer provides the potential for a security breach. It is argued that despite efforts to produce secure devices and applications, many contain serious flaws. Hackers and malware constitute an increasing threat to the security of telehealth systems (AMA, 2014). Furthermore, when providers treat patients off-site, they have no way of knowing who else is in the room during a videoconference, which could violate the patient’s HIPAA privacy rights (Medscape, 2017). Nurses deal with private patient data that cannot be at risk of getting lost or sent to the wrong person, as such an error are costly and potentially harmful for patients (Medscape, 2017). Another challenge, is the technical aspects of telehealth. Creating a secure and strong platform for telehealth is important, especially due to the amount of sensitive patient information, and must be both compliant to the guidelines of HIPAA and PCI. The complexity of video conferencing networks, encryption and authentication protocols, and the possibility that the system could crash or be deployed improperly, could result in security and privacy breaches (Medscape, 2017). Furthermore, experts note that improvements are needed for managing and obtaining “informed consent,” which keeps patients aware of advantages and potential concerns associated with medical treatments. Improved documentation can help providers limit legal exposure associated with telehealth by using easy-to-understand language, explaining the risks and benefits of telehealth, and providing other information to help the patient make an informed choice, such as alternatives and referral information for a local provider (Medscape, 2017).

Telehealth is transforming how nurses approach and deliver healthcare and improving patient care in an increasingly dynamic healthcare environment. Telehealth covers a broad variety of technology and strategies to deliver virtual medical, health, and educational services. From monitoring patients with chronic conditions such as diabetes through videoconferencing, to providing critical care to patients in remote areas, telehealth provides efficiency, and allows nurses to directly communicate with remote physicians for questions or consultations (CCHPCA, 2017). The American Journal of Critical Care (AJCC) conducted a 2-phased study on a national benchmarking survey of nurses working in intensive care telehealth facilities in the United States, to assess nurses’ perceptions on the adoption of telehealth in the intensive care unit. In phase one, 1,213 nurses strongly agreed that using telehealth care enabled them to accomplish tasks more quickly (63%), improved collaboration (65.9%), improved job performance (63.6%) and communication (60.4%) is useful in nursing assessments (60%), and improved care by providing more time for patient care (45.6%) (AJCC, 2016). Nurses reported that benefits also included easier ways to detect trends in vital signs and unstable physiological status, provide medical management, and enhance patient safety (AJCC, 2016). Reported obstacles included technical problems— audio and video, and interruptions in patient care (AJCC, 2016). In phase two, 60 nurses ranked 15 priority areas of care, including critical thinking skills, communication, intensive care experience, mutual respect, and management of emergency patient care (AJCC, 2016). The purpose of this study was to measure nurses’ perception of the benefits and barriers of the adoption of telehealth, and to identify the benefits and barriers, with respect to nursing care (AJCC, 2016). The findings showed that although there were identified barriers related to perceptions of interference and interruptions in care, the majority of nurses that participated reported that tele-ICU enhanced patient care, improved productivity and collaboration, and made their job easier (AJCC, 2016).

For nearly 50 years, telehealth programs have served as innovative tools for delivery of care, connecting patients and providers separated by geographic and socioeconomic barriers. Although there are several advantages of telehealth in the healthcare world, it is still uncertain how it may evolve in the future. However, for now, advantages like keeping patients in their own homes and out of rehab centers, lowering costs and providing a boost to rural hospitals appear to outweigh the negatives. More focus needs to be on how we can do a better job of harnessing the technology to improve care and to do that as effectively and efficiently as possible. While there are many challenges going forward, renewed thinking on what needs to be done to overcome barriers and capitalize on opportunities, are critical in ensuring that telehealth programs succeed. All in all, the opportunities in telehealth can make a real difference in the healthcare system in terms of access, quality and efficiency.

References

• Kay, M. (2010). World Health Organization. Telemedicine. Opportunities and developments in Member States. Retrieved by: http://www.who.int/goe/publications/goe_telemedicine_2010.pdf
• (2017). Mayo Clinic. Telehealth: Technology meets health care. Retrieved by: https:// www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878
• Bala, A. (2017). Medscape. How Technology is Changing Nursing: The Impact of Telehealth. Retrieved by: https://www.medscape.com/viewarticle/883380#vp_2
• (2017). American Hospital Association. Telehealth: Helping Hospitals Deliver Cost-Effective Care. Retrieved by: http://www.aha.org/content/16/16telehealthissuebrief.pdf
• (2017). Center for Connected Health Policy. The National Telehealth Policy Resource Center. What is Telehealth?. Retrieved by: http://www.cchpca.org/what-is-telehealth
• Kleinpell, R. (2016). American Journal of Critical Care. Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units. Retrieved by: http://ajcc.aacnjournals.org/content/25/1/ e14.full
• Hale, T. (2014). American Medical Association. Privacy and Security Concerns in Telehealth. Retrieved by: http://journalofethics.ama-assn.org/2014/12/jdsc1-1412.html