TELENURSING AND REMOTE ACCESS TELEHEALTH NURSING INFORMATICS CHAPTER 7 1

CHAPTER OBJECTIVES Objectives: 1. Explore the use of telehealth technology in nursing practice. 2. Identify socioeconomic factors likely to increase the use of telehealth interventions. 3. Describe clinical and nonclinical uses of telehealth. 4. Specify and describe the most common telehealth tools used in nursing practice. 5. Explore telehealth pathways and protocols. 2

CHAPTER OBJECTIVES 6. Identify legal, ethical and regulatory issues of home telehealth practice. 7. Describe the role of the telenurse. 8. Apply the Foundatin of Knowledge model to home telehealth. 3

Introduction: “Telehealth” is a relatively new term in our medical /nursing vocabulary; referring to and a wide range of health services that are delivered by telecommunications-ready tools, such as the telephone, videophone, and computer. The growing field of telehealth, particularly in nursing practice, will allow us to improve care delivery services even more. 4

Introduction: Early uses in the 1970s of more advanced forms of telehealth in the medical field, referred to as “telemedicine,” included teleradiology and telepathology—radiological and pathological images transmitted to specialists who were located at some distance. Success in telehealth was achieved after decades were spent refining the technology, which resulted in clearer imaging, more speedy transmissions, and accurate replication of data from remote locations to a central hub. 5

Introduction: The end results of telehealth interactions today have helped to insure that professionals can replicate usual clinical interactions in all specialties regardless of the distance involved in the contact. 6

Key Terms Defined: Call Centers:  Registered nurse-staffed facilities at which nurses typically act as case managers for callers or perform patient triage. Chronic Disease:  Range of long-term diseases, such as congestive heart failure, diabetes, and respiratory ailments. Centers for Medicare and Medicare Services (CMS):  The largest health insurer in the U.S., particularly for home healthcare services and for the elderly healthcare services received under Medicare. 7

Key Terms Defined: Central Stations/Web Servers/Portals:  Multifunctional telehealthcare platforms for receiving, retrieving, and/or displaying patients’ vital sign and other information transmitted from telecommunications-ready medical devices. Home Healthcare:  Alternate site care health services typically focusing on post- hospital discharge patient needs. Home Telehealthcare:  Home healthcare clinical and educational services provided via telecommunications-ready tools. 8

Key Terms Defined: Medication Management Devices:  Range of telecommunications-ready medication devices to remind or otherwise alert patients to medication compliance needs. Outcomes and Assessment Information Set (OASIS):  Center for Medicate and Medicare required process of collecting and reporting performance data by home healthcare agencies. 9

Key Terms Defined: Patient Health Outcomes:  Measurable effects resulting from best practice treatment interventions that improve/stabilize the course of health over time. Patient Informed Consent:  Document that a patient signs to agree to treatment; document which a home healthcare patient signs to agree to receive telehealthcare services in addition to conventional home healthcare. 10

Key Terms Defined: Personal Emergency Response Systems (PERS):  Signaling devices for patients to access emergency and other care needs. Peripheral Biometric (Medical) Devices:  Range of telecommunications-ready measurement devices, such as blood pressure cuffs and blood glucose meters, that typically use the household telephone jack to transmit patient data to a central server location. Real-Time Telehealth:  Live interactions between 2 or more clinicians, usually performed with videoconferencing equipment. 11

Key Terms Defined: Sensor and Activity Monitoring System:  Systems for tracking activities of daily living (ADLs) of seniors and other at-risk individuals in their place of residence.  Additional applications are sensors’ use in detecting anomalies or problems such as faucets and stoves left turned on. Store-and-Forward Telehealth:  Application of telehealthcare, in which images and other clinical data are captured and transmitted to specialist clinicians. 12

Key Terms Defined: Telehealthcare:  Health services delivered by telecommunications-ready tools, usually supervised by a nurse or other clinician. Telehealth:  Telecommunication technologies used to deliver health- related services or to connect patients and healthcare providers to maximize patients’ health status.  A relatively new term in our medical/nursing vocabulary, referring to a wide range of health services that are delivered by telecommunications-ready tools such as the telephone, videophone, and computer. 13

Key Terms Defined: Telemedicine:  Health services delivered by telecommunications-ready tools supervised or directed by a physician. Telemonitoring:  Remote measurement of patients’ vital signs and other necessary data. 14

Key Terms Defined: Telenursing:  Health services delivered by telecommunications-ready tools supervised or directed by a nurse; refers to the use of telecommunications and information technology for providing nursing services in health care to enhance care whenever a physical distance exists between patient and nurse, or between any number of nurses.  As a clinical field, telenursing is part of telehealth, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, and telemonitoring. 15

Key Terms Defined: Telenursing…….  Telenurses do not, in effect, work outside of the broader clinical team effort, no matter where they are located.  They are indeed an integral part of the healthcare delivery team. 16

Key Terms Defined: Telephony:  Telephone monitoring of patients at home by off-site telenurses. Teleradiology:  Use of telecommunications technology to electronically transmit and exchange radiographic patient images with the consultative text or radiologist reports from one location to another. 17

Key Terms Defined: Telepathology:  Use of telecommunications technology to facilitate the transmission and transfer of pathology data for the purposes of diagnosis, education and research; transmission and exchange of image-rich pathology data between remote locations. 18

Nursing Aspects of Telehealth: Understanding telehealth and the potential use of telehealth technology in nursing practice is necessary in today’s changing healthcare arena. Telehealth interventions or contacts are performed off-site and often require less time spent on task because of the efficiencies offered by the technology applications. 19

Telehealthcare: “Telehealth” is generally used as an umbrella term to describe all of the possible variations of healthcare services which use telecommunications. In store-and-forward telehealth, digital images, video, audio and clinical data are captured and “stored” on the client computer or device; then, at a convenient time, the data are transmitted securely (“forwarded”) to a specialist/clinician at another location where they are studied by the relevant specialist/clinician. 20

Telehealthcare……. “In real-time telehealth, a telecommunications link between the involved parties allows a real-time or “live” interaction to take place. Use of computers for real time two-way audio and video streaming between centers over ever improving and cheaper communication channels is becoming common. 21

Telehealthcare……. “Examples of real-time clinical telehealth applications include:  Telemental health  Telerehabilitation  Telehomecare  Teleconsultations  Telehospice/ telepalliative care In remote monitoring, devices are used to capture and transmit biometric data. Telephone monitoring is the most basic type of telehealth 22

“Telenursing: Telenursing refers to the use of telecommunications and information technology for providing nursing services in health care to enhance care whenever a physical distance exists between patient and nurse, or between any number of nurses. The most developing area of telenursing today is in home telehealthcare. According to regular surveys by the Association for Retired Persons (AARP)(AARP, 1996), more than 90% of seniors want to remain independent at home and age in place. 23

“Telenursing: Telenursing refers to the use of telecommunications and information technology for providing nursing services in health care to enhance care whenever a physical distance exists between patient and nurse, or between any number of nurses. The most developing area of telenursing today is in home telehealthcare. According to regular surveys by the Association for Retired Persons (AARP)(AARP, 1996), more than 90% of seniors want to remain independent at home and age in place. 24

“Telenursing: Care at home is clearly a key concern and preference. The home care industry’s newest challenge is to work with sicker patients, many of whom have been discharged from hospitals to home earlier than in the past. 25

“Telenursing: Home care telenursing can also involve other activities such as providing customized patient education in dietary or exercise needs, nursing teleconsultations, review of results of medical tests and exams, and assistance to physicians in the implementation of medical treatment protocols. Home care telenurses can well expect to play a vital and dynamic role in the changing delivery systems that are to be in place in the next decades. 26

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