1. By Shnese Mills, RN Penn State University Nursing 457

2. OBJECTIVES  Describe telemedicine  Discuss hardware used for telemedicine  Discuss software used for telemedicine  Discuss information system components

3. OBJECTIVES  Discuss Advantages of Telemedicine  Discuss Disadvantages of Telemedicine  Discuss Legal and Ethical Issues  Review Nursing Competencies

4. OBJECTIVES  Describe Informatics Competencies  Review Nurse Informatics Specialist  Summary

5. DEFINITION  Telemedicine is an application of clinical medicine  Widely associated with populations living remotely or isolated  Hands on physical assessment and history component omitted  Communication/technology combined to provide clinical care (Kurtz, 1994)

6. Telemedicine Defined  Appointment times set aside for patients to be contacted  Patients receive care advice without leaving home  Care can range from simple to complex

7. TYPES OF TELEMEDICINE  Telemedicine has three main parts, they include:  store-and-forward  remote monitoring  interactive services

8. Telemedicine Communication Hardware  PSTN/POTS  ISDN  LAN  GSM

9. Telemedicine Communication Hardware  GSM/GPRS/G3 Wireless/Satellite links

10. Software For Telemedicine  DICOM  Video-conferencing Units  PIR (Patient Information Records)

11. DICOM & Software Used  Digital Imaging and Communication in Medicine  Recognized as medical imaging standard  Specific software required for DICOM usage

12. DICOM Usability  Ease of use  Ease of learning  Satisfaction with using (Staggers, 2003)

13. DICOM Usability  Efficiency of use  Error tolerance  Fit of system to the task (Staggers, 2003)

14. Axioms Evaluated  Axiom 1  Axiom 2  Axiom 3

15. Information Systems  Telemedicine uses Patient Care Information Systems:  Clinical information systems  Pharmacy Information Record  Laboratory Information Systems  Radiology Information Systems (McGonigle & Mastrian 2009)

16. Information Systems Cont.  Patient Care information system  Used by health providers / administrative staff  Used for downloading medical records  Configured through LAN  Data System is Healthlevel 7 (HL7)

17. Information System Cont.  Classification system  Nursing Classification scheme  Recommendations for future usage

18. Discuss Advantages of Telemedicine  Medical appointment without leaving home  Decreased anxiety in own home  Reduced expenditure for traveling

19. Discuss Disadvantages of Telemedicine  No hands on assessment  Insurance Payments  Equipment

20. Discuss Ethical and Legal Issues  Confidentiality and HIPPA  Medical Providers Licensure  Professional Liability

21. Describe Nursing Competency  Case Management and Triage skills  Knowledge of computer systems

22. Review Informatics Competencies  Beginning Nurse  Experienced Nurse  Informatics Nurse Specialist  Informatics Innovator (McGonigle & Mastrian, 2009)

23. Review Nurse Informatics Specialist Functions  Project Manager  Consultant  Educator  Researcher (McGonigle & Mastrian, 2009)

24. Review Nursing Informatics Specialist Roles Cont.  Product Developer  Decision Support/Outcomes Manager  Advocate/Policy Developer  System Specialist  Entrepreneur (McGonigle & Mastrian, 2009)

25. Summary  Computer Centered Care  Future of Telemedicine

26. REFERENCES  Bidgood, W, Horii, S, Prior, F, & Van Sckyle, D. (1997). Understanding and using DICOM, The Data Interchange Standard for Biomedical Engineering. JAMIA, 4(3), 199-212  Kurtz, GL. (1994). The Future of telecommunications in rural healthcare. Healthcare Information Management, 8(3), 5- 9.

27. REFERENCES  McGonigle, D, & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury: Jones and Bartlett Publishers.  Perednia, DA, & Allen, A. (1995). Telemedicine technologies and clinical applications. JAMIA, 273(6), 483-8

28. REFERENCES  Staggers,N. ( 2003). Human factors: Imperative concepts for critical care. AACN Clinical Issues 14(3), 310-319