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·Telehealth is always changing. From making access easier, quality care, improving systems efficiencies and interoperability. All areas of telehealth is being reimagined.

·Patient data will be obtained through wearables such as watches and smart shirts.

·5G will transform telehealth.5G will be important for transmitting large medical images, remote patient monitoring and complex uses of AI, AR, and VR.

·Virtual reality or VR can and will be used to educate patients, used in hospitals as a distraction, and will be used to improve procedural intervention by overlaying imaging data and important information.

·Telehealth will expand it’s reach and scope of services. More physicians are providing telehealth services. A patient recovering from surgery will be able to get an on-camera consultation without the physical and financial cost of travel.

·  Regardless of a patient’s age or condition, familiarity with telehealth will prompt more use.

·The future of telehealth is bright and offers convenience and better medical care for all patients that use it. As the telehealth industry continues to grow, it will begin to offer more services and technology for both doctors and patients. New and evolving technology are ready to impact the delivery of care in 2020 and beyond.

References

https://www.healthcareguys.com/2020/05/05/the-future-of-telemedicine-6-telehealth-trends-shaping-the-industry/

https://www.healthcareguys.com/2020/05/05/the-future-of-telemedicine-6-telehealth-trends-shaping-the-industry/

https://healthtechmagazine.net/article/2019/12/5-healthcare-tech-trends-watch-2020

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Intro Video

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The Foundation of Knowledge Model and Home Telehealth

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The Foundation of Knowledge Model and Home Telehealth

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Humans acquire data and information in small increments and then transform the information into knowledge. The brain has information-processing commonly compared to those of a computer, and vice versa. People can be thought of as living information systems that are continuously obtaining, processing, and generating information of knowledge or knowledge in their professional and personal lives. They have an incredible ability to achieve knowledge. This ability is learned and practiced from birth as people make their way through the lifespan.  Humans interact with the environment become overwhelmed with data and information. Each person experiences the environment differently and generates knowledge by attaining, processing, producing, and distributing knowledge.

For nurses, acquired knowledge starts in nursing education programs and continues to grow their foundation of knowledge by engaging in career activities. These can be but not limited to research and theory projects, attending continuing education programs, consulting with seasoned colleagues.  Nurses use clinical databases and clinical practice guidelines throughout the career lifespan. As they interact in the clinical setting, they obtain knowledge for processing.  This causes them to restructure their knowledge base and generate fresh knowledge. They can then share this new knowledge with other colleagues and receive new perceptions. This feedback sharing builds the knowledge foundation.  The nurse repeats the process they attain, practice, generate, and distribute new knowledge as a result of their interactions. This ongoing nursing process is the Foundation of Knowledge Model.  Due to the ever changing and advancements in technology all nurses must continue to acquire knowledge regardless of experience.

Nurses are knowledgemanagers, apprehending and processing collective expertise and allocating it where it can create the largest advantage. Nurses are knowledge workers, working with evidence and generating info and knowledge creation. Nurses are knowledge acquisition determined while providing convenient and efficient means of capturing and storing knowledge. Nurses are users of knowledge giving individuals or groups the benefit of appreciated and sustainable knowledge. Nurses are knowledge engineers who design, develop, implement and maintain information. They are evidence based developers and generators of knowledge in an evolving healthcare industry.

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Telemedicine Can Improve Care, Especially for Underserved Patients

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It's time to put today's technology to good use for our health, the environment and our budget. This short (less than 2 min) video shows you how Telehealth can help you take care of your health - close to home!

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Telehealth expanding access to care | Irina Gelman | TEDxFMCC

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According to the American Telehealth Association, "telehealth nursing is a tool for delivering nursing care remotely to improve efficiency and patient access to healthcare. A telehealth call or inquiry is more than just a phone call, however, and the nurses who respond to these calls are participating in the healthcare continuum."

Mataxen, Patti A, MSN,M.H.A., R.N.-B.C., & Webb, L. D. (2019). Telehealth nursing: More than just a phone call. Nursing, 49(4), 11. doi:http://dx.doi.org.ju.idm.oclc.org/10.1097/01.NURSE.0000553272.16933.4b

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The growth in the number of technological tools available for communication has implications in all fields of society. Companies are doing home office, educational institutions are implementing distance learning tools and the way society consumes entertainment is changing. Health systems are also adapting to this new scenario.

Telehealth has several positive aspects, such as increasing access and improving outcomes; decrease waiting times and patient absenteeism; an improvement in communication between patients and health professionals; and lower costs (Kruse et al.) Perhaps the aspect of improving communication is noteworthy, and patient rejection should be expected due to the physical distance imposed by this type of care, however Donelan et al. states that telehealth allows shorter and more frequent meetings between the parties, which may explain this trend.

According to Colvin, some improvement should be implemented, mainly in the bureaucratic part involving reimbursement and state licensing restrictions. One should also consider the difficulties among older patients in adapting to these technological solutions (Lyons et al.)

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Telehealth involve a broad range of healthcare technologies used for a variety of functions in many clinical conditions and patient care settings. There have been thousands of research and studies on telehealth consisting vast systematic reviews in disparate healthcare functions and clinical conditions. According to Agency for Healthcare Research and Quality (AHRQ), among the evidence that sufficiently support the effectiveness of telehealth are remote access to monitor patients with chronic conditions, counseling and communication for patients with chronic conditions and offering psychotherapy as part of behavioral health (AHRQ, 2016).

Current research about applications of telehealth also resulted to findings that can challenge and help future developments in telehealth applications. Primary studies regarding maternal and child health and consultation are readily available but still warrants additional systematic reviews. Other topics and uses that telehealth has been valuable to such as urgent cares’ triage features also suggest need of more evidence. Moreover, future research should incorporate how the use of telehealth in an organization and how payment models are assessed as health informatics grow as fast as technology itself (AHRQ, 2016).

Information literacy is most pertinent to all consumers of telehealth in this day and age. It is almost inevitable especially during the pandemic, where telecommunications are utilized more than ever. The rapid expansion of telehealth requires more research evidence that will validate its effectiveness in healthcare system, patient care, and other implementation specifics such as technical assistance, staffing, and reimbursement structures. The pandemic, being it a global crisis, sped up the adoption of telehealth, which opened opportunities to learn more about its application and created an opportunity for more evidence to be gathered as we enter a new era of medicine (AHRQ, 2020).

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Telehealth: Legal and Ethical Considerations for Success | Telehealth and Medicine Today

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Telehealth and Medicine Today (TMT) publishes articles on a continuous basis. As articles are accepted, they are published to ensure timely and accurate reflections of developments to assist building rapid consensus and adoption by the community.

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•	At the federal level, the Dept of Health and Human Services, largely through its Health Resources and Services Administration and Office for the Advancement of Telehealth has become increasingly involved in telehealth by administering telehealth grant programs, providing technical assistance, developing telehealth policy initiatives to improve access to quality health services and promoting knowledge exchange about “best telehealth practices.”

•	In 2016, the American Medical Association adopted new guidelines for ethical practice in telemedicine.  These guidelines advised physicians participating in telehealth/telemedicine to recognize the limitations of the relevant technologies and to take appropriate steps to overcome such limitations, recognizing that a coordinated effort across the profession is necessary to achieve the promise and to avoid the pitfalls of telemedicine.

•	There is currently no uniform legal approach to telehealth, which continues to be a major challenge to its progress.  Telehealth implementations varies widely from state to state in terms of how much service providers will be reimbursed for delivering telehealth services, as well as what sort of parity is expected between in-person health services reimbursements vs telehealth reimbursements. Currently, only 41 jurisdictions have laws that govern private payer reimbursement of telehealth.

•	On the federal level, Medicare reimburses for synchronous communications and does not cover any store and forward services or remote patient monitoring for chronic diseases, except in Alaska and Hawaii.  The federal government places numerous limitations on Medicare reimbursement for telehealth services, based on the location of the patient and practitioner as well as the type of distant site facility.

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The increasing demand for healthcare care and the cost saving potential are the biggest driving forces of telehealth. Implementation of telehealth and telemedicine has been a fundamental contributing factor in closing the gap between the demand and supply of healthcare services for different populations across life span. Foreseeably, millennials comprised the majority of the workforce, driving the inevitable growth of the telehealth industry. Telehealth offers convenience to all consumers, both healthcare providers and patients – dramatically shorter wait times and travel times, allowing patients to see their healthcare providers faster, potentially reducing any growing health concerns. It brings down costs by implementing telehealth as a step before a hospital visit or in non-emergency events. For instance, many health insurance plans utilize telehealth/ telemedicine for a video/phone consultation to see a nurse first before they go for a trip to the emergency room (Greenlight Medical, 2018).

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The American Nursing Association (2015) listed these five trends that will influence the future of nursing informatics:

1.       Changing practice roles in nursing

2.       Increasing informatics competence requirements

3.       Rapidly evolving technology

4.       Regulatory changes and quality standards that include healthcare consumers as partners in healthcare models

5.       Care delivery models and innovation

(Mastrian & McGonigle, 2018)

The evolution of healthcare technology has continuously reconceptualize and enhance the roles of nurses in the healthcare system. Nurses have always been adaptive to all fundamental changes in healthcare, making them integral part of all aspects of healthcare delivery. Nursing informatics has paved way to greater heights in improving use of information to achieve better patient outcomes, develop more efficient systems, and promote quality of care with effective interoperability. Even though healthcare technology has been emerging for quite awhile, nursing informatics is still at its beginning stages. The increased pace of technology in healthcare sets a stage for new challenges by which each challenge may demand more training, education, and competencies for new and current nurses, without compromising best practices in nursing and quality of patient care (Mastrian & McGonigle, 2018).

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An Example of Application of Telehealth/Telemedicine

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An Example of Application of Telehealth/Telemedicine

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The following is a video of a thoracic surgeon discussing how telemedicine has been beneficial in providing post-operative care to patients all over British Columbia.

https://www.youtube.com/watch?v=eWZP6kRfFc0&t=13s

Disclaimer: The video used is from 9 years ago and from Canada. The poster just found the video as the most simple and concise, yet elaborate on interprofessional collaboration in patient care, especially the nurse-patient interaction in providing care through telehealth.

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Canada Health Infoway. (2011). A thoracic surgeon talks about the benefits of telemedicine. Retrieved from https://www.infoway-inforoute.ca/en/what-we-do/blog/174-what-we-do/digital-health-and-you/stories/clinician-stories/67-a-thoracic-surgeon-talks-about-the-benefits-of-telemedicine

Greenlight Medical. (2018). Will telehealth change the future of healthcare. Retrieved from https://www.greenlightmedical.com/telehealth-and-the-future-of-healthcare/

McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge (4th ed.) with Navigate 2 Premier Access. Burlington, MA: JB Learning. ISBN-13: 9781284121285

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When the coronavirus outbreak hit, health care providers needed to figure out a different way to connect with their patients. That's where telemedicine came in. Healthcare systems across the region are not only using it, they're embracing it.

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What to expect from a virtual visit to your doctor

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When the coronavirus outbreak hit, health care providers needed to figure out a different way to connect with their patients. That's where telemedicine came in. Healthcare systems across the region are not only using it, they're embracing it.

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Guidelines to Home Telehealth include:
-Licensure:  Depending on the state, physician may need to be licensed in state where the patient is located
-Establish physician/patient relationship
-Evaluation and Treatment: All must my documents in electronic health record
-Informed Consent
-Continuity of Care: Follow-up care should be made available for patient whether it be with the physician providing telemedicine visit or referral to another physician
-Referrals to Emergency Services: Physician should provide patient with emergency plan
-Medical Records: Should include everything that meets standard requirement for documentation such as communication, lab results, prescriptions, etc
-Privacy and Security of Patient Records: Includes HIPAA
-Disclosures: Examples of disclosures to the patient are fees for services and patient rights
-Prescribing: Precautions need to be taken by physician for safety of the patient since the physician is unable to do a physical examination on patient

References:

King, M. (2019, January 9). Guideline for Telemedicine Policies and Procedures. https://www.magmutual.com/learning/article/guidelines-telemedicine-policies-and-procedures-0/

Yahoo!News. (2020, April 20). What to Expect from a Virtual Visit to your Doctor.
https://m.youtube.com/watch?v=F4i2iAKPHFk

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YouTube: Patient benefits with telehealth 

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YouTube: Patient benefits with telehealth 

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YouTube of patient and nurse discussing their views on telehealth 

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YouTube of patient and nurse discussing their views on telehealth 

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For some patients daily monitoring of their health is very important, and many would like to maintain control. One of the benefits patients like about telehealth is the ability to set their own schedule for monitoring. If a nurse comes to the house, patients often must be available based on the nurse’s schedule. Telehealth gives patients the ability to manage chronic conditions at home to hopefully avoid unnecessary hospitalizations. Nurses usually work with patients to help them monitor chronic conditions such as: COPD, Diabetes, Heat Failure, and Frequent Pneumonias. If something is off the nurse intervenes by first calling the patient and then contacting a provider if needed. Telehealth has helped decrease readmissions in some facilities by 50 percent. This decrease helps the organization save money and allows the patient to stay in the community. The downside of telehealth monitoring is that only about 30% of healthcare organizations can afford telehealth monitoring, and in many cases Medicare and Medicaid will not reimburse for telehealth monitoring. The plus side of telehealth monitoring is that patients are involved with their care and they have a better awareness of their own health. It also gives patients a sense of security knowing the nurse is on the other end frequently reviewing their health information.
Retrieved from:
https://www.youtube.com/watch?v=I4vpHZ5adIA

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Telehealth Care Allows for Remote Monitoring of Patients

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Telehealth is an essential aspect of nursing as it facilitates the provision of remote care through telephones, computers, and other visual accessories. The practice comes with implications for nursing and technological applications, information management, research and ethics, and patient care.

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Telehealth influences nursing practice and informatics by enhancing the accuracy and communication of data and care plans for patients. Besides, it improves data sharing, which is a significant aspect of nursing informatics, to assist in addressing challenges posed by the shortage of nurses. In that regard, telenursing supports remote home care and patient monitoring for improved quality, safety, efficiency, and care outcomes. According to Mataxen, and Webb (2019), telehealth offers more than just a phone call; it is a resource for both patients and their families.

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Telehealth facilitates information management for nurses and other caregivers. Telehealth promotes quick and efficient entry and retrieval of information for the improvement of daily workflow and patient care. The practice enables automatic capture and storage of patient data, which is readily available to the care team for better coordination.
Moreover, telenursing supports evidence-based practice (EBP), which is vital for the improvement of care. Evidence-Based Practice (EBP) is an essential aspect of nursing research, which helps to identify areas of improvement regarding the provision of remote care to patients. Developments in telehealth emphasize the significance of ethical consideration concerning technological applications in nursing, data security and confidentiality, patient and family satisfaction, nurse-patient relationship, and informed consent (Langarizadeh, Moghbeli, & Aliabadi, 2017). Moreover, telenursing enhances patient care by ensuring adherence to ethical standards and best practice for improved services. It facilitates access to patients and health data to enable decision-making among caregivers. Overall, health is a vital component of nursing that supports technological advancement and mobile device incorporation to ensure better care and patient outcomes.

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Comparison of patient perceptions of Telehealth-supported and specialist nursing interventions for early stage COPD: a qualitative study

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Comparison of patient perceptions of Telehealth-supported and specialist nursing interventions for early stage COPD: a qualitative study

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Although patients receive less visits with telehealth nursing, they reported great enthusiasm with the care they receive. Some patients think telehealth nursing is the best care they have ever received. Remarks from patients support telehealth as an acceptable alternative to traditional healthcare visits.

Reference:
Fitzsimmons, D. A., Thompson, J., Bentley, C. L., & Mountain, G. A. (2016). Comparison of patient perceptions of Telehealth-supported and specialist nursing interventions for early stage COPD: a qualitative study. BMC Health Services Research, 16(1), 420. https://doi.org/10.1186/s12913-016-1623-z

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Patient's Role in Telehealth Word Search

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Patient's Role in Telehealth Word Search

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What is Telehealth Nursing? Remote Nursing Practice - eVisit

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Discover the answer to, "What is telehealth nursing?" With telehealth technologies, nurses are able to remotely conduct their practice while still serving patients!

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Mataxen, Patti A. MSN, MHA, RN-BC; Webb, L. Denise RN-BC Telehealth nursing, Nursing: April 2019 - Volume 49 - Issue 4 - p 11-13 doi:10.1097/01.NURSE.0000553272.16933.4b

Langarizadeh, M., Moghbeli, F., & Aliabadi, A. (2017). Application of Ethics for Providing Telemedicine Services and Information Technology. Medical archives 71(5), 351–355. https://doi.org/10.5455/medarh.2017.71.351-355

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Agency for Healthcare Research and Quality. (2016). Mapping the evidence for patient outcomes from systematic reviews. Retrieved from https://effectivehealthcare.ahrq.gov/products/telehealth/technical-brief

Agency for Healthcare Research and Quality. (2020).  The evidence base for telehealth: reassurance in the face of rapid expansion during the COVID-19 pandemic. Retrieved from https://effectivehealthcare.ahrq.gov/products/telehealth-expansion/white-paper

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Colvin, Loretta. “Telehealth: Helping Solve a Problem We Created.” Journal of Clinical Sleep

Medicine, vol. 15, no. 9, 2019, https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.7958. Accessed 27 May 2020.

Donelan, Karen; Barreto, Esteban A.; Sossong, Sarah; Michael, Carie; Estrada, Juan J.; Cohen,

Adam B.; Wozniak, Janet & Schwamm, Lee H. “Patient and Clinician Experiences with Telehealth for Patient Follow-up Care.” Trends from the Field, 2019, https://www.researchgate.net/profile/Esteban_Barreto/publication/330544973_Patient_and_Clinician_Experiences_With_Telehealth_for_Patient_Follow-up_Care/links/5c488050458515a4c73b127a/Patient-and-Clinician-Experiences-With-Telehealth-for-Patient-Follow-up-Care.pdf. Accessed 27 May 2020.

Kruse, Clemens Scott; Krowski, Nicole; Rodriguez, Blanca; Tran, Lan; Vela, Jackeline &

Brooks, Matthew. “Telehealth and Patient Satisfaction: A Systematic Review and Narrative Analysis”. BMJ Open, vol. 6, no. 8, 2017, https://bmjopen.bmj.com/content/7/8/e016242.long. Accessed 27 May 2020.

Lyons, Joseph P.; Watson, Kimberly & Massacci, Angela. “The Evolution of Elderly

Telehealth and Health Informatics.” InterchOpen, 2019, https://www.intechopen.com/online-first/the-evolution-of-elderly-telehealth-and-health-informatics. Accessed 27 May 2020.

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1 - Discuss two competencies for a Telehealth nurse requirement  and why this is relevant to nursing informatics?

2. How effective are healthcare professionals at providing holistic and patient centered care using telehealth services?

3. How are nursing interventions related to telehealth nursing services?

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Rochelle Shafer
Yovalis Roses
Marie Reyes
Lola Swanson
Jillian Stempel
Chaka Mitchell
Lisa Davis Watson
Rex Reeves