Remote & Telehealth Medicine " Transforming Healthcare Delivery" by

Introduction

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The covid-19 pandemic led to a rapid increase in telehealth usage (Soliman et al., 2023). Physicians stated they were able to care, especially during covid-19, far easier by allowing greater accessibility for patients, including follow-ups, allowed patients to stay on track with care, especially those with chronic conditions (Gomez et al., 2021). However, some providers questioned the ability to accurately diagnose and fear malpractice lawsuits as a result (Yassa et al., 2022).

Implications for Nursing Practice

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For nursing practice, the implication is vast. Telehealth relieves nurses of many routine cases, thus preserving more time for face-to-face cases. Therefore, in the emergency department, telehealth increases the efficiency and capacity of an organization since it reduces patient congestion and improves output time (Madisetti et al., 2021). Nurses are also in a good position to use telehealth to reduce decision-making time and ensure that the right patients get the necessary care. It also fosters health system coordination of a respite patient's primary care with intermittent and specialized care over time. Newer research suggests that integrating telehealth into the prehospital setting can create a six percent decrease in unnecessary emergency room visits (Hairston et al., 2020). A study was implemented with a Virtual ED initiated during the SARS-CoV-2 (Coronavirus) pandemic across Metro North Medical Hospital and Health Services (MNHHS) (Kelly et al., 2023). The review ran from April 2020 through to March 2022 (Kelly et al., 2023). The Virtual ED only evaluated patients referred by healthcare practitioners. All patients of any age qualified to triage through the Virtual ED but to be evaluated, they would have had to be referred by an NP and live, visiting, or getting treatment in the MNHHS network (Kelly et al., 2023). No patient saw the Virtual ED administration to be pointless, and the Virtual ED forestalled 70% of community triaged patients from presenting to the ED, which led to demonstrating its viability in lessening a surplus of physical ED visits (Kelly et al., 2023). Majority of the non-urgent ER visits (CTAS of 4 and 5’s) at the University Hospital in Saudi Arabia consisted of routine care, medication prescriptions, and symptoms of upper respiratory infections (Alnassar, 2023). Women were the majority of these visits, concluding that they are more likely to misuse the ER. Researchers found that participants chose to use the ER over PCP due to long distances and wait times, appointment availability, and resource shortages (Alnasser, 2023)

Driving Forces for Telehealth

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Telehealth Bridging the gap and expanding access

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Home Telehealth Practice and Protocols

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The Patient's Role in Telehealth

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Patients play a crucial role in the success of telehealth, unlike traditional healthcare, telehealth requires active patient participation, digital literacy, and self-management to ensure effective care. As telehealth expands, understanding the responsibilities, benefits, and challenges of patient involvement is essential.

Telehealth Research

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Telehealth research plays a vital role in shaping policies, improving technology and enhancing patient outcomes. Over the past decade, numerous studies have explored the effectiveness, accessibility, cost effectiveness, and patient satisfaction associated with telehealth services (Smith et al., 2023).

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As tele-health becomes an increasingly common mode of delivering care, particularly in rural or underserved areas, important ethical considerations come into play. What ethical challenges might arise when providing telehealth services to vulnerable populations, such as those with limited internet access, low health literacy, or language barriers?

Legal, Ethical and Regulatory Issues

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As telehealth continues to grow legal, ethical and regulatory challenges must be addressed to ensure patient safety, privacy, and equitable access to care. The rapid adoption of telehealth has outpaced existing regulations, raising concerns about licensure, reimbursement policies, patient confidentiality and liability (Smith et al., 2023).

References

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Alnasser, S., Alharbi, M., AAlibrahim, A., Aal ibrahim, A., Kentab, O., Alassaf, W., & Aljahany, M. (2023). Analysis of emergency department use by non-urgent patients and their visit characteristics at an academic center. International Journal of General Medicine, Volume 16, 221–232. https://doi.org/10.2147/ijgm.s391126

Helping patients prepare for their telehealth appointment | Telehealth.HHS.gov. (2024, August 20). Telehealth.hhs.gov. https://telehealth.hhs.gov/providers/preparing-patients-for-telehealth/helping-patients-prepare-for-their-appointment

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Kelly, J. T., Mitchell, N., Campbell, K. L., Furlong, K., Langley, M., Clark, S., Rushbrook, E., & Hansen, K. (2023). Implementing a virtual emergency department to avoid unnecessary emergency department presentations. Emergency Medicine Australasia, 36(1), 125–132. https://doi.org/10.1111/1742-6723.14328

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Krupinski, E., & Bernard, J. (2014). Standards and Guidelines in Telemedicine and Telehealth. Healthcare, 2(1), 74–93. https://doi.org/10.3390/healthcare2010074

Madisetti, M., Newman, J. C., Butcher, M. C., Pittman, M. C., Qanungo, S., & Kelechi, T. J. A pre and post COVID-19 global assessment of telehealth use within the respite care industry: A quantitative study.

SEO Optimizer. (2024, May 2). Learn more about the benefits of telemedicine and how it improves senior care services. Summit Pointe Senior Living. https://www.summitpointeseniorliving.com/blog/benefits-of-telehealth-for-seniors/

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‌Telehealth resource center: Research findings. (n.d.). American Medical Association. https://www.ama-assn.org/practice-management/digital/telehealth-resource-center-research-findings

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Tuckson, R. V., Edmunds, M., & Hodgkins, M. L. (2017). Telehealth. The New England Journal of Medicine, 377(16), 1585–1592. https://doi.org/10.1056/NEJMsr1503323

David-Olawade, A. C., Olawade, D. B., Ojo, I. O., Famujimi, M. E., Olawumi, T. T., & Esan, D. T. (2024). Nursing in the digital age: Harnessing telemedicine for enhanced patient care. Informatics and Health, 1(2), 100–110. https://doi.org/10.1016/j.infoh.2024.07.003

Evolving Telehealth Models

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Telehealth, often used interchangeably with telemedicine, is defined as the electronic exchange of medical information to improve a patient’s health. Its broader goal aligns with achieving the Quadruple Aim:

Enhancing the patient experience
Improving population health
Reducing costs
Improving the work life of healthcare providers

Telehealth models are evolving across several axes:

A. Virtual Clinical Care

Leading health systems (e.g., Kaiser Permanente, Geisinger) have increasingly shifted from traditional in-person models to virtual-first strategies. These include:

Email, phone, and video consultations
Remote prescription refills
After-hours access
Triage and chronic disease management
Mental health counseling and follow-up care

B. Technology-Driven Tools

Modern telehealth models use:

Smartphone apps
Wearable monitors
Remote wireless devices
Web portals
These tools not only monitor patient health (e.g., activity, diet, medication adherence) but also integrate with electronic health records (EHRs) and use data analytics to personalize care.

Team Members

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Jenny Gomez

Bethany Watson

Telehealth Patient Population

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Telehealth has significantly expanded access to healthcare, improving outcomes for various patient populations. By overcoming geographical barriers, reducing wait times, and enabling remote monitoring, telehealth enhances care for numerous groups (Smith et al., 2021). Some of the populations that benefit the most from telehealth are rural and undeserved communities due to some of the challenges they face such as limited access to healthcare facilities and specialist, longer travel distance for medical appointments, higher prevalence of chronic conditions due to lack of preventative care (Johnson& Brown,2022). Elderly patients and patients with chronic conditions also have challenges due to mobility issues that make in person visits difficult. This population has an increased need for regular checkups and chronic disease management, which can lead to risk of hospitalizations due to lack of early interventions. Special needs patients also require frequent specialist care and ongoing care.

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"What are the biggest challenges to maintaining patient privacy and data security in telehealth, and how can they be addressed?"

Hospital Care at Home

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Career opportunities for telehealth nurses are expanding as virtual care becomes more integrated into healthcare systems. Telehealth nurses play a vital role in remote patient monitoring, managing chronic conditions like diabetes and hypertension by interpreting data from wearable devices and adjusting treatment plans. In Tele-ICUs, they provide critical care oversight remotely, supporting on-site teams. Nurses in primary care and chronic disease management conduct routine follow-ups, medication management, and patient education, while telenursing in home health allows for symptom monitoring and self-management support. Teleconsultation and triage nurses assess symptoms, provide health education, and direct patients to appropriate care, while telerehabilitation nurses assist patients in virtual recovery programs.

Tele-ICU: Critical support

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Fact Sheet on Telehealth

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Intro Video

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Implementing Telehealth and Reducing ER Wait Time

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Implementing ER telehealth on average, telehealth availability in the emergency room significantly reduces average patients’ length of stay, which is partially driven by the flexible resource allocation (Sun et al., 2022). Telehealth has turned into a growing service in the healthcare industry. Australian ED visits have expanded by an average of 3.2% yearly to over 8.8 million visits per year (Kelly et al., 2023). More than 27% of ED visits globally might be better overseen in alternative settings (Kelly et al., 2023). Many non-urgent facilities have incorporated telehealth into their patient care. However, many people don’t have a PCP or insurance to utilize these facilities, therefore, resorting to the ER (Alnasser, 2023). Defining telehealth-Telemedicine, a type of health information technology (hereafter denoted as HIT), is defined as the “remote delivery of healthcare services and clinical information using telecommunications technology” (Sun et al., 2020). Telehealth has many modalities in the healthcare system and has enhanced access for patients that are in areas with limited resources (Hayden, 2021). The Virtual ED model of care gives real-time virtual emergency consultations through phone or video for patients to avoid ED visits. (Kelly et al., 2023). This model fabricates a pathway for care providers who already evaluate patients with crisis care requirements to straightforwardly train other practitioners and nurses to become subject matter experts in this specialty as well. (Kelly et al., 2023). This will help to expand the demand for clinicians who will operate the Virtual ED model. Testing customary ED structures will allow doctors to encourage pathways that will furthermore build the credibility of obtaining virtual assistance for patients in non-emergent complaints opposed to alluding to the patient to the actual ED (Kelly et al., 2023). Reducing ER wait times- Wall Street Journal recently reported an ER telemedicine initiative at New York Presbyterian Hospital, the goal is to reduce waiting time and get patients with non-urgent health concerns in and out of the emergency room efficiently without compromising care (Sun et al., 2020). It was determined that for patients who received treatment through this program, their total amount of time spent in the ER dropped from an average of 2–2.5 hours to only 35–40 minutes (Sun et al., 2020). Non-critical health complaints- A research study at King Abdullah Bin Abdul-Aziz University Hospital revealed that nearly 61% of all ER visits were considered less or non-urgent and could potentially have been treated at a local clinic or urgent care (Alnasser, 2021). Non-urgent ED visits are visits for injuries or conditions that would not result in an adverse outcome if not treated for several hours (Hairston et al., 2022). Overcrowding in the ER- Emergency rooms tend to be overcrowded with long wait times, potentially delaying care for patients of all acuity levels. EMTALA has mandated that hospitals should provide care to all individuals seeking treatment for a medical condition, so the ER becomes the safety net for those with access barriers (Sun et al., 2020). Overcrowded emergency rooms is an ongoing, nagging problem. (Sun et al., 2022). This is troublesome because it is costly for hospitals and can compromise the quality of care and patient experience (Sun et al., 2022). Patients seeking care for these non-urgent conditions risk receiving unnecessary tests, procedures, and treatments in addition to overall lower quality of care (Hairston et al., 2020). Non-urgent emergency room visits are those for injuries or conditions that would not result in an adverse outcome if not treated for several hours (Hairston et al., 2020).