A relatively new term in the medical and nursing vocabulary

Telephone Videophone Smartphone Computer

Telephone

Nurses to counsel a patient Doctors to change a patient’s plan of care

President Trump announced widespread expansion of telehealth services for Medicare beneficiaries and relaxation of rules so that seniors could avoid exposure to COVID-19 in physician offices and clinics.

American Hospital Association

A best practices document

Centers for Medicare & Medicaid Services

General Provider Telehealth and Telemedicine Toolkit

American Medical Association

AMA Quick Guide to telemedicine in practice

Knowledge Acquisition Knowledge Processing Knowledge Generation Knowledge Dissemination

Receives information from telehealth devices

Assesses patient’s vital signs with subjective data received from the patient

Considers all of the data and information as they apply to the patient

Determines how the knowledge will be used and disseminated

1. Patients’ responses to new medications, for example, can be tracked within hours rather than the several days that elapse between face-to- face. 2. Telehealth interventions or contacts are performed off-site and often require less time on certain tasks because of the efficiencies of technology applications visits. 3. Telehealth interventions must never be associated with less care. 4. Nursing activity in telehealth follows the same best practice standards as those espoused in conventional care. 5. Telehealth tools are a means for nurses to do their work better.

Have taken place in the last 20 to 30 years

Bonfires to alert neighboring villages of the arrival of bubonic plague during the middle ages

Occurred in the 1950s, which then led to the development of interactive closed- circuit applications in the mid-1960s.

Ever-evolving technologies in digital transmission, the falling costs of computing in general, and the explosion of mobile phones and satellite communications will sustain the advance of telehealth.

1. Viewed as an enhancement to care 2. Allows more direct, physical intervention to occur only when it is actually needed 3. Care is not directed by prescheduled appointment or subjective perceptions of condition, but instead can be determined by objective measures of physical status. 4. Enables care at the most appropriate site, reducing reliance on EDs and inpatient facilities

1. Demographics 2. Nursing and healthcare worker shortages 3. Chronic diseases and conditions 4. The new, educated consumers 5. Excessive costs of healthcare services that are increasing in need and kind

The U.S. healthcare system spends $1.4 trillion per year on conventional medical care.

Develop a new clinical model for U.S. health care that includes technology. In particular, telehealth technology should fill the gap resulting from an overabundance of patients and a scarcity of healthcare providers.

1. Use of medical information exchanged from one site to another via electronic communications to improve patients’ health status 2. Use of technology to deliver health care, health information, or health education at a distance 3. An umbrella term for all of possible variations of healthcare services that use telecommunications 4. Can refer to clinical and nonclinical uses of health-related contacts 5. Health-promoting aspects

1. Delivery of patient education, such as menu planning for patients with diabetes 2. Transmission of medication reminders

1. Transmitting 2. Providing disease prevention and health promotion 3. Using telephonic or video interactive technologies to provide health advice in emergent cases 4. Using real-time video such as exchanging health services or education live via videoconference

Images for assessment or diagnosis such as images of wounds for assessment and treatment consults Clinical data for assessment, diagnosis, or disease management such as remote patient monitoring and transmitting patient vital signs

Telephonic or smartphone app case management; patient education through asthma and weight management programs in school

Performing teletriage in call centers

1. Become familiar with the varied clinical and nonclinical transmission formats and applications of telehealth technologies 2. Make informed choices about the tools available

1. Store-and-forward telehealth 2. Real-time telehealth 3. Remote monitoring 4. Telephony 5. mHealth

1. Distance education 2. Administrative uses 3. Research

1. All of these activities overcome obstacles of distance and provide access to needed health-related information. 2. The range of patient care possibilities broadens significantly.

Use of telecommunications and IT to provide nursing services and enhance care when a physical distance exists between patient and nurse or among nurses

Telediagnosis, Teleconsultation, and Telemonitoring

Work with sicker patients, many of whom have been discharged from hospitals to home earlier than in the past

1. Immobilized 2. Live in remote or difficult to reach places 3. Have chronic ailments 4. Have debilitating diseases

1. Requiring immediate postsurgical situations 2. Needing care of wounds and ostomies 3. Needing physical therapy interventions or telerehabilitation

Telephony-based call centers 1. Telemonitoring services 2. Telehealthcare devices to transmit biometric and other medical information back to the call center

American Telemedicine Association

A clinical care guideline for TeleICU that identified three practice models

1. Continuous Care Model 2. Scheduled Care Model 3. Responsive (Reactive) Care Model

1. Patients with chronic diseases 2. At-risk populations 3. Isolated patients 4. Incarcerated patients 5. Hospitalized patients

Telemedicine applications allow for a dramatic extension of patient management and triaging options and allow off-site providers to be involved in care. If an infectious or communicable disease is involved, patient isolation could be accomplished in the home using telemedicine technology.

Patients and families who want to have reliable and objective information that allows them to be involved in healthcare decision making

A kiosk can be used to obtain vital signs for large groups of people. Vital signs reports can be forwarded on a schedule to physicians and others involved in the patient's care. Some facilities have even used access to telemonitoring systems as an inducement to attract potential residents.

1. Interested in lowering costs 2. Benefit financially from illness preventive strategies (reduced absenteeism and increased productivity)

Some companies create financial incentives for employees who achieve healthcare objectives.

1. Central stations, Web servers, and portals 2. Peripheral biometric (medical) devices 3. Telephones 4. Videocameras and videophones 5. Personal emergency response systems 6. Sensor and activity-monitoring systems 7. Medication management devices 8. Special needs telecommunications-ready devices

1. Trending 2. Triage 3. Communication 4. Data Access and Information Sharing

Tools of telehealth are devices that enable remote care delivery, enhance patient care, and improve outcomes. It is a practice, albeit one that represents a change in the current clinical model of practice for home care.

Attending nurses must be licensed to practice in all of the states in which they provide telehealth services by directly interacting with patients. It is important for nurses working for health systems located near state borders, drawing patients from both states.

Telehealth is affected by certain legal, ethical, and regulatory issues. 1. All licensed professionals must be specifically aware of legislation governing their practice. 2. Patient confidentiality and the privacy and safety of clinical data must be given special consideration. 3. Informed consent releases to receive telehealth services are a critical first step. 4. Telehealth providers must adhere to all data privacy and confidentiality guidelines and remain vigilant to ensure that all involved parties, including the technical staff assistants, have appropriate training in privacy and confidentiality issues.

Medicare Payment Advisory Commission

Discussed need for streamlining interstate licensure for physicians and nurses who provide telehealth services.

Nurses should ask, "Will my patient use this device?"

The range and sophistication of home telehealth tools are expanding regularly. Elderly patients may find monitoring technology that speaks to them in their homes and video cameras to assist in wound care tracking, for example, to be a daunting introduction to home health care.

1. How provider-centric or patient-centric is the technology? 2. Does the shift to remote services promote rationality and efficiency at the expense of values traditionally at the heart of caregiving? 3. How does the design affect home life and family dynamics? 4. To what extent should technology use involve attempts to manipulate users into different behaviors? 5. How might the replacement of human contact by new technologies be ameliorated? 6. To what extent is the deployment of technology an end in itself, aimed not toward the improvement of health or well-being, but to create market needs? 7. How do we identify the boundaries between genuine solutions and futility in light of technologies that may shift them?

Focuses primarily on clinical outcomes, such as: Effectiveness of telehealth compared to usual care, cost effectiveness of telehealth, and patient and family satisfaction

"Mapping the Evidence for Patient Outcomes from Systematic Reviews" provided a systematic review of evidence related to the impact of telehealth on clinical outcomes.

Previous telehealth care deliveries were largely provider initiated, but we are beginning to see that consumers will drive the way health care is delivered in the future. Consider that tomorrow's healthcare facility might have no walls.

1. Retail clinics 2. Telehealth apps 3. Internet of Things 4. Telemed Tablet 5. Novel software apps:

1. Improve beneficiary access under fee-for-service payments 2. Revise the Medicare Chronic Care Initiative

1. Options for high-risk pregnancy telehealth networks 2. Consolidation of HHS telehealth grants 3. Promotion of autism telehealth networks to improve care quality and accessibility 4. License portability for HHS health professionals

A clinical and caregiver structure that uses the data collected from patients to make better and more informed healthcare decisions.

Will become increasingly sophisticated and more patient centric.

Tools should be used to improve care delivery models. In an ideal world, there will be seamless integration of clinical data systems and robust data exchange to provide quality care for patients no matter their location.

The electronic provision of health information, products, and services online as well as the electronic automation of administrative and clinical aspects of care delivery

The use of telecommunication and computer technologies for delivery of medical care

Electronic transmission of prescription and patient specific clinical information

The use of mobile devices to collect and provide real time monitoring of patient health data, to provide direct provisions of care through mobile telemedicine

Transmission of cardiac catheterization studies, echocardiograms, and other diagnostic tests in conjunction with electronic stethoscope examination for second opinion by cardiologist at another site

The remote delivery of HC services into the persons home facilitated by communication technologies that include the use of person centered reactive monitoring devices

Video conferencing between 2 HC professinals or client. Remote health consultation

The detection of a disease by using data recieved from monitoring a patient at distant site

Distance learning via a computer and or telephone connection

The use of telecommunication and computer technologies to monitor and render services and support to home care clients

Real time advice offered to a practitioner in a remote site via telecommunications technology

The use of telecommunication and IT for delivery of nursing services

Transmission of high resolution virtual image, often via robotic miscroscope, for interpretation by pathologist at a remote site

The use of tele education technology to provide opportunities to promote health

Variant of telemedication that allows observation and interviews of clients at one site by a psychiatrist at another site through videoconferencing

The use of interactive communication technology to facilitate assessment of patients functional abilities and provide excercise and rehabilitation therapies

Transmission of high resolution radiological patient images for interpretation or consultation by a radiologist at a distant location

Transfer digital images and data from one location to another. Nonemergent situation