Running head: TELEHEALTH IS RISING, IMPROVEMENT IS STILL NEEDED 1

Telehealth Is Rising, Improvement Is Still Needed

Christine Davis

NUR 410 Nursing Informatics

Dr. Wheeler

Delaware Technical Community College

April 19, 2019

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Nursing Informatics Process

The impact of nursing informatics on telehealth/nursing is that it incorporates nursing

principles, computer science and information science, to enhance patient care (Cigliuti, 2015).

Nurse informaticists combines clinical expertise and technical knowledge to determine the

technology that will best suit the needs of their patients, while also providing technical support to

users (Cigliuti, 2015). According to Lilcyn (2016), telenurses are able to case manage patients

with chronic illnesses, provide counseling, and coordinate care among healthcare providers.

Allowing the telenurse to collect and transmit data for clinicians to interpret so medical

interventions may be applied (Lilcyn, 2016). The Nursing process is inherent in telephone

practice, you assess (information gathering), diagnose and plan (cognitive processing), and

intervene and evaluate (output) (Greenberg & Koehne, 2014). As a telehealth nurse you are

accountable for practicing in accordance with your standards of practice, code of ethics, and

federal legislation as you would if you were face-to-face.

Process Improvement

Video conferencing and other telehealth methods promote the opportunity to ensure

timely care that is efficient, safe, and patient-centered (Fathi, Modin, & Scott, 2017). These

outcomes cannot be accomplished without a cadre of nurses and other healthcare professionals.

Providers are increasingly looking to telehealth as a viable care delivery model for the future,

and the adoption of certain telehealth technology and delivery of services is on the rise (Fathi,

Modin, & Scott, 2017). As a telehealth nurse we are also must recognize when telenursing will

not be able to provide care for the caller and a face-to-face assessment is needed. Telehealth is a

unique field that uses innovative technologies to improve patient care and thereby improve
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safety. Informatics has grown to offer a wider capability for telehealth/telenursing practice. With

telehealth technologies, patient adherence to care increases, access to care is improved, providers

can network with each other, and the safety of patients can be monitored more closely in homes

and alternative living facilities (Schlachta-Fairchild, Elfrink & Deickman (2008).

Legal/ethical Issues with Telehealth/nursing

According to the American Nursing Association (2015), the ongoing advances in

technology, including computerized medical databases, telehealth, social media and other

Internet-based technologies, have increased the likelihood of potential and unintentional

breaches of private/confidential health information. New technologies and care models come

with attendant risks (Agboola & Kvedar, 2016). One of the top 10 patient safety concerns for

2019 according to Health Data Management is “Patient safety concerns surrounding mobile

health.” The risks of mobile health technology include lack of regulation of new technologies,

barriers to ensuring that providers are accurately receiving the data a device collects, and the

possibility that a patient is not using the technology correctly or is not using it at all (Goedert,

2019).

The risks of being a telehealth nurse/provider is that they can pick up sensitive

information while a patient is using a sensor to detect a fall, safety issue, or medical emergency,

it can transfer information from household activities, example: interactions with a spouse,

religious activity, or when no one is home (Hall & McGraw, 2018). Transmissions from a devise

that the patient is using while at home may be on a mobile app with third party advertisers, that

have embedded sensors and can retrieve the private information due to weak privacy protection.

The consumer may not read the privacy policy protection for the app, check off the “I agree” box
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and use the app, not realizing they allowed the app manufacturer to their information. The FDA

oversees only technologies it considers to be medical devices and focuses only on security

protections designed to ensure safety. It does not focus on privacy safeguards that enforce rules

or policies regarding collection, use, and disclosure of potentially sensitive health information

(Hall & McGraw, 2018). Data encryption can be broken by any one that has availability to the

correct key and can retrieve the private information. Guidelines specific to telemonitoring for

specific patient populations are in need to better serve the community (Bothun, 2017).

Informatics Benefits: Monitoring

Remote Cardiac Services offers a PT/INR meter for home. They are cleared for home use

by the FDA and have been extensively tested for accuracy and precision in measuring

anticoagulant levels in blood (Remote Cardiac Services, 2017). The patient does the test by

themselves at home weekly. This saves the patient from going out to get the test done monthly,

wait for the physician to get the results and then write a prescription if needed. This service will

send the results to the physician. When the physician receives the results, if they are out of limit,

he can write a new prescription and send to the pharmacy by computerized provider order entry

(CPOE). The telehealth nurse will receive the orders on the e-Mar and proceed with the patients

care. The telehealth nurse will continue to monitor the patient with the new medication order and

document the conversations and care provided; the physician will be able to look at the patient

progress by going into the eMAR (see attached workflow map). The telehealth nurse will be able

to provide teachings with the patient on diet and what to look for if there is an interaction, and

the risks of bleeding. According to Remote Cardiac Services (2017), studies have shown using a

PT/INR meter has reduced medical complications, adjustments to their medications are made

quicker, and it helps prevent complications if the patient is out of range for a long period of time.
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Having this service will also benefit the patient with a disability or patients that live at a

geographic distance. Telehealth is improving the health of patients and has the expectation to

bring about a change in the way health care is delivered. The current rise in adoption and

integration into clinical workflows will no doubt continue (Agboola & Kvedar, 2016).

Evidence Based Practice: Needs Improvement

Since telehealth relates directly to informatics in the way technology is used to

communicate and deliver care, it is pertinent to have more improved guidelines. According to

Fernandez-Llatas, Meneu, Traver and Benedi (2013), in the case of telehealth, where the

physician may not have direct access to the patient, the use of patient-centered protocols to

monitor and empower the patient in their own care process is critical. Evidence-based medicine

(EBM) and clinical guidelines have been used for creating specific telehealth protocols

(Fernández-Llatas, Meneu, Traver & Benedi, 2013).

Schlachta-Fairchild, Elfrink and Deickman (2008), state that the research related to

telehealth and telenursing practice has shown great benefits related to diagnosis and

consultations, monitoring and surveillance of patients, clinical and health services outcomes, and

technology advancement. According to Gidora, Borycki, and Kushniruk (2019), some evidence

that suggests telenursing services empower clients to access levels of care in keeping with the

severity of their symptoms, as well as enabling clients to engage in self-care when appropriate.

This will lead to more savings for the healthcare system. Gidora, Borycki, and Kushniruk (2019),

also state that more evaluation of telenursing programs is needed to identify consistent savings

and health outcomes should be a part of the research. The constant advances in technological

innovations present new opportunities for care delivery innovation as well as new challenges.

Some telehealth programs can prevent medical errors, known and emerging threats to patient
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safety are real (Agboola & Kvedar, 2016). Agboola and Kvedar (2016) feel that there is a need to

increase research efforts evaluating the impact of telehealth on patient safety. As healthcare

providers we need to balance our commitment to the ethical principle of nonmaleficence with the

need to adopt technology-driven innovations in health care to enhance quality and efficiency.

Doing so should allow us to use these technologies to improve patient safety (Agboola &

Kvedar, 2016).

Policy

The Telehealth nurse will provide safe effective care. Monitoring the patient by technology and

act accordingly to the data that is received. Following the treatment plan that has been provided

by the heath care team. Provide safety and privacy while using technology to treat the patient.
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References

Agboola S., and Kvedar J. (2016, September). Telemedicine and patient Safety. Patient Safety

Network. Retrieved from https://psnet.ahrq.gov/perspectives/perspective/206/telemedicine-and-

patient-safety

ANA center for Ethics and Human Rights. (June, 2015). Privacy and Confidentiality. American

Nursing Association. Retrieved from

https://www.nursingworld.org/~4ad4a8/globalassets/docs/ana/position-statement-

privacy-and-confidentiality.pdf

Bothun, J. (2016, July 10). Informatics and its crossover with EBP and PBE.

Jbothnnursing.wordpress.com. Retrieved from https://jbothunnursing.wordpress.com/

Cigliuti, M. (2015, December 18). What is the role of nurse informatics in Telemedicine?

Linkedin.com. Retrieved from https://www.linkedin.com/pulse/what-role-nurse-

informatics-telemedicine-cigliuti-bsn-rn-

Fathi, J. T., Modin, H. E., & Scott, J. D. (2017). Nurses Advancing Telehealth Services in the

Era of Healthcare Reform. Online Journal of Issues in Nursing, 22(2), 10. https://doi-

org.libproxy.dtcc.edu/10.3912/OJIN.Vol22No02Man02\

Fernández-Llatas C, Meneu T, Traver V, Benedi JM. (2013, October 31). Applying evidence-

based medicine in telehealth: an interactive pattern recognition approximation. Int J

Environ Res Public Health.10(11):5671–5682. doi:10.3390/ijerph10115671

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Gidora, H., Borycki, H., & Kushniruk, A. (2019). Effects of telenursing triage and advice on

healthcare costs and resource use. Studies in Health Technology and Informatics, 257,

133-139. Doi:10.3233/978-1-61499-951-5-133.

Goedert, J. (2019, March 19). The 10 largest patient safety concerns for 2019. Health Data

Management. Retrieved from https://www.healthdatamanagement.com/list/the-10-

largest-patient-safety-concerns-for-2019

Greenberg, M. E., & Koehne, K. (2014). Reflecting on What We Do: Opening Pandora’s Box.

AAACN Viewpoint, 36(1), 12–13. Retrieved from

http://search.ebscohost.com.libproxy.dtcc.edu/login.aspx?direct=true&db=c8h&AN=104

033701&site=ehost-live

Hall, J., & McGraw, D. (2014). For telehealth to succeed, privacy and security risks must be

identified and addressed. Health Affairs. Retrieved from

https://www.healthaffairs.org/doi/10.1377/hlthaff.2013.0997

Lilcyn. (2016, May 23). Telenursing: The future of nursing. Allnurses.com. Retrieved from

https://allnurses.com/telenursing-the-future-nursing-t613098/

Remote Cardiac Services. (2017). PT/INR Self testing at home. Remote Cardiac Services.

Retrieved from https://inrselftest.com/for-patients/about-pt-inr-meters/

Schlachta-Fairchild L, Elfrink V, & Deickman A. (2008). Patient Safety, Telenursing, and

Telehealth. Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

Rockville (MD): Agency for Healthcare Research and Quality (US). Retrieved from:

https://www.ncbi.nlm.nih.gov/books/NBK2687/