Nursing Trends in Telehealth Homecare

1. Nursing Trends in TelehealthHomecare Presented by: Norma I. Rojas

2. Objectivesduring this presentation we will… • Describe the trend in telehealth homecare • Describe and evaluate the hardware and software utilized with this trend • Describe and evaluate the information system used with this trend • Assess the role and functions of the nurse informaticist when working with this trend. • Examine related legal issues

3. Objectives (cont.)during this presentation we will… • Discuss the advantages/disadvantages from a nursing perspective

4. What is telehealth homecare? Telehealth homecare provides patients with healthcare, health information, and health education across a distance with the use of telecommunications technology, and specialty adapted equipment. (Telehealth leadership initiative, 2008)

5. What is telehealth homecare? This service allows doctors, nurses, and other healthcare providers to assess, diagnose and treat patients without having to be in the same physical location. (Telehealth leadership initiative, 2008)

6. The evolution of healthcare In order to provide more services to our growing population, healthcare will evolve into a highly community-based industry. (Auerbach et al, 2009)

7. Hardware used in telehealth homecare • Blood Glucose Meters • Cardiac monitors • Electronic stethoscopes • Blood pressure monitors • Pulse oximetry devices • Electronic thermometers (Liddy et al, 2008)

8. Hardware used in telehealth homecare • Home PC • Video conferencing devices • Telephone, fax, Emails • Specialized telephone adapters (Liddy et al, 2008)

9. How to use telehealth hardwareusing telephone adapters • Adapter is connected to a simple telephone line • Patient logs into a system and follows a series of directions • Voice prompts patient to adhere to medication regimens and treatments • Patients vital signs, weight, electrocardiogram, etc. are transmitted to the healthcare provider • This information is used to treat patients at home (Center for Aging Technologies, 2008)

10. Types of software used in telehealth homecare • AFHCAN Software • CapSure Software • GIGISim • Philips Web-based Clinical Software • Omnivisor • WebVMC and more…

11. Use of Philips Web-based software • Software flags patients vital signs if they are out of range • Library of surveys available for patients with various diseases • Care plans and protocols available • Tracks trends and generates reports • Patient contact information available to facilitate a rapid response (Phillips, Inc., 2008)

12. Philips Web-based software usability • Easy to use • Easy to learn • Patients reported satisfaction with its use • Efficient • Error tolerance- minimal workarounds • The system fit with the task at hand (Staggers, 2003) (Phillips, Inc., 2008)

13. Cardiocom’s Telehealth Computer-based Clinical Information System • Collects, stores and manipulates healthcare data in real-time • Provides secure access by multidisciplinary healthcare team • User-friendly system • Used for observation, interventions and documentation (Mastrain, K. & McGonigle, D., 2009) (Cardiocom, 2008)

14. Review of the Cardiocom Information System • Clinical computer-based information system • Used primarily by doctors, nurses, pharmacists, etc. • Used to diagnose and treat • Configuration: LAN, microcomputers, etc. • Data standards set by Health Level 7, DICOM and PACS (Cardiocom, 2008) (Tan , J., Cheng, W., & Rogers, W., 2008)

15. Review of the Cardiocom information system • The disease and procedure classification used in telehealth are SNOMED and ICD10 • Recommended by healthcare providers (Wikipedia, 2008)

16. Advantages of telehealth services for nurses and other healthcare professionals • Recommended for the treatment of chronic and low acuity diseases • More cost-effective • Reduce hospital ER wait times • Provide patients with more autonomy • Increase accessibility (esp. rural areas) • Promote health through comprehensive follow-ups (Center for Aging Technologies, 2008) (Cardiocom, 2008)

17. Disadvantages of telehealth services for nurses and other healthcare professionals • Possible lack of compliance from patients • Some patients may seem overwhelmed with the equipment use (esp. the elderly) • Lack of human contact • Nurses fear of being replaced with automation (Cassin, 2008)

18. Telehealth legal issues • Privacy issues • Reimbursement • Malpractice • Licensing issues • Accreditation and regulations • Fraud and abuse (Center for Telehealth and E-Health Law, 2006)

19. Informatics competencies for telehealth nurses • Proficient with computers and telehealth software • Proficient with the use of specialized equipment • Obtain excellent clinical and critical thinking skills • Ambulatory care and/or informatics nurse certification (American Nurses Credentialing Center, 2008)

20. Functions and responsibilities of an informatics nurse in telehealth Telehealth home care nurses: • Setting up telehealth software and hardware in patients homes • Assessing and monitoring patients from a distance • Providing patients with health education and education regarding equipment

21. Functions and responsibilities of an informatics nurse in telehealth Telehealth home care nurses: Act as a patient advocate and promotes client health and safety Performs accurate documentations of assessments and care plans Provides ethical care and is accountable for own actions Provides evidence-based care

22. Functions and responsibilities of an informatics nurse specialist in telehealth Telehealth clinical manager/coordinator: Administration/management of facility and staff Theory formulation, design and development Testing and selection of telehealth technology Oversees training and education Research and evaluation of services (American Nurses Credentialing Center, 2008)

23. Telehealth Nursing Summary Telehealth home care provides patients with healthcare, health information and health education across a distance with the use of specialized telecommunications technology.

24. Telehealth Nursing Summary • Specialized hardware devices used in telehealth: cardiac monitors, electronic stethoscopes, etc • How to use a hardware device (with a telephone adapter) • Specialized software used in telehealth: Omnivisor, Philips Web-based software, etc. • Review of Philips Web-based software including evaluating its level of usability

25. Telehealth Nursing Summary • Review of Cardiocom’s clinical information system in telehealth • Advantages of telehealth include: increasing accessibility, reduce healthcare costs, etc. • Disadvantages of telehealth include: lack of human contact, possible lack of compliance, etc. • Legal issues in telehealth include: licensing, malpractice, reimbursement, etc.

26. Telehealth Nursing Summary • Informatics competencies in telehealth nursing include: knowledge of computers and use of specialized equipment • Functions and responsibilities of an informatics nurse in telehealth include: health education, equipment management, research, etc.

27. In conclusion The remarkable advances in technology continues to change the way that we conduct healthcare. Telehealth homecare provides patients with healthcare services in a new and innovative way. Healthcare professionals should embrace technology as we continue to improve our healthcare delivery methods to provide high-quality care.

28. References Auerbach, D.I., Buerhaus, P., Staiger, D.O. (2009). The future of the nursing workforce in the united states: Data , trends and implications. Sudbury,MA: Jones and Bartlett Publishers. Cardiocom Multi-disease Management. (2005). Health plans. Retrieved December 5, 2008, from http://www.cardiocom.com/health_plans.html Liddy, C., Dusseault, J. J., Dahrouge, S., Hogg, W., Lemelin, J., & Humber, J. (2008). Telehomecare for patients with multiple chronic illnesses. Canadian Family Physician, 54(1), 58-65.

29. References Center for aging services technology. (2006). Economic benefits of e-technology in managing congestive heart failure. Retrived October 11, 2008, from http://www.aging tech.org/documents/EconomicBenefits_of_eTech.pdf Philips, Inc. (2008). Web-Based clinical software. Retrieved October 11, 2008, from http://www.medical.philips.com/ main/products/telehealth/products/software.wpd Telehealth leadership initiative. (2008). What is telehealth. Retrieved October 11, 2008, from http://www.telehealthleadership. org/telehealth101.html.

30. References Cassin, K (2008). Implementation of home telemonitoring for chronic disease: A case study of resurrection home health services. Telemedicine Information Exchange, Retrieved December 1, 2008, from http://tie.telemed.org/articles/article.asp?path=articles&arti cle=resurrectionHomeServices_kcassin_tie08.xml Mastrain, K. & Mcgonigle, D. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Barlett Publishers. Center for Telehealth and E-Health Law (2006). Nurse licensure. Retrieved December 05, 2008, from http://www.telehealthlawcenter.org/?c=143

31. References Tan, J., Cheng, W., Rogers, W. (2002). From telemedicine to e-health: Uncovering new frontiers of biomedical research, clinical applications & public health services delivery. The Journal of Computer Information Systems: Special Issue, 42(5), 7-18.  Retrieved November 1, 2008, from ABI/INFORM Global  database. ICD. (n.d.) Retrieved November 1, 2008, from Wikipedia Web site: http://en.wikipedia.org/wiki/ICD Staggers, N. (2003). Human factors: Imperative concepts for information systems in critical care. AACN Clinical Issues, 14(3), 310-319.

32. References American Nurses Credentialing Center. (2008). Informatics nurse certification eligibility criteria. Retrieved December, 5, 2008, from http://www.nursecredentialing.org/Eligibility/ InformaticsNurseEligibility.aspx