By Diane Castelli, RN, MS, MSN
In addition to providing better care for patients at a distance, telehealth technology applications can provide a real means for the nursing profession to alleviate the impending nursing shortage. According to a report of the Health Resources and Services Administration (HRSA), there will be an unmet need for more than one million nurses in the United States by 2020.
Though looking to nursing schools to address this coming shortage seems logical, a recent Advance for Nursing article noted that there has been a decrease in the growth of the number of students being admitted to entry-level baccalaureate nursing programs. The article quotes American Association of Colleges of Nursing (AACN) President Jeanette Lancaster, PhD, RN, who states that the reason for the decrease in growth is the “...diminishing faculty and financial resources of nursing schools…”
So now what? What can the nursing profession do to address the nursing shortage?
Telehealth -- A Ray of Hope for Nursing and Health Care
A realistic approach to this advancing and imminent nursing need is to utilize clinical telehealth solutions. Clinical telehealth applications enable healthcare professionals to have face to face meetings with patients. They can see images and hear patient output as it is occurring or at a later time. For example, telehealth applications enable clinicians to send and listen to a patient's captured heart and lung sounds.
These applications also allow professionals to view, send, or store video and digital images for a patient assessment, diagnosis, treatment, and evaluation over video conferencing technology and computer applications. This process can be especially helpful for health facilities with limited nursing resources, such as, health clinics, schools, prisons, or rural hospitals.
In the homecare environment, telehomecare technologies assist home care nurses to monitor a patient's vital signs, including heart and lung sounds. These applications also enable a nurse, who is in a remote location relative to the patient, to identify changing trends in the patient's physiological state. This type of technology can also assist with medication compliance and decrease the need for in-home care or office visits.
Using telehealth applications, nurses can extend and share their knowledge and skills. However, in order to make use of telehealth technologies today, it may be necessary for nurses to seize the initiative and become educated.
Telehealth Technologies -- Offering a wide array of new opportunities for nurses worldwide
The good news about telehealth is that not only can it be of great value to patients in remote locations, it can also help nurses in their everyday practice and provide them with an expanded set of career choices. Telehealth makes it possible to share medical skills, information, and know how; it can also provide nurses -- be they novices, experts, or somewhere in-between -- the opportunity to play an important role in the development, deployment, and utilization of telemedicine and telehealth applications in patient care.
Telehealth technologies allow clinicians to conduct remote physical assessment and consults, as well as capture and store patient information (with a store-and-forward software application) for further evaluation and sharing with a consulting physician or nurse practitioner.
Nurses in Telehealth
A telehealth program at Rochester General Hospital connects specialist doctors in Rochester, New York, with patients from communities surrounding Newark Wayne Hospital's Outpatient Clinic in Newark, New York. The telehealth clinic is run by Telehealth Clinic Coordinator Cynthia Gordon, RN, BSN.
Cynthia, who has worked both in the US and internationally on telehealth projects, heads the telehealth clinic headquartered at Rochester General Hospital. It is her job to identify which doctor at Rochester General Hospital is needed by the Newark Wayne Hospital patient and then coordinate scheduling for the telehealth consult and follow-up. She also is involved in educating hospital staff on how to use the telemedicine equipment.
“Our telehealth clinic addresses a very important need,” explains Nurse Gordon. “It gives people, who don't, and sometimes cannot, travel or who feel threatened by going into a city to see a doctor, access to specialty care for a condition before they are too sick to do anything about it.”
“In addition,” Gordon continues, “we are also implementing a telehealth program in the Rochester General ER, where there's a huge throughput issue. We see over 90,000 patients a year there, so we have to look at ways to get ER patients the care they need and move them through the department quickly for treatment and discharge. With the telehealth program, not only can emergent cases from rural areas be seen quickly to identify those that need to be transferred to Rochester and those who don't, but the patients waiting in the ER for their doctors to arrive are also positively impacted. Doctors sitting in their offices can now see their patients in the ER through the telehealth video link. The doctor can make a diagnosis of the patient's condition and get treatment begun, all from his own office. This also saves the doctor and the patient wasted travel and waiting time, respectively.”
Telehealth nurses have also developed leadership roles within the following associations: American Telemedicine Association, Canadian Society of Telehealth, International Society of Telehealth and eHealth and the International Council of Nurses. In 2007 the Canadian Society of Telehealth was led by organization president, Laurie Poole, RN.
The American Telemedicine Association has a Special Interest Group (SIG) and webpage for telehealth nurses that provides a communications venue for projects including the development of a white paper on “Telehealth Nursing”, “Clinical Practice and Guidelines for Telehealth Nurses”, telenursing seminars and workshops introducing the concepts of telehealth nursing, and telehealth nursing foundations and future directions.
Telehealth/Telemedicine/e-Health - What's Important to Know
There are six areas that are important to master in clinical telemedicine.
- Learning how to use the telemedicine medical devices as well as audio, video, and digital software applications over phone, Integrated Services Digital Network (ISDN), or Internet Provider (IP) communication networks
- Becoming techno-savvy in using other software applications for entering patient demographic data, saving, sending, and retrieving information to or from the consulting physician or nurse practitioner
- Collaborating with information technology staff, biomedical engineers, and telehealth physicians and nurses in one's health care system or hospital as a telemedicine/telehealth/e-health team
- Assisting in the development of telehealth guidelines, policies, and procedures
- Reviewing and understanding the applicable Health Insurance Portability and Accountability Act (HIPAA) laws with use of telehealth applications
- Learning the evolution of telehealth/telemedicine/e-health technologies and how they are being used in healthcare
Nurses can educate themselves on these areas in several ways, including:
- Seeking out telehealth information online:
- Attending telehealth/telemedicine conferences including:
- 13th ISfTeH International Conference and the 11th Annual Meeting of the Canadian Society of Telehealth: Convergence to Care: Patients, Providers and Technology
Oct 5 - 7 2008, Ottawa, ON
- The 4th Annual World Healthcare Innovation & Technology Congress (WHIT 4.0)
Dec. 8-10, 2008, Washington, DC
- Additional International Telehealth Shows in 2008
- Med-e-Tel 2009: The International Educational and Networking Forum for eHealth, Telemedicine and Health ICT
April 1-3, 2009, Luxembourg
- ATA 2009: 14th Annual International Meeting and Trade Show
April 26-28, 2009, Las Vegas, NV
There are also grant programs that offer aid specifically for telemedicine projects.
- Public Sources
- The U.S. Department of Health and Human Services - HRSA provides a Telehealth Grantee Directory that includes a listing of all the grant programs available for telehealth/telemedicine projects. It is important to be aware that submission windows can be very short.
- The World health Organization (WHO) has put in place a report on eHealth tools and services that outline the needs and funding that will enable developing countries to utilize telehealth technologies
- Private Sources
A general Internet search can provide several additional organizations that provide grant funding for starting a telemedicine/telehealth programs.
Educational Leadership in Telemedicine
AMD Global Telemedicine, Inc conducted an informal internet search of U.S. colleges and universities seeking any kind of telemedicine/telehealth initiatives offered. According to AMD Global Telemedicine researcher, Lara Saba, within U.S. colleges and universities found on the internet, only 14.6% offer telemedicine/telehealth courses and only 7% of those same U.S. colleges and universities include telemedicine/telehealth clinics, centers, programs, institutes, etc.
Some schools within that 14.6% that have developed courses on telemedicine/ telehealth include:
For additional schools that offer telemedicine/telehealth courses go to http://www.amdtelemedicine.com/links.cfm
Additional online telemedicine/telehealth educational resources include:
- AMD Global Telemedicine (www.amdtelemedicine.com) offers both onsite installation and training, teleconferencing product demonstrations or video training for telemedicine devices and how to properly use these devices during telemedicine encounters.
- American Telemedicine Association (ATA) (www.atmeda.org) has 12 Special Interest Groups (Business & Finance, Emergency Preparedness and Response, Home Telehealth & Remote Monitoring, Human Factors, International, Ocular Telehealth, Technology, Teledermatology, Telemental Health, Telehealth Nursing, Telepathology, and Telerehabilitation). The ATA is the leading organization for disseminating information and knowledge on telemedicine. (ATA provides annual and mid-year meetings addressing specialty areas of telemedicine.)
- Canadian Society of Telehealth (CST) (www.cst-sct.org) features multiple programs including podcasts that provide web-based telehealth programs, as well as an annual conference.
- International Council of Nurses (ICN) (www.icn.ch) has an online section on telenursing with both national and international resources.
- International Society for Telemedicine and e-Health (ISfTeH) (www.Isft.net) offers annual meetings, education, telemedicine directory and newsletters for members.
- ITelehealth, Inc. (www.itelehealthinc.com) offers telehealth educational presentations and products as well as consulting services for nurses.
- Med-e-Tel (www.medetel.lu) is an annual exhibition and congress meeting that provides services, communications, education, and networking opportunities for healthcare providers.
Telemedicine/Telehealth Today and Tomorrow
Telemedicine and telehealth applications extend the skills and knowledge nurses use every day. It is also one of the most promising and practical solutions, available not only to address an inevitable nursing crisis, but also to bring modern day healthcare to more people and save more lives both in the US and around the world.
Now, it is a matter of mastering the tools and knowledge necessary to utilize this innovative process. Today's nurses should seize the opportunity and run with it.
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Diane Castelli, RN, MS, MSN, and Director of Clinical Training, AMD Global Telemedicine, Inc., has over twenty-years of clinical nursing experience in specialties including; critical care, emergency department, private home care, child and adolescent psychiatric care, forensic nursing, medical software development, project management, installation and training. Working with AMDTelemedicine, the leader in telemedicine equipment and software applications with over 5000 installations in 70 countries around the world, she has provided her expertise to implementations in Sweden, Botswana, South Africa, China, Canada, Armenia, The Bahamas, and Puerto Rico, as well as numerous locations and specialty health care areas within the United States.