Chapter 19by Audrey Kinsella and Kathleen Albright

Telenursing and Remote Access Telehealth

Objectives

• Explore the use of telehealth technology in nursing practice.

• Identify socioeconomic factors likely to increase the use of telehealth interventions.

• Describe clinical and nonclinical uses of telehealth.

Objectives

• Specify and describe the most common telehealth tools used in nursing practice.

• Explore telehealth pathways and protocols.• Identify legal, ethical and regulatory issues

of home telehealth practice.

Objectives

• Describe the role of the telenurse.• Apply the Foundation of Knowledge model

to home telehealth.

Key Terms Defined

• Call Centers• Chronic Disease• Centers for Medicare and Medicare

Services • Central Stations/Web Servers/Portals

Key Terms Defined

• Home Healthcare• Home Telehealthcare • Medication Management Devices• Outcomes and Assessment Information

Set

Key Terms Defined

• Medication Management Devices• Outcomes and Assessment Information

Set• Patient Health Outcomes• Patient Informed Consent

Key Terms Defined

• Patient Health Outcomes• Patient Informed Consent• Personal Emergency Response Systems• Peripheral Biometric (Medical) Devices

Key Terms Defined

• Real-Time Telehealth• Sensor and Activity Monitoring System• Store-and-Forward Telehealth• Telehealthcare

Key Terms Defined

• Telehealth• Telemedicine• Telemonitoring• Telenursing

Key Terms Defined

• Telephony• Teleradiology• Telepathology

Nursing Aspects of Telehealth

• Understanding Telehealth

• Telehealth Interventions

Driving Forces For Telehealth

• What will affect nursing in the next decades to come?

• Estimations by the year 2040• The Nursing Shortage Crisis is Two-Fold

Driving Forces For Telehealth

• Health Resources and Services Administration 2002 Report

• Pennsylvania Homecare Association and Penn State University 2004 Study

• How many Americans are living with one or more chronic conditions?

Driving Forces For Telehealth

• Centers for Disease Control and Prevention 2005 Report

• Securing Necessary Resources

Driving Forces For Telehealth

• Baby Boomers are Shifting Health Care Needs• Many Baby Boomers are More Comfortable With

Technology• How much does the American health care system

spend on conventional medical care?• Is this figure expected to grow? • What is the solution for this growing need? • The Use of Telehealth Technology

Telehealthcare

• “Telehealth” and it’s Broad Meaning • Store-and-Forward Telehealth• Real-Time Telehealth• The Use of Computers in Telehealthcare

Telehealthcare

Examples telehealth applications:– Telemental Health– Telerehabilitation– Telehomecare– Teleconsultations– Telehospice/ Telepalliative care– Remote Monitoring Devices – Telephone Monitoring and Telehealth

Telenursing

• Telenursing • The most developing area of telenursing • Association for Retired Persons 1996

Study• Care at Home

Telenursing

• The Home Care Industry’s Newest Challenge

• Home Care Telenursing Involvement• Home Care Telenurses Expectations

Terms of Home Telehealth

• Telecommunications-Ready Tools • Multifunctional Telehealthcare Platforms

and Application Servers. • Key Components to Telehealth

Terms of Home Telehealth

• Peripheral Biometric Devices • What is the most popular household

communication tool for telehealthcare? • A Telephone Device Can be Augmented

Terms of Home Telehealth

• Video Cameras and Videophones are Useful Tools

• Personal Emergency Response Systems

Terms of Home Telehealth

• Sensor and Activity Monitoring Systems • Medication Management Devices • There are 32 million people that take 3 or

more medications daily

Home Telehealth Practice and Protocols

• Different Home Telehealth Programs • Informed Written Consent and Telehealth• Telehealth and Patients

Home Telehealth Practice and Protocols

• The Use of Telehealth Tools• Home Telehealth Protocols • Telehealth, Law and Ethics • A High Level of Security Must Be Achieved

The Patient’s Role in Telehealth

• What was a “mega trend” of Telehealth in 2007?

• Telehealth and Home Goals for the Patients

The Foundation of Knowledge Model and Home Telehealth

• There is Much to Learn about “usual” Home Telehealthcare

• Knowledge Acquisition and Telehealth • Knowledge Processing and Telehealth

The Foundation of Knowledge Model and Home Telehealth

• The Next Step After Processing Information• Nurses Apply Data as it Pertains to the

Patient • The Nurse Determines How the Knowledge

Will be Used • Telehealth is Rapidly Developing • Telehealth Will Provide New Advances for

the Medical Community

Thought Provoking Questions1. Telehealth technology has extended the arms of

traditional health care delivery into homes, clinics, and other environments outside the bricks and mortar of hospitals. Will the increased use of these telehealth technology tools be viewed as “de-humanizing” patient care or will they be viewed as a means to promote more contact with healthcare providers and new ways for people to “stay connected” as in on-line disease support groups), thereby creating better long term disease management and patient satisfaction?

Thought Provoking Questions2. As telehealth technology advances

towards seamless data access regardless of distance or health system, how can we protect patient privacy rights and the confidentiality of personal medical data?