Telehealth and telemedicine as digital health tools are becoming an important part of healthcare delivery today. Numerous studies have shown that telemedicine can prevent hospitalizations, reduce readmission rates, cut costs and improve health outcomes.
Nurses engaged in telenursing (a subset of telehealth) can identify health problems before they escalate in acuity. In particular, telehealth is being used in the management of chronic diseases, such as diabetes, COPD, asthma, heart disease and cancer—all known causes of frequent ER visits and hospitalizations.
In the United States, for example, nurses at Visiting Nurse Services of New York (VNSNY) are monitoring some 130,000 patients through the use of telehealth and EHR systems. Nurses check vital signs, fluid status, and blood glucose levels transmitted remotely. In the field, they can refer the findings of a physical assessment to a specialist and facilitate a video or online consultation between the patient and the physician.
VNSNY nurses look at trends, check and send alerts, and share data with home care nurses and remote doctors. The clinical information allows nurses to know if a patient needs an expedited referral to a specialist, a home visit by a home health nurse, or if a phone call from a nurse care manager would be more appropriate.
“Being able to get that real-time information is very useful for patients because we're pulling in all the care providers—the nurses inside the institution [and] out in the field—and we're communicating the information [with everyone],” VNSNY telehealth program manager Alice Rainford-Miller told FierceHealthIT. “In general this empowers our staff members for making timely interventions and managing patients who have chronic illnesses like congestive heart failure, diabetes, hypertension and COPD.”
In Canada, telehealth has also proven beneficial for patients with chronic illnesses. In a recent study by the University of Toronto and McMaster University School of Nursing, a telehealth videoconferencing and remote monitoring program by nurses “enabled family caregiving, citing increased access to care, and patient and family caregiver reassurance.”
Instant Connection, Instant Diagnosis
Across the Atlantic, in the UK, telehealth is connecting patients and nurses 24/7. For example, on-demand videoconferencing allows nursing staff working remotely at Airedale General Hospital in West Yorkshire to talk to sick patients as far afield as Kent and Carlisle.
“Sometimes patients and their families just want reassurance,” nurse Verity Kolin said in a Financial Times report. “Sometimes they’re not sure which way to go, which service to access, whether it’s a nurse, a doctor, whether to come into hospital. It gives them that independence and security while they are at home.”
In the adjacent county of Lancashire, in-home dialysis patients receive one-to-one care from a specialist via a video link. Part of a Video-as-a-Service (VaaS) system operated by Lancashire Care NHS Foundation Trust, a local provider for community nursing services, the telemedicine program is planned to be implemented in more areas.
“We now want to roll this more into primary care type scenarios, where we can run virtual clinics from GPs in Lancashire or South Cumbria. The subscription-based service which we've created enables patients to be wherever they want to be,” Andrew Thompson, the trust’s business development manager, said in a Lancashire Telegraph article.
In India, a huge country with large gaps in healthcare resources and infrastructure, nurses could soon connect with underserved patients in rural communities through telehealth and mHealth solutions. New devices and smartphone apps that can detect abnormal conditions at the point of care could expand the Indian nurses’ decision making role, and allow doctors to diagnose conditions from a distance.
For instance, a “smart health” project was recently launched by the The George Institute for Global Health and Oxford University to train nurses and health workers in rural areas on how to use a smartphone app that can detect heart rhythm problems.
The mHealth/telehealth program has demonstrated that nurses and health workers in the field are “identifying health problems and recommending the best treatments equivalently to highly-trained doctors in more well-equipped clinics” and that “the system also allows doctors centrally to monitor the decisions being made.”
Separately, AliveCor, creator of an FDA-approved ECG smartphone attachment to detect atrial fibrillation, is partnering with Apollo Hospitals to provide the device to patients throughout India, according to a report by FierceMedicalDevices.
Telenursing from Home: Less Nurses, More Sensors?
Home care nurses collect data from a range of devices at home—such as blood pressure monitors, weighing scales, pulse oximeters, glucometers, and peak flow meters, among others. Physiologic signals from these medical devices can now be gathered by smartphones, tablets, sensors and wearables. Nurses are now using all of these devices in their assessments, planning and implementation of care plans.
For example, nurses are taking snapshots of wounds or skin lesions with their smartphones, transmitting the images to a dermatologist or wound care specialist if needed, making virtual consults, and carrying out interventions. The barriers of time, cost and distance are broken down in this and countless other scenarios.
In the U.S. alone, about half of nurse home visits are replaced by telenursing, according to an article citing the book, Intelligent Technologies for Bridging the Grey Digital Divide. With the coming nursing shortage, telehealth is set to take an even more important role to replace in-person visits to patients who are aging-in-place at home.
Telehealth is not a substitute for face-to-face consultations or a hands-on approach by a care provider. Nevertheless, it is an important tool in the toolbox for nurses who are in the frontline of healthcare.
As Judith Donath, a fellow at Harvard University’s Berkman Center for Internet and Society, said in a Pew Research article, “Telemedicine will be an enormous change in how we think of healthcare. Some will be from home—chronically ill or elderly patients will be released from hospitals with a kit of sensors that a home nurse can use.”
Jof Enriquez is a registered nurse, medical writer and healthcare journalist. You can follow him on Twitter @jofenriq.