Healthcare Anywhere: The Pledge of Telehealth

Laura A. Stokowski RN, MS

Disclosures

October 30, 2008

In This Article

Telehealth's Vision and Reality

In spite of its great promise, telehealth has not yet gone mainstream.[8]We haven't, for the most part, implemented what is technically possible to improve healthcare delivery on a broad scale. Privacy, security, and reimbursement issues are among the impediments to the growth of telehealth.[21] Providers can also be barriers to telehealth if managers fail to consider ease-of-use and incentives for use when designing telehealth programs.[22] Another significant obstacle is acceptance of home-based care by patients who are uneasy with the idea of distance healthcare or the technology they must use.

Concern has also been expressed that telehealth technologies will be applied to replace needed health services with cheaper substitutes for in-person care.[22] Standards should be developed to ensure that telehealth technologies are used appropriately not to replace but to augment existing services.[23]

Some nurses are more comfortable with computers and technology than others. Most did not learn about telehealth in nursing school. These 2 facts may explain some of the reticence about telehealth voiced by nurses.

"Nurses need to realize that telenursing is here, and it's growing" maintained Schlachter-Fairchild, continuing, "It's not futuristic and it's not science fiction. Telenursing is real, and it's doable. It's not a cold, impersonal replacement for a nurse, but an enhancement to nursing care. Rather than patients feeling more distant from nurses, telenursing actually makes them feel more connected, because the nurse's presence is extended, and there is a sense that someone is watching over them all the time." Bonnie Wakefield agrees, noting that "patients don't always recognize when they are getting into trouble, but they are reassured to know that someone will be calling to check up on them the next day." Patient satisfaction with telenursing, according to Wakefield and Schlachter-Fairchild, is overwhelmingly positive.

Others have even questioned whether nursing care provided electronically, over a distance, is truly nursing practice.[12] There is a misperception that because telenursing, by definition, isn't "hands-on," it isn't nursing. Hutchinson argues that telenursing meets the definition of nursing practice that requires nurses to use knowledge, skill, judgment, and critical thinking achieved through nursing education in providing care. A nurse assessing a patient over the telephone using this information to plan, intervene, and evaluate the outcomes of care, is undoubtedly engaged in the practice of nursing, albeit with a different delivery medium.[7,12]

It is important to consider privacy when designing and implementing telenursing. Patient confidentiality must be maintained just as though the patient was being examined and treated in the privacy of his/her own home or in an examination room. Patient information must be protected and secured regardless of the manner in which it is transmitted and stored.[8] Patients will need reassurance that privacy and security of their healthcare information can and will be protected even with new, unfamiliar methods of healthcare delivery.

It is not really a question of technology, or the willingness to use it, but it is the issue of who will pay for it that is impeding the widespread application of telehealth. "Our country is sorely lagging behind the rest of the world in using telehealth because we have no business model for reimbursement," explains Schlachter-Fairchild.

The issue of who will pay for telehealth services is important; so important, in fact, that it has slowed the development and adoption of telehealth.[24] One of the most serious obstacles to the integration of telemedicine into health practices is the absence of consistent, comprehensive reimbursement policies. Medicare authorizes only partial reimbursement. Medicaid policies established at the state level vary widely and are inconsistent from state to state.

The potential savings in healthcare costs can run into millions of dollars. The savings in ambulance costs for transporting medical assistance patients to providers alone are predicted to amount to tens of millions of dollars annually. But, unfortunately, because providers are not reimbursed for telemedicine services to medical assistance patients, many do not offer them.

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