COMMENTARY

How Technology Is Changing Nursing: The Impact of Telehealth

Aparna Bala, RN, MSHI

Disclosures

July 28, 2017

How Technology Is Changing Nursing

Within the past decade, many advances in technology have been made available to help nurses and clinicians perform their jobs and care for patients more efficiently and safely. Consequently, nursing today isn't the same as it was 30 years ago. From such inventions as tablet computers and mobile electronic charts, to radio-frequency identification (RFID)-enabled devices, the healthcare landscape is becoming more advanced and efficient, and the field of nursing has adapted along with these advances.

Naturally, many of these technologies did and still do require education, training, and a period of adoption for nurses to fully embrace them; implementation doesn't simply happen overnight. Evolving care delivery processes in such areas of the hospital as intensive care units (ICUs), emergency/trauma treatment, and recovery rooms have created a need for nurses with advanced clinical skills and technical savvy. Today, nurses are adapting along with the industry to take advantage of new career opportunities and expand their roles across the care continuum.

Nurses and Telehealth: An Ideal Match

As a relatively new healthcare delivery approach, telehealth is transforming how nurses approach and deliver care. Telehealth is currently on the rise, and experts predict that the industry could become a $34 billion market by the end of this decade. Telehealth comes in many flavors, from monitoring patients with chronic conditions through video chat, to providing critical care to patients in remote areas. For example, some healthcare systems have created an eHospital care delivery model in which a small team of nurses and intensivists can remotely monitor and support patient care for more than 100 beds in multiple ICUs. The remote team is stationed around the clock in a "bunker," from which they serve as the clinical resource for smaller hospitals. Moreover, with cameras in all rooms, the remote team can view and interact with patients and their nurses in this version of telehealth.

While this is a common application of telehealth, the care delivery approach can also be as simple as a health system leveraging a mobile application that allows clinicians to collaborate remotely. Increasingly, the objective of telehealth is efficiency, with asynchronous workflows that are highly mobile as opposed to the traditional real-time, provider-to-patient encounter that relies on video or voice technology. In an asynchronous situation, nurses can use telehealth to communicate directly (although not simultaneously) with remote physicians for questions or consultations. This improves the quality and efficiency of patient care in an increasingly dynamic healthcare environment.

The Power of Telehealth

At a time when the aging population is increasing and chronic conditions are becoming more prevalent, the cost of care is also rising. Now more than ever, the healthcare industry needs to prioritize its activities using more cost-effective care delivery processes to streamline clinical workflows and improve patient outcomes. In addition to reducing costs, telehealth and remote monitoring will effectively extend nursing care to a larger and more diverse patient population, which is especially important for areas where clinical resources are limited. This ability to fill in gaps and provide direct care regardless of location means that telehealth can greatly benefit nurses, patients, and health systems.

In rural areas, hospitals face two types of challenges at both the patient and caregiver levels. Nurses and clinicians in remote areas may be responsible for delivering general care to patients, while specialists are centralized in the nearest urban setting. Telehealth offers an alternative means of providing the best care possible should these nurses find themselves in situations in which they need a specialist's assistance to assess and treat certain patients. For example, a pregnant woman might live more than an hour's drive away from the obstetrician managing her high-risk pregnancy. Through leveraging telehealth, she can be monitored remotely from home with self-administered non-stress tests, obviating the need to travel hours to reach a clinic. This can reduce the unnecessary transporting of patients, an undertaking that can worsen their conditions and increase costs.

Telehealth: An Enabler

Telehealth technology is only an enabler. To be successful, telehealth must fit into nurses' workflows. While some nurses may prefer to care for patients at the bedside or lack confidence in describing patient conditions to doctors over the phone, the reality is that technology is becoming embedded into everyday life, including the workplace, because it has a uniquely positive influence on the way nursing is practiced. However, as with any medical technology, telehealth tools need to meet the high standards that nurses require to protect and care for their patients.

First and foremost, telehealth must meet HIPAA standards for privacy, security, and auditing. Nurses deal with private patient data that cannot be at risk of getting lost or sent to the wrong person. The consequences of such an error are costly and potentially painful for patients.

The second requirement is for nurses to have the proper training and resources to confidently use these tools. Because nurses spend their days multitasking to address the needs of multiple patients, new tools—no matter how well intentioned—need to fit seamlessly into the workflow. Everything must work. Proper training upfront and the availability of resources to troubleshoot problems are critical components of successful telehealth adoption and, subsequently, improved patient care. Also, protocols and standards of practice must be established to define nursing roles and expectations in various telehealth settings.

Adapting to the Workflow

Telehealth and smart devices are challenging nurses to adopt technology that will sharpen their ability to care for multiple patients. By checking an app, a nurse may be able to determine that the alarm going off in another room is actually a false alarm and that there is no need to rush from the bedside of one patient to assess another. Or perhaps, in the middle of the night, a patient in a community hospital requires urgent care that isn't available from an in-house specialist. Instead of rousing the on-call clinician or making a best judgment, telehealth provides access to a specialist who can give advice after reviewing the patient's chart and near-real-time data.

Certain telehealth applications, such as mobile devices that foster clinician communication, can be directly embedded into any nurse's daily workflow. Laws, regulations, and policies that govern the use of other types of telehealth can differ from state to state and faculty to facility.

No certification for telehealth nursing is yet available, but the American Academy of Ambulatory Care Nursing (AAACN) recognizes telehealth as a subspecialty with defined competencies for various care delivery models. Regardless of the type of technology, as leaders in healthcare, nurses will be expected to master the latest technology and information systems designed to improve care and patient outcomes, presenting a real opportunity to benefit patients and the nurses who care for them.

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