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INTRODUCTION

As we can see technology is and it is going to be the world revolution of any time. Since
scientists, engineers and all kind of people will look for better ways of making life easier and safer. And
the only way to achieve this is with the help of Technology. This science is growing rapidly and is
offering us great advantages to our life. Life is in the hospital industry. We could see that technology is
very important in here because, one of the most important things for the humanity is our health that is
why this industry has to be updated inorder to offer new discoveries to help people to survive and
always be healthy. We can see that we dont have the same utensils as before, now we are updated and
we have the newest and biggest technology in medicine.
E NURSING
Nurses all around the world have risen to the challenge of new technology. Today, the nurses
work in a variety of E-Health programs such as tele-triage. They access online libraries and databases of
clinical practice guidelines from computers in their work places. Nurse in specialized areas of practice
now interact with their peers in discussion groups over the internet. Nurses are also involved in
standards development for the implementation of electronic health records and many nursing
educational programs are now offered online.
In recent years there has been an explosion in the health care, knowledge globally. Nurses as the
largest group of knowledge workers in health care, must rely on a board range of information sources
and extensive clinical knowledge to support their discussions. In todays health care environment, nurses
are required to be flexible, innovative and information literate professionals, able to solve complex client
problems by utilizing the best available evidence.
Patient safety is fundamental to nursing care. To provide safe, high quality care, nurses must
integrate new health care knowledge into their practice. Though life long learning, nurses must work
to maintain their area of practice, they must be able to access information on best practices from expert
nurses and other professionals nationally and internationally. Nurses need resources to be available 24
hours a day, seven days a week, whenever and wherever they are working or living. Many nurses
practice in remote and isolated regions where accessing needed information and resources is difficult.
DEFINITION OF E NURSING/ E LEARNING
E nursing involves the use of computers or electronic devices in some way to provide training, education
and learning material
Derek Stockley
E nursing comprises of all forms of electronically supported learning and teaching. The information and
communication system whether networked learning or not, serves a specific media to implement the
nursing process

Tavangarian D et al
E nursing has been defined as the learning and teaching facilitated online through network technology
Garrison &Andresson
GOAL OF E-NURSING
To enhance nurses to benefit from all developments in information, communication and technology, to
improve nursing and client outcomes.
MODALITIES OF E LEARNING

Individualized
selfpaced e-learning online

Individualized
selfpaced e-learning offline

Group-based e-learning
synchronously

Group-based e-learning
asynchronously

Individualized self-paced e-learning online


It refers when the nurse assess the information online in the Internet. For example a nurse student is
searching for data on some nurse research on the Internet or a local network.
Individualized Self-paced e-learning offline
This refers when an individual nurse learner is using nursing database or a computer-assisted learning
package offline (i.e., while not connected to an Intranet or the Internet). For example a learner working
alone offs a hard drive, a CD or DVD.
Group-based e-learning Synchronously
It refers when groups of nurses are working together in same time through an Internet or the Internet.
For example one or two-way audio and video conferencing.

Group-based e-learning Asynchronously


It refers when groups of nurse are working over an Intranet or the Internet and they exchange among
themselve with a time delay. For example: on-line discussions through e-mailing lists.
LEARNING PREFERENCES AND STYLES IN E-LEARNING
These comprises of: Offline and online activities, Synchronous and asynchronous activities, Different
multimedia assets. Different didactical interactions, Different ways of delivering the content, Self study
and collaborative learning and Formal and informal learning
Offline and Online Activities
Learning teaching activities takes place while offline i.e. not connected to an Internet and online i.e.
connected to Intranet
Synchronous and Asynchronous Activities
Within synchronous learning, learning and teaching takes place in same time (real time) while the trainer
and learner are physically separated from each other (place shift) e.g. listening to a live radio broadcast,
watching live television broadcast. Audio/video conferencing, internet telephony, online lectures, two
ways live satellite broadcast.
Different Multimedia Assets
The activities are carried out through more than one media.
Different Didactical Interactions
Within e-leaming, different didactical approaches can be used, e.g. assignments, assessment, pre test,
discussions, reading, presenting information, watching a video, asking questions workshop,
demonstration, participating in a simulation, etc.
Different Ways of Delivering the Content
Various ways to deliver the content are computer, PDA, TV, mobile phones, iPod etc. Every device has
its own characteristics, advantage and disadvantages.
Self Study and Collaborative Learning
Learning can be both ways: individualizes as well collaborative in e learning. Formal and Informal
Learning E-learning consists of both informal and formal learning activities. Informal learning is
unstructured, unplanned and formal learning is a learning that is planned with specified learning
objectives. a didactical approach and a planning.

TYPES OR FORMS OF E-LEARNING


Bates and Poole (2003) and the OECD (2005) classified different forms of e learning services as
Asynchronous learning

Synchronous learning

Fax E-mail Knowledge base forum Computer based training


Quick reference guide Blogs, wikis and discussion boards

Telephone Screen sharing Chat or a skype conversation


Desktop conferencing Online Seminar

IMPORTANCE OF E NURSING
To Organization

Improve training costs

Producing learning content is time consuming whether it's online Or not but it improves the overall cost
through decreased travel, reduced material, and hopefully improving performance.

Decrease material costs

By creating the environment online and letting the learner practice, the costs associated with set up will
be negligible.

Increase productivity

Because e-Learning is not bound by geography or time the learner can enhance their performance at
anytime.

Standardization

E learning allows creating a standardized process and consistency in delivery time.


To Learners/Employees

Real-time access

E-learning courses can be accessed anytime, anywhere even without internet access, i.e. On-demand
availability.

Cost effective

E-Learning is transforming continuing nursing education (CNE) without wasting time and money for
sending them to attend conferences, seminars, etc.

Interactivity

Interactivity engages nurses, physicians, and other employees motivates them to become active
participants for the learning process, increasing retention and ultimately improving patient and employee
safety and quality.

Good learning environment

A good learning environment is created with the right feedback.

Improve retention

The combination of multimedia and instructional design can produce a very rich learning experience that
is repeatable.

Individualized learning

E-Learning allows to progress with learner's own pace.


To Organization and Community

Ongoing access to resources

E-Learning gives the opportunity to continue to have access to the online content and resources to brush
up and to update knowledge and skill.

Knowledge management

E-Learning includes all sort of online technologies that allows collaboration and conversation to capture
organizational knowledge.

Encourage sharing

Sharing of resources can be encouraged in E-Learning.

Employer of choice

This allows employers to explore other opportunities in the organization.

THEORETICAL BASES OF E-LEARNING


The main theoretical bases upon which e-learning revolves are andragogy and constructivism. These
theories support the use of e Ivarninq.
Arndragogy
Andragogy is a term refers to the le teaching methodology that best facilitates learning among adult. The
flexibility of anytime anywhere learning allows the learners to develop a learning plan that fits their
needs related to family, vocation, and other areas of life. The dynamic interactions with other learners
can demonstrate relevance as they work together to create new found meaning.
Constructivism
In constructivism there is flexibility and learning occurs as a result of the learner thinking about and
interacting with the subject matter. It focuses on the concept of knowledge construction versus
knowledge transmission. E-learning is ideal for instructional design that is constructivist in nature. The
learner can construct their own plan for achieving the learning outcomes based on personal interests.
BENEFITS OF E-LEARNING

It enhances innovative teaching


It promotes self-directed and interactive learning
Convenient for the learner
E-learning saves time and place for learning
It enables to enhance data search by hyperlinks
E-learning aids to learn as and when required
It promotes internet use
Build responsibility and self-confidence among learners
It increases retention and application of information
Consistent delivery of content is possible with e-learning
Proof of completion and certification is also automated.

ADVANTAGES OF E-LEARNING

Identified some advantages of e-Learning are as:


It increases the flexibility of learning and it is fast and has no geographical barriers
E-learning technology offers a wide range of opportunities for development of education
The use of e-learning are independence of time and space and individual can have easy access
E-Learning has quality assured programmes
E-Learning is cost effective in terms of material cost, travelling cost expenditure in achieving
goals
It is learner centered and provides the learner with information.

DISADVANTAGES OF E-LEARNING

Some forms of e-Learning perceived as isolating from the personal touch.


Nurses may not have the IT skills needed to take advantage of e-Learning.

BENEFICIARIES OF E NURSING
This provides direction over time as new challenges are presented in the health care system and may
need to be revised as developments take place in the electronic environment surrounding nursing. The
beneficiaries are:
o
o
o
o
o
o

Individual nurses
Their clients
Employers
Nursing professional
Regulatory organization
The profession as a whole both nationally and internationally.

TELEMEDICINE
INTRODUCTION
Telemedicine is an upcoming field in health science arising out of the effective fusion of
information and communication technologies (ICT) with medical science having enormous potential in
meeting the challenges of healthcare delivery to rural and remote areas bedsides several other
applications in education, training and management in health sector. It may be as simple as two health
professionals discussing medical problems of a patient and seeking advice over a simple telephone or as
complex as transmission of electronic medical records of clinical information, diagnostic tests such as
E.C.G, radiological images etc. and carrying out real time interactive medical video conference with the
help of IT based hardware and software, video- conference using broadband telecommunication media
provided by satellite and terrestrial network.Telemedicine is an invaluable tool in Healthcare.
Telemedicine allows patients to visit with physicians live over video for immediate care or capture
video/still images and patient data are stored and sent to physicians for diagnosis and follow-up
treatment at a later time.
DEFINITIONS
Telemedicine is a system of healthcare delivery in which physicians examine distant patients through
the use of telecommunications technology.
Preston Jane, 1993
It is defined as 'the delivery of health care services, where distance is a critical factor, by health care
professionals using information and communication technologies for the exchange of valid information
for diagnosis, treatment and prevention of disease and injuries, and for the continuing education of
health-care providers as well as for research and evaluation, all in interest of advancing the health of
individuals and their communities.
WHO, 1997
Telemedicine is the combined use of telecommunications and computer technologies to improve the
efficiency and effectiveness of healthcare services by liberating caregivers from traditional constraints of
place and time and by empowering consumers to make informed choices in a competitive marketplace.'
Bauer and Ringel, 1999
TELECOMMUNICATIONS
Telecommunication refers to the transmission, emission or reception of data or information, in the form
of signs, signals, writings, images and sounds or any other form, via wire, radio, visual or other
electromagnetic systems.

TELEHEALTH
Telehealth is the 'use of electronic information and tele-communication technologies to support the long
distance clinical health care, patient and professional health related education, public health and health
administration'
. Health Resources and Services Administration (http:// www.hrsa.gotiltelehealth).
Telehealth is the removal of time and distance barriers for the delivery of health care services or related
health care activities. Some of the technologies used in telehealth include: telephones, computers,
interactive video transmissions, direct links to health care instruments, transmission of images and
teleconferencing by telephone or video.
TELEHEALTH CARE
It includes all the health disciplines such as radiology, pharmacy, and psychology.
E-HEALTH
It refers to the use of modern information and communication technologies to meet the needs of citizens,
patients, health care professionals, health care providers, as well as policy makers. It includes e Care, e
Learning, e Surveillance, and e Administration. This definition is officially adopted the denomination by
major international Organizations like, WHO, European Union (EU), International elecommunication
Union (ITU) and European Space Agency.
IsfTeH
International Society for Telernedicine and eHealth established under the Swiss law is dedicated to
promote te.).lemedicine, telecare, telehealth, and eHealth around the world.
mHealth or Mobile Health
Efficient high quality health care services for mobile citizens.
uHealth or Ubiquitous Health Care
This is focusing on eHealth applications that provide health care to people anywhere at any time using
broadband and wireless mobile technologies.
OBJECTIVES OF TELEMEDICINE IN DIFFERENT FORMS

Information exchange between hospitals and physicians.


healthcare professionals Networking of group of hospitals, research centers.
Linking rural health clinics to a central hospital.

Video conferencing between a patient and doctor, among members of healthcare teams.
Training of in widely distributed or remote clinical settings.
Instant access to medical knowledge base, technical papers etc.

TYPES OF TELEMEDICINE
Telemedicine can be broken into three main categories
1. Store- and- forward (asynchronous)
2. Remote monitoring
3. Interactive services (synchronous) (real time)
STORE- AND- FORWARD
Involves acquiring medical data (medical images, biosignals) and then transmitting this data to
the doctor or medical specialist at a convenient time for assessment offline.
It does not require both the parties at the same time.
Medical specialties like dermatology, pathology etc is conducive to this kind.
Most beneficial for population living in isolated communities and remote regions.
REMOTE MONITORING
Remote monitoring also known as self- monitoring/ testing.
It enables medical professionals to monitor a patient remotely using various technological
devices.
It manages chronic diseases or specific conditions, such as heart disease, diabetes mellitus or
asthma.
It gives greater satisfaction to patients.
It is cost-effective.
INTERACTIVE SERVICES

Interactive telemedicine services provide real-time interactions between patient and provider.
It includes phone conversations, online communication and home visits.
face-to-face visits.
In clinician-interactive telemedicine services may be less costly than in-person clinical visits.

Many activities such as history review, physical examination, psychiatric evaluations and
ophthalmology assessments can be conducted comparably to those done in traditional
PROCESS AND THE REQUIREMENTS NEEDED
A) Nodal Hospital
A patient getting treated.

A Doctor
A remote telemedicine console having audio visual and data conferencing facilities.
B) Referral Hospital
An expert / specialized doctor.
A Central telemedicine server having audio visual and date conferencing facility.
THE DATA:

Data related to patients personal information.


Data related to a patients medical information.
Data of patient management in telemedicine.
Data related to the doctors.
Data for system management.

PERSONNEL INVOLVED
Referral end A group of specialist doctor
System Administrator.
Studio Technician
Nodal end A group of general physician
System Operator
Data entry Operator
Studio Technician.
DATA RELEATD TO THE DOCTOR
Doctors personal information.
Unique identification key.
DATA FOR SYSTEM MANAGEMENT
Users list
Password file
Log files
APPLICATION
Tele-health care: It is the use of information and communication technology for prevention,
promotion and to provide health care facilities across distance. It can be divided in the following
activities
Teleconsultation
Telefollow-up
Tele-education: Tele-education should be understood as the development of the process of
distance education (regulated or unregulated), based on the use of information and

telecommunication technologies, that make interactive, flexible and accessible learning possible
for any potential recipient.
Disaster Management: Telemedicine can play an important role to provide health care facilities
to the victims of natural disasters such as earthquake, tsunami, tornado, etc and man-made
disaster such as war, riots etc. During disaster, most of the terrestrial communication links either
do not work properly or get damaged so a mobile and portable telemedicine system with satellite
connectivity and customized telemedicine software is ideal for disaster relief.
Tele-home health care:Telemedicine technology can be applied to provide home health care to
elderly or underserved, homebound patients with chronic illness. It allows home health care
professionals to monitor patients from a central station rather than travelling to remote areas
chronically ill or recuperating patients for routine check-ups. Remote patient monitoring is less
expensive, more time savings, and efficient methodology. Tele-home care virtual visits might
lead to improved home health care quality at reduced costs, greater patient satisfaction with care,
increased access to health care providers and fewer patients needing transfer to higher, more
costly levels of care. A Computer Telephone Integrated (CTI) system can monitor vital functions
of patients twenty four hours a day and give immediate warnings.
USES OF TELEMEDICINE
o Telemedicine is most beneficial for populations living in isolated communities and remote
regions and is currently being applied in virtually all medical domains. Specialties that use
telemedicine often use a tele prefix; for example, telemedicine as applied by radiologists is
called Teleradiology. Similarly telemedicine as applied by cardiologists is termed as
telecardiology etc.
o Telemedicine is also useful as a communication tool between a general practitioner and a
specialist available at a remote location.
o The first interactive telemedicine system, operating over standard telephone lines, for remotely
diagnosing and treating patients requiring cardiac resuscitation (defibrillation) was developed
and marketed by Med Phone Corporation in 1989 in the U.S served as receiving and treatment
centers.
o Monitoring a patient at home using known devices like blood pressure monitors and transferring
the information to a caregiver is a fast growing emerging service. These remote monitoring
solutions have a focus on current high morbidity chronic diseases and are mainly deployed for
the First World, Glucometer.
BARRIER IN TELEMEDICINE
Physician / Patient acceptance:It has been found that patients have no difficulty in accepting telemedicine program. A survey done in
Orissa revealed that 90% patients were satisfied with using elemedicine technology. In almost all the
cases the patients are more than happy and satisfied as they dont have to travel long distance to show

their diagnostic reports to their doctors and also they got the specialist consultation and their cases has
been seen by some expert doctors.
Some resistance is seen amongst doctors. They see telemedicine as an additional duty or workload.
Therefore there is a need to weave telemedicine into the routine duties of the doctors. Some private
doctors fear that telemedicine is likely to reduce their practice. They need to realize that this technology
enhances their reach and exposure and is only likely to increase their practice further.

Availability of technology at a reasonable cost:


There is a myth that establishment of a telemedicine platform is expensive. The basic system needs
hardware, software and the telecommunication link. In all the areas there is a significant reduction in the
price. Most of these costs are well within the reach of most of the hospitals, and can be recovered by
nominal charge to the patient and student in case of tele education.
Accessibility:
Although information technology has reached in all corner of the country but the accessibility of people
living in remote and rural area to the nearest health centre (PHCs, CHCs or district hospital) may not
be easy due to poor infrastructure of road and transport. It may be possible that the available
telemedicine system in theses health centered may not function because of the interruption in power
supply / technical problems.
Reliability:
Some healthcare professionals has a doubt about the quality of images transmitted for tele consultation
and tele diagnosis. In tele radiology, tele pathology, tele dermatology the quality of image (color,
resolution, field of view, etc should be of international standard to avoid any wrong interpretation of data
may be of critical importance in tele-mentoring and robotic surgery and have to be reduced to the
minimum.
Lack of trained manpower:
Telemedicine is a new emerging field there I lack of training facilities with regard to application of
telemedicine. Most of the healthcare and IT professionals are not familiar with the program.
Telemedicine is not the part of course curriculum of medical students.
ADVANTAGES OF TELEMEDICINE

For the patients


People at remote areas get top class medical facility from reputed hospitals.

Reduces travel cost and save time for the rural patients.
Reduces lot of inconvenience for the rural patients.

For the hospitals


Hospitals can spread their reach in remote villages and serve people without much
investment on the infrastructure.
The hospitals get revenue from the reference made from the remote locations.
After care or post operated care patients need not come to the main hospital for
minor consultation.
Primary diagnosis can be done with the use of telemedicine and patient can come
to the main hospital for major surgery.
Hospitals can have CME programmes with other hospitals and medical colleges.
Hospital can run training programme from their hospitals to doctors of other
hospitals.
A rare operation or a diagnosis can be broadcast to other hospitals.
Doctors can learn new techniques by connecting to foreign hospitals. Overseas
consultation and second opinion can be got.
Job interviews can be conducted.
Live images like ECG, USG, CT scan, Echo, X-rays and any video output from
medical instruments can be transmitted.
Screen captures software- use of graphic image.
Clip art commonly used in library as graphical image such as computer, flowers,
building, a nurse etc.
Others
Animation
Audio, recording
Video
Multimedia application- conferencing, video games.
Advertisement
Practicum invitation preparation, collect data and display in graphic form.

DISADVANTAGES

Do rural homes have PC


Cost of telecom infrastructure
Lack of standards
Difficulty in trained users
Difficulty in maintaining equipments
Patients confidentiality

INDIAN TELEMEDICINE
Telepathology India, Dibrugarh

Apollo Hospitals, Hyderabad


SankaraNethralaya, Chennai
Online Telemedicine, Ahmedabad
NarayanaHrudayalaya, Bangalore
Medisoft Telemedicine, Ahmedabad
Heartcare India, New Delhi

CONCLUSION
Telemedicine will soon be just another way to see a health care professional, just as seeing friends and
family. Technology manufactures and telecommunication companies are already flying each other to
produce low cost equipments and bandwidth needed. Telemedicine is a boon to our medical field which
help he rural population the physician and even the government in maintaining and promoting the health
care of the nation.

TELE NURSING
INTRODUCTION

It refers to the use of telecommunication technology in nursing to enhance patient care and involves the
use of electromagnetic channel (e.g. wire, radio. optical) to transmit voice, data and video
communications signals..This has been used to describe many health care services such as telemedicine,
telehealth, and telenursing etc. The common denominators are distance and technology. It is in practice,
feasible and cost effective in developed countries like Europe, US, Australia. In Indian scenario,
telenursing needs to be considered and should move side by side with telemedicine. Telenursing in
which nurses deliver, manage, and coordinate patient care and services via telecommunication
technology is one of the fastest growing areas in healthcare. In India, telenursing is in infancy stage
required to be planned carefully, keeping in mind the quality of nursing practice. scope for monitoring,
and accreditation.
DEFINITION
Telenursing refers to the use of telecommunications and information technology for providing nursing
services in health care whenever a large physical distance exists between the patient and nurse.'
Wikipedia.
Telenursing is the delivery of nursing care and services using telecommunications, increases access to
nursing care interventions for clients in remote or distant locations.
Chaffee, 1999; Helmlinger & Milholland, 1997; Yensen, 1996
Telenursing -is the use of telecommunications technology in nursing to enhance patient care. It involves
the use of electromagnetic channels (e.g. wire, radio, and optical) to transmit voice, data and video
communications signals. It also is defined as distance communications, using electrical or optical
transmissions between humans and/or computers.
Skiba, DJ, & Barton, AJ, 2000
Types of Telecommunication Tools
There are a variety of telecommunication tools available to the nursing professional today, e.g,
Teleservices, TeIehealth, Tele medicine, Telenursing, Telephone nursing.
Telephone Nursing It is the use of the nursing process to provide care to patients over the telephone.
First used by nurses in the late 1800s.
Teleservices
Care services provided via telecommunication technology transmitting information from one site to
another. This includes telephone consultations, triaging and follow-up.
Telehealth

It is the specific delivery of health care services over distances, utilizing monitors, cameras, and
computers to achieve improved patient outcomes.
Telemedicine
Medicine practiced at a distance, including but not limited to, Teleradiology, telepathology,
telepsychiatry, teledermatology, and teleoncology.
Telenursing Delivery of nursing care and services using telecommunications, a few examples may
include, interactive video, videomonitoring, digital cameras.
Telephone nursing
This has been a reliable source for information to be shared between healthcare providers and patients.
This process provided the building block for other telenursing services.
Tele home care
It incorporates the principles of telehealth into the homecare setting, not specific to the nursing team.
Tele kid care A telecommunication service for families of children with health issues.
REQUIREMENTS FOR TELENURSING
1 . Hardware
Telephone :The telehealth system is used via the patient's telephone system. A working phone must be
available. The monitor is plugged directly into the phone and the phone is directed through the monitor
so phone service is not interrupted.
Telehealth hardware :The telehealth equipment consists of a monitor, electronic blood pressure cuff,
pulse oximeter, scale, there is also EKG leads, video camera, blood glucose, and peak flows capabilities.
Many companies are designing wireless versions of these pieces of equipment, this allows for ease of
use and convenience for placement in a patient's home.
PC or laptop computer :The nurse must have access to a PC or laptop, with internet service available to
access the patient data once it has been transmitted to the secure data base. A power source is needed
such as wall outlet.
Power supply and Web access
2. For Tele health Monitoring
Depending on the needs of the patient the monitor should Have vital sign measurement capabilities,
pulse oximeter readings, glucose measurements and peak flows readings can be manually typed into the
monitor .Each monitor can be programmed to provide personalized communications with the patient.

The monitor should be compact, light weight and portable. The readings of monitor should easy to read,
large print can be provided, some are voice prompted, the monitors are easy to use, and user friendly.
3. Software
The following are the software used in telehealth:
Operating system-Linux, National database. Security technology and firewalls and Rewritable flash
memory. Operating system-Linux Once the patient data is obtained it is sent to a secure web site. One
operating system that is used by Telehealth companies is the Linux system. This is an operating system
such as windows XP; this is a free operating system that is accessible to anyone.
National database A national data base system that uses technology to ensure compliance and privacy
standards is used. The nurse must have a user password to access the data. Patient information is stored
at the data base and can be accessed at any time by the nurse or physician via the web site. Patient
trending is also available.
Flash drive Data can be stored on a flash drive and transport by the patient to hospital. Once the patient
is no longer using the system the monitor is reprogrammed via the data base by the nurse.
Firewalls and other security devices These are used to provide security and prevent information theft.
The top monitor is for multiple patient uses and the bottom monitor is for individual use.The patient
would use the monitor as instructed by the nurse, the information is then sent via the POTS (plain old
telephone system) through the router and firewalls (set-up for protection) to the Internet servers, flowing
to the application server then secured in the database. As demonstrated the nurse would then access the
information using her knowledge of computers and the Internet.
4. Software programmes
Cerner software a widely used software program by many health care facilities
APPLICATION OF TELENURSING
Telephone consultation
E mail enquires
Distance learningvideo monitoring
Digital photography
BENEFITS OF TELE NURSIG

Enhance patient care


Reduce travel time
Increase productivity
Access to specialties
Enlarged educational opportunities

USES OF TELE NURSING

Home care agencies


Hospices
Hospital based telemedicine center
Managed care center
Rehabilitation center
All branches of military

EVIDENCE BASED USES OF TELE NURSING


In medical surgical conditions

For patients who are immobilized, or live in remote or difficult to reach places, citizens elderly,
children and adults with chronically conditions and debilitating illnesses such as chronic
obstructive pulmonary disease, diabetes, congestive heart disease, neural degenerative diseases,
etc.
Care of patients in immediate post-surgical situations, having wounds, ostomies, etc.
Nursing intervention to support mothers with difficult infants, reduces fatigue and distress.
Allow women with pregnancy-induced hypertension to remain at home.

Monitoring

Home monitoring of physiologic parameters, such as blood pressure, blood glucose, respiratory
peak flow, and weight measurement, taking a pulse oximeter reading, and visually assess via the
Internet and telephone from a base station.
Enables nurses to provide accurate and timely information and support online
Examination of test results
Monitoring of Daily Life and Symptoms for Home Oxygen Therapy Clients.

Self Management

Helps patients and families to be active participants in care, particularly in the chronic illness,
changing of dressing, giving insulin injection

Cost Effective

Reduces the requirement for, or the length of, hospital stay of patients and saves nurses time.

Professional education

Helps to sharing Clinical information with national and international experts.


Increases access to nurse education, particularly for continuing education.

Clinical skills can be learned and practiced through patient siniulation modeling
Offers a doctorate in nursing completely via online distance education.
Provides opportunities for senior nurses to bring their years of experience back to the clinic,
Allows a nursing student to have contact with a clinical data repository, a faculty supervisor, and
the Web,
To disseminate educational and other materials by using Web. Increase satisfaction among nurses
by creating more collaborative and autonomous roles.

IMPLICATIONS OF TELENURSING
Delivery, management, Coordination of Care

Nursing knowledge and processes are used to provide care to patients in many geographic areas.

Multi-disciplinary Teams

A multi-disciplinary team can use many technologies available to view and share patient
information providing prompt and effective care.

Disease Management

Nursing care and the new innovative technologies can play a vital role in disease management,
and improving patient outcomes through Distant Care.

OBSTACLES IN TELENURSING
The implementation of telenursing may encounter following problems:

Patients and their family members may not be able to use home based equipment. Many patients
may be having fear to use it
Acceptance by patients who prefer to see health care providers face-to-face
Initial cost outlay may be very high
Privacy is an ongoing concern
Security of data is questionable
May be difficult to track and proves for reimbursing providers.

DISADVANTAGES OF TELENURSING
Dehumanizing Effects

Cost

There are healthcare professionals who feel the telehealth system has dehumanizating effects.
Without the human touch how is the nurse able to do a thorough assessment

Telenursing is quite costly due to the cost of the monitor and equipment.

Inability for Patient to Use Equipment

Many patients threatened to use electronic equipment and may not like to use.

Knowledge Base of the Nurse

Because telehealth, is often based on limited interaction physically with the patient and data is
collected via monitors, knowledge of the nurse and her clinical competence is vital in the
appropriate interpretation of the patient .

Equipment malfunction

Malfunctioning of the equipment may create problem to the patients In telenursing. The system
can only be used if equipments are working properly

PROBLEMS IN IMPLEMENTING TELE MEDICINE

Understanding of software
System error
Patient understanding
Cost

ISSUES IN TELENURSING

Societal
Technical
Safty standards
Regulatory issues
Professional liability
Egal issues
Reimbursement

TELENURSING PRACTICE STANDARDS BASES


The bases for nursing practice standard should be in consistent with:

INC practice standards


Code of ethics
State registration Act
Clinical protocols

GUIDELINES

There should be practice standards guidelines

To address the quality of care issues for providing the nursing services through distance.
Practice standards guidelines should be directed to promote safe, competent and ethical nursing
practice and in term of structure, process and outcome with indicators.
Telenurse should have special license, specially trained for Telenursing.
There should also be a provision for continuing education to update their level of performance.
Telenursing Practice standard guidelines should be within the competency framework
.The core competencies related to technology, proper working of equipments, clinical/technical,
education and knowledge and code of ethics are required to be defined for the telenurse.
Policies for the safe and ethical Telenursing practice need to be focused on accountability, client
choice regarding, informed consent to treatment/care, seat-liability, and confidentiality and
privacy.

ELECTRONIC MEDICAL RECORD

INTRODUCTION:
Paper-based records have been in existence for centuries and their gradual replacement by computerbased records has been slowly underway for over twenty years in western healthcare systems. Electronic
health record systems co-ordinate the storage and retrieval of individual records with the aid of
computers.
Electronic medical record systems lie at the center of any computerised health information
system. Without them other modern technologies such as decision support systems cannot be effectively
integrated into routine clinical workflow. The paperless, interoperable, multi-provider, multi-specialty,
multi-discipline computerised medical record, which has been a goal for many researchers, healthcare
professionals, administrators and politicians for the past 20+ years, is however about to become reality
in many western countries.
DEFINITION:
An electronic modification of records.medical record (EMR) is a computerized medical record created
in an organization that delivers care, such as a hospital or physician's office. Electronic medical records
tend to be a part of a local stand-alone health information system that allows storage, retrieval and
(OR)
A longitudinal collection of electronic health information for and about persons
TYPES OF ELECTRONIC HEALTH RECORD
Departmental EMR
Informations entered by a single hospital department.
Eg. Pathological record system, anesthesia record, internal medicine recordd
Inter departmental EMR
Information from a two or more hospital department

Hospital EMR
Contains all or most patients clinical information from a particular hospital
Inter hospital EMR patients information from two or more hospitals
Electronic patient record contain all or most of patients clinical information from a particular hospital
Computerized patient record- this record contains all or most of patients clinical information from a
particular hospitall
Electronic health care record- contain all patients information
FUNCTIONS OF THE EMR:
1. Health information data:
Allows care givers to have immediate access to key information such as allergies, lab results etc.
2. Result Management:
Allow caregivers to quickly access new and past test results, increasing patient safety and effectiveness
of care.
3. Order management:
Allows caregivers to enter and store orders for prescription, tests/ services in computer based system
that improves legibility, reduces duplication, and increases the executing the orders.
4. Decision support:
Allows the use of reminders, alerts and prompts that will improve compliance with the clinical
practices, ensure regular screening and identify possible drug interaction.
5. Electronic communication and connectivity:
Allows for efficient, secure and readily accessible communication among care givers and patients that
will improve the continuity of care, enhance timeliness of diagnoses and treatments, and reduce the
frequency of adverse occurrences.
6. Patient support:
Provides tools that give patients access to their own health records, provides internet education, assists
them carrying out home monitoring and self teaching, which can help improve chronic conditions.
7. Administrative processes:
Allows for administrative tools such as scheduling, which would improve efficiency and provide more
timely service.
8. Reporting:
Allows electronic data storage using uniform data standards that will enable organizations to respond to
third-party regulatory agencies.

ADVANTAGES OF AND BARRIERS TO IMPLEMENTING AN ELECTRONIC MEDICAL


RECORD:
Advantages:
a) Accessibility:
Accessibility of patients information by the care givers regarless of the location of the patient. It is
even helpful for medical professional. For eg: after a surgery an organ has been sent to pathology
for evaluation. The pathologist may access the medical record to review the clinical history and
surgical findings before performing the pathological examination.
b) Improving in of quality health care:
The quality of health care will improve because EMR will assist in reducing the medical errors.
Health care providers will have access to timely and appropriate treatment information to aid in the
diagnosis and treatments of diseases . this will include to practice protocols.
c) Standardization:
Electronic health systems that share data will have to standardize the health record formats used
within the various computer systems. The various diagnostic reports will look similar, allowing the
caregivers to find the necessary information in less time.
d) Promote evidence-based medicine:
EMRs provide access to unprecedented amounts of clinical data for research that can accelerate the
level of knowledge of effective medical practices.
Replace paper-based medical records which can be incomplete, fragmented (different parts in
different locations), hard to read and (sometimes) hard to find. Provide a single, shareable, up to
date, accurate, rapidly retrieveable source of information, potentially available anywhere at any
time. Require less space and administrative resources.
Potential for automating, structuring and streamlining clinical workflow.
Provide integrated support for a wide range of discrete care activities including decision support,
monitoring, electronic prescribing, electronic referrals radiology, laboratory ordering and results
display.
Maintain a data and information trail that can be readily analysed for medical audit, research and
quality assurance, epidemiological monitoring, disease surveillance.
Support for continuing medical education.
A review of all the advantages of the EMR might suggest that no disadvantage exists, however there
are few barriers.
DISADVANTAGES:
a) Cost of conversion:

The biggest disadvantage of the EMR at this time is the cost of converting from paper record to
an electronic record which include both the acquisition of both hardware and software.
b) Training:
Training is a massive undertaking involving all the employees including the physicians. Even
though computers have become our part of lives, many individuals are not comfortable in using
them. Initially productivity flatters as the employees learn the new system . some employees
might consider reluctant to convert to a completely electronic environment. Even some
physicians might consider electronic ordering and documentation more time consuming .
Remedy-space to employees during the implementation phase and periodic updates.
c) Privacy issues:
An important barrier under discussion by a number of consumer agencies is the privacy issue.
When multiple users have access to the record, the ability to maintain the security of the record
becomes a risk.
Remedy-policies, procedures and sanctions must be developing if there is breach in security.
d) Reliability:
Another issue of concern is reliability. The paper record is reliable in the sense that it will be
available during a power outage where as electronic records are vulnerable to programming
problems.
BARRIERS OF EMR:
Widespread implementation of EMRs has been hampered by many perceived barriers including:
Technical matters (uncertain quality, functionality, ease of use, lack of integration with other
applications,
Financial matters - particularly applicable to non-publicly funded health service systems (initial costs
for hardware and software, maintenance, upgrades, replacement, ROI ...)
Resources issues, training and re-training; resistance by potential users; implied changes in working
practices.
Certification, security, ethical matters; privacy and confidentiality issues
Doubts on clinical usefulness.
Incompatibility between systems (user interface, system architecture and functionality can vary
significantly between suppliers' products).
CONCLUSION:
Electronic medical record systems lie at the center of any computerised health information
system. Without them other modern technologies such as decision support systems cannot be effectively

integrated into routine clinical workflow. The paperless, interoperable, multi-provider, multi-specialty,
multi-discipline computerised medical record, which has been a goal for many researchers, healthcare
professionals, administrators and politicians for the past 20+ years, is however about to become reality
in many western countries.

BIBLIOGRAPHY
Books
1. Joginder Vati. Principles and practice of Nursing Management and administration. 1 st edition.
Jaypee publishers. Page no 664- 678
2. Tabish S. A. Hospital and Nursing Home Planning, Organization and Management. New Delhi.
Jaypee brothers medical publishers, 2003. Page no: 213- 220.
3. Selvashekhran. Essentials of Computers for Nurses. New Delhi. Jayeebrothers medical
publishers, 2008.
4. Armer J.A. A Case Study of the Use of Telemedicine by Advanced Practice Nurses In Rural
Missouri. The Journal of Continuing Education in Nursing. Volume 34:5, 2003.
5. Davis N, Lalour M. Health Information Technology. Missouri:Elsevier;2007.
6. Marquis B.L, Huston c.j, Leadership Roles and Management Functions in Nursing: Theory and
Application. Philadelphia: Lippincott; 2006.
Website
1. www. nursing world. com
2. www. indian journals. com
3. www. discovery computers.com