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The Rise of Tele-health

Tele-Health is a broad variety of technologies and tactics to deliver
virtual medical, health, and education services.

Tele-health is not a specific service, but a collection of means to

enhance care and health education delivery. Sometimes called tele-
medicine or tele-nursing when performed by nurses. Tele-health is often
used to provide health services to underserved areas and/or create
efficiencies that save costs without compromising quality of care.

The definition of tele-health nursing is thought of as the use of tele-

medical-nursing knowledge and practice through technology to conduct
nursing and deliver care in a remote location.

Nurses who practice tele-health come from all settings and use
technology like web cameras, the Internet and telephone lines to deliver care
over a long distance.

Tele-health, Tele-nursing, and Tele-medicine: What are the

differences?
Tele is a prefix meaning “at a distance,” and it is used in terms such as
telescope, or telemetry. The prefix Tele, when combined with the
term scope, has the single clear following meaning: an instrument to view
phenomena at a distance.

Previous literature has used the terms tele-health, tele-

medicine, and tele-nursing somewhat interchangeably.

Tele-health is defined as “the use of electronic information and

telecommunications technologies to support long-distance clinical health
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care, patient and professional health-related education, public health and

health administration”, Tele-nursing, is considered a component of tele-
health.

Tele-nursing is the use of “technology to deliver nursing care and

conduct nursing practice”. Although the use of technology changes the
delivery medium of nursing care and may necessitate competencies related
to its use to deliver nursing care, the nursing process and scope of practice
does not differ with tele-nursing. Nurses are engaged in tele-nursing practice
continue to assess, plan, intervene, and evaluate the outcomes of nursing
care, but they do so using technologies such as the Internet, computers,
telephones, digital assessment tools, and tele-monitoring equipment.

Tele-medicine, refers to medical practitioners, using

telecommunication for diagnosis and medical care distant from the
client.

Tele-health Consultation, is a ‘referred consultation between a

patient and practitioner (a specialist) performed by video conferencing.

Tele-triage, is like traditional triage but uses technology to supplement

or replace elements of the patient interaction. Tele-triage involves screening
patients remotely to determine the patient's condition and the care needed. is
frequently referred to as telephone triage by nurses using predetermined
protocols and/or referral to other health professionals or services from a
distance.

Tele-triage can be used in a variety of ways:

 Patient uses a web or app-based tool to enter their symptoms and get
guidance on whether they need to seek additional treatment

 Patient connects from their home to a provider to discuss if they

should come to the emergency department

 Patient is assessed upon entering the emergency department using a

kiosk or video interaction with a provider
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Benefits of tele-triage services:

 Reduces overcrowding in the emergency department.

 Reduces wait times and bottlenecks by processing patients more

quickly.

 Provides rapid care to low-risk patient populations with low-risk

health conditions.

 Reduces the number of patients who leave the emergency department

without being treated.

 Supports patients in nursing homes, home health, and homeless

shelters by providing a direct link to the emergency department to
help decide if or when a patient needs to be transferred.

Tele-triage is especially important during COVID-19 to help:

 Screen patients for COVID-19 so patients who may be infected can be

isolated.

The delivery of tele-health care is not limited to physicians and

nurses; it includes other health disciplines such as radiology, pharmacy, and
psychology. These disciplines also deliver care using electronic information
and telecommunications technologies and are accordingly called tele-
radiology, tele-pharmacy, tele-psychology, and so forth.

Where do nurses practice Tele-health?

Tele-health nursing can be done anywhere. Nurses can make use of
technology to conduct tele-health sessions in their homes, at physician’s
offices, in prisons, and in clinics and hospitals. Basically, any place where
the proper technology is available is a suitable place for tele-health nursing.
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In emergencies, nurses from around the world can participate in

telephone triage set-ups. Wherever nursing is done in a tele-health setting,
nurses can monitor a patient’s oxygen levels, heart rate, respiration, blood
glucose and more.

Patients contact their nurses through the tele-health system to get help.
In non-emergency situations, they can get the nurse to take their blood
pressure readings or glucose readings, for instance. Nurses can instruct
patients as to how to dress a wound or treat a minor burn.

The patients usually find their tele-health nurses through their

managed health care organization. Nurses must be overseen there to regulate
patient access to the system. Most of the time, the goal is to reduce the
number of trips patients make to the Emergency Room.

Telehealth nursing does not always require certification, but it may

require a nurse obtain licensure in order to practice in several areas. In USA
for example, a setting that is not federal, telehealth nurses must possess a
registered nurse license that complies with federal as well as state
regulations. The US recognizes that the nurse licensure compact allows
registered nurses to practice in all compact member states.

What circumstances are ideal for Tele-health Nursing?

Those circumstances where nursing care must be done quickly
and efficiently where getting to a patient physically is difficult are the
ideal situations. After a natural disaster, it may be that tele-health nursing is
the only option available for those with minor injuries once
telecommunications systems are up and running.

Routine pre-surgical and post-surgical care can be administered with

tele-health nurse help. Nurses can also help continue to develop the best
practices for specific circumstances as they arise.

Competency Standards in Tele-nursing

All tele-health nurses have to meet standards of care. In USA,

they must practice with in the American Nurses Association standards for
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safety and quality as well as competency. Specific tele-health standards are

available at the American Academy of Ambulatory Care Nurses and the
American Nurses Association.

International tele-nursing competencies are available. These can be

obtained through the International Council of Nursing (ICN). ICN
competencies are applicable to nurses in the US, Canada and in nearly 130
other countries.

Sixteen Standards are included the first six standards addressing the
six phases of the nursing process. The remaining ten standards address
professional performance in tele-health practice.

Standards of Professional Nursing Practice

Standard I: Assessment

The registered nurse collects comprehensive data pertinent to the

health-care consumer’s health or the situation.

Standard II: Diagnosis

The registered nurse analyzes the assessment data to determine the

diagnoses or issues.

Standard III: Outcome Identification

The registered nurse identifies expected outcomes for a plan

individualized to the healthcare consumer or the situation.

Standard IV: Planning

The registered nurse develops a plan of care that prescribes

strategies

and interventions to attain expected outcomes.

Standard V: Implementation
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Standard VI: Evaluation

The registered nurse evaluates progress toward attainment of

outcomes.

Standard VII: Ethics

The registered nurse practices ethically.

Standard VIII: Education

The registered nurse attains knowledge and competence that reflects current
nursing practice.

Standard IX: Evidence-based Practice and Research

The registered nurse integrates evidence and research findings

into practice.

Standard X: Quality of Practice

The registered nurse contributes to quality nursing practice.

Standard XI: Communication

The registered nurse communicates effectively in a variety of

formats in

all areas of practice.

Standard XII: Leadership

The registered nurse demonstrates leadership in the professional

practice setting and the profession.

Standard XIII: Collaboration

The registered nurse collaborates with the healthcare consumer,

family

and others in the conduct of nursing practice.

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Standard XIV: Professional Practice Evaluation

The registered nurse evaluates her or his own nursing practice in

relation to professional practice standards and guidelines, relevant

statutes, rules and regulations.

Standard XV: Resource Utilization

The registered nurse utilizes appropriate resources to plan and

provide nursing services that are safe, effective and financially
responsible.

Standard XVI: Environmental Health

The registered nurse practices in an environmentally safe and

healthy manner.

How does Tele-health work (means for application)?

Tele-health can be divided into four types of technology-based
services.

 Video Conferencing: Utilizing internet technology, video

conferencing allows healthcare providers, such as nurse practitioners,
to speak “face-to-face” with patients. Video conferencing is best used
for consulting, conducting mental health evaluations, and diagnosing
basic ailments.

 Digital Transmission: Internet technology also allows healthcare

providers to read scans, watch pre-recorded videos of patients, and
review charts from just about anywhere.

 Remote Patient Monitoring (RPM): RPM is any technology that’s

designed to monitor a patient’s medical issues, such as blood pressure,
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blood sugar, heart rate, etc. It can help healthcare providers track
patient health data without the need for numerous appointments.

 Mobile Health: Smartphones and tablet technology allow patients to

use apps that provide health information and track health choices,
such as calorie intake and exercise.

What Are the Advantages to Tele-health?

 It’s Convenient: With tele-health, healthcare providers can move
between patients faster and patients can take care of appointments
from home.

 It Can Save Money: By reducing the need for travel, office staff, and
office space, tele-health creates cost-saving efficiencies.

 It Can Expand Access: For those who are homebound or live in

underserved areas, tele-health provides much needed access to
healthcare providers.

 It Can Increase Patient Engagement: By making healthcare and

health information easier to obtain, tele-health makes patients more
likely to work to improve lifestyle choices and comply with treatment
guidelines.

 Tele-health eases the impact of the nursing shortage because it

provides easier access to professionals for patients; nurses
can better focus on patient care and satisfaction without all the “red
tape” of traditional on-site appointments, so efficiency is markedly
improved.

What Are the Disadvantages to Tele-health?

 There can be technology barriers: Tele-health requires patients to
have access to appropriate technology, such as a laptop with video
conferencing capability. Those who can’t get a hold of the appropriate
technology can’t benefit from tele-health.
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 There can be reduced continuity of care: Patients using tele-health

may connect with different providers each time they use a tele-health
service. They may also come to rely on apps rather than in-person
exams. This disassociation between patient and provider can increase
the likelihood that medical issues go unrecognized and/or untreated.

 There can be insurance issues: Tele-health is still so new that rates,

payments, and patient reimbursements remain in flux. This can
complicate matters for both providers and patients.

 It’s not good for every situation: While tele-health can help a
healthcare provider assess patient needs, many health services (from
surgery to physical examination) still require a patient to see a
provider in-person.