TELEHEALTH 2
Informatics Paper: Part 1
It is important in healthcare to provide access to quality care to all remote and rural areas
within the United States. With advancements in technology, many opportunities are developing
to reach these rural areas. Telehealth is a new way to provide quality healthcare using
telecommunications and information technology. It is a broad definition used interchangeably
with telemedicine, eHealth, or mHealth (Nelson and Staggers, 2018). Wade, Elliot, and Hiller
(2014) believe telehealth is the answer to many barriers that patients face on a daily basis to
access healthcare such as lack of access, poor distribution of specialists, cost and more direct
care for the aging patient. This paper will address what is needed to implement a telehealth
program, what types of programs that are available, and a way to build a framework to explain
the importance of a telehealth program.
Telehealth Programs
Telehealth programs have been used by several different areas within healthcare for many
years. Examples of this would be radiology and neurology transferring images electronically for
interpretation (Olsen and Thomas, 2017). One of the most successful telehealth programs is
utilized by the United States Army. It began in 1992, and includes services in cardiology,
dermatology, infectious disease, neurosurgery, pain management, and orthopedic surgery (Nelson
and Staggers, 2018). Another way to apply telehealth is through a home health programs This
idea was successfully implemented by the U.S. Department of Veteran Affairs, it was found to
reduce long term care bed days and inpatient hospital admissions, decrease costs, and had a high
level of satisfaction from active participants (Nelson and Staggers, 2018).
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Implementation
Before implementating a telehealth program, an executive team should be formed to
supervise over project goals, budget, progress, and growth (Nelson and Staggers, 2018). This
team would convene and assess the multiple steps needed to create a successful telehealth
program. The first step has already been completed by knowing there is a significant health need
in this rural community. The second most important factor is to identify a work environment with
staff equipped to implement (Nelson and Staggers, 2018). After the work environment is
acknowledged, the organization must prepare for the technology needed that is user-friendly and
employ access to technical support (Nelson and Staggers, 2018). Nelson and Staggers (2018) go
on to address the final step of learning how to implement, manage, and support these
technologies. They suggest starting one telehealth specialty, then adding additional specialties
after successfull implementation.
There are many telehealth challenges that must be addressed before beginning a
telehealth program. The standard of care for telehealth medicine is still regulated by The Joint
Commission, Centers for Medicare and Medicaid Services, and the Affordable Care Act; but
licensing, credentialing, malpractice, and reimbursement are endorsed at the state level (Olsen
and Thomas, 2017). Licensing has been made slightly easier to address for nurses by the Nurse
Licensure Compact, allowing nurses to hold one license and practice in over 25 other states.
Another similar act has been made in 2011 for licensed medical professional called the Service
Members’ Telemedicine and E-Health Portability Act (STEP Act). This act only allows federal
and military personnel to practice in one state and treat in another (Nelson and Staggers, 2018).
Hopefully, with advancements in telehealth this act will grow to include all licensed
professionals. It is important for all practitioners to comprehend that the laws and regulations are
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based on the patient’s location (Olsen and Thomas, 2017). Credentialing and privileges are
another process the telehealth program must address. The healthcare provider must be
credentialed in each state not only where they are located but where the patient is located. This
became easier when credentialing by proxy was permitted in 2011 by CMS and TJC (Olsen and
Thomas, 2017).
There are multiple ways a rural program could potentially gain funding to improve access
to care. Olsen and Thomas (2017) suggest grants and charitable contributions can be found for a
rural program like the one planned. Even though telehealth is considered cost effective,
reimbursement is critical to every program. Telehealth medicine is coded for billing just like in-
person services (Olsen and Thomas, 2017). A study by Adler-Milstein, Kvedar, and Bates (2014)
found that adoption rates of telehealth medicine varied tremendously across states and that
implementing policies to promote private payer reimbursement of telehealth would improve
those adoption rates.
Theory
Interest in new telehealth technologies and the impact it has on individuals and
communities has intrigued researchers to develop important concepts to telehealth research (Dyk,
2014). One of these concepts is the diffusion of innovation theory. I feel this informatics theory
is most important for the development of telehealth. The diffusion of innovation theory was
developed by Everett Rogers to enlighten how people respond to new practices and technologies.
“It encompasses qualities of the innovation and the environmental context, although the
individuals who choose whether or not to adopt an innovation remain central” (Wade, Eliot, and
Hiller, 2014). With telehealth being a new innovation in a rural community this theory would
give insight into how patients might be impacted by this new technology. Rogers categorized the
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individual’s responses to the new technology into five groups; innovators, early adopters, early
majority, late majority, and laggards (Dyk, 2014). Not only does the theory categorize individuals
but also how organizations will respond. These characteristics are centralization, complexity,
formalization, interconnectedness, and organizational slack (Nelson and Staggers, 2018). This
theory attributes five attributes to the characteristics of the new technology. These attributes can
be used to assess if the technology will be adopted at a fast rate; or if there is a problem with
acceptance, it can be utilized to evaluate the source of the problem (Nelson and Staggers, 2018).
If the theory is applied successfully and the new technology is accepted the technology can be
implemented. The final stage of the theory is the confirmation phase this is when the technology
is no longer an innovation but a standard practice (Nelson and Staggers, 2018).
Informatics Nurses.
According to Wade, Elliot, and Hiller (2014) telehealth programs will have difficulties
with low patient and healthcare provider uptake and diffusion. This is why informatics nurses are
vital to successful implementation of a telehealth program. Wade, Eliot, and Hiller (2014) believe
by utilizing a nurse informaticists the program will be legitimized by enhancing clinical
acceptance. The informaticists obtains this by building relationships with clinical staff and
providers (Wade, Eliot, and Hiller, 2014). Another way nurse informaticists can be utilized is by
applying the aforementioned theory to assess how the community, including the patients and
organization, will be affected by the change. By having a specialist understand this process, the
informatics nurse can support both the organization and patient in capitalizing on the benefits of
this new technology (Nelson and Staggers, 2018).
In conclusion, telehealth programs have been proven to improve access to quality care,
accessibility, efficiency, and effectiveness with the added advantage of cost reduction to rural
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areas like the one suggested (Dyk, 2014). Even though implementing a program such as this
faces many challenges; with the help of an informatics nurse, these barriers can be broken. Using
the informatics theory of Diffusion of Innovation, the informatics nurse can assess both the
individual and organization; and carry through the innovation from the implementation phase
through the final stage of confirmation.
References
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Adler-Milstein, J., Kvedar, J., & Bates, D. W. (2014). Telehealth among US hospitals: Several
factors, including state reimbursement and licensure policies, influence adoption. Health
Affairs, 33(2), 207.
Dyk, L. (2014). A review of telehealth service implementation frameworks. International
journal of environmental research and public health, 11(2), 1279-98.
doi:10.3390/ijerph110201279
Nelson, R. and Staggers, N. (2018). Health Informatics: An Interprofessional Approach. St.
Louis, MO: Elsevier.
Olson, C. A., & Thomas, J. F. (2017). telehealth. Advances in Pediatrics, 64(1), 347-370.
doi:10.1016/j.yapd.2017.03.009
Wade, V. A., Eliott, J. A., & Hiller, J. E. (2014). Clinician Acceptance is the Key Factor for
Sustainable Telehealth Services. Qualitative Health Research, 24(5), 682–694.
https://doi.org/10.1177/1049732314528809
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