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Running head: TELEHEALTH PROGRAM
Telehealth Program
Liberty University
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TELEHEALTH PROGRAM
Telehealth Program
The delivery of patient care has evolved over time and with the application of informatics
and technology, healthcare professionals have established innovative ways of promoting patient
care at home using digital technologies. One of the many ways to deliver care to patients in
remote area is by utilizing telehealth. Telehealth is a program that enables delivery of patient
care remotely with the use of digital technologies that allows healthcare professionals to perform
patient evaluation, education, public health services, health monitoring, and caregiver support
(Nelson & Staggers, 2018, p. 131). The objectives of telehealth programs in an organization is to
improve health outcomes for patients who live in distant locations using technologies in
telecommunications such as video conferencing and mobile or wireless devices to diagnose and
treat illness/injury or prevent health complications (Chi & Demiris, 2017). Nurses are among the
healthcare professionals who are trained and competent in providing nursing care with the use of
technology. Nurse informatics is one of the specialties in the nursing field that utilizes
information technology, creates health policy and develop and facilitate new health information
technology in an organization. I selected scenario no.1 on the case study to investigate what
necessary requirements are needed to start a telehealth program in my organization to address
health needs in rural communities.
Needs Assessment
Implementation of a telehealth program in an organization requires an extensive amount
of planning to establish an effective program, and it can be very challenging to clinical staff and
patient population to accept the concept of telehealth. A beneficial telehealth program in my
organization that will significantly address the health needs of rural community via digital
technology is the establishment of a telewound program. Before establishing a telehealth
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program, it is important to consider several steps to achieve the goal of telehealth in an
organization. Firstly, a background analysis of the type of patients seen in my organization is the
first step to starting up a telewound program. My organization, David Grant Medical Center
(DGMC), located in Northern California, is the Air Force’s largest medical facility in the United
States and primarily delivers patient care to active service member, beneficiaries, and veterans
(Travis Air Force Base, July 10, 2014). After the affiliation of DGMC with the Veterans Affair
in 2007, the majority our patients are the older veteran population. One of the many services that
our organization provide is performing surgical operations to patients from different areas of
Northern California region.
Secondly, the health need of a community is an important factor when establishing a
telehealth program. Wound management and post-operative surgical complications including
surgical site infections among the older population living in rural community is a significant
health needs that can be met in the using telehealth program, therefore, a telewound program will
address the gap of health needs in rural communities. Implementation of telewound will prevent
post-operative complications, improve wound healing, reduce the number of readmission rates,
infection control, improve patient health outcome, and provide caregiver support. Evidence from
a study of telewound program was performed to identify the needs and effect of telewound
management and found that the clinical study not only resulted in positive clinical outcomes in
wound care but also resulted in positive cost-effective outcomes (Chakraborty, Gupta, Ghosh,
Das, & Chakraborty, 2016). The population of veterans alone in the state of California is
approximately 1.7 million from age group 18- 85+ ("Veteran population," November 12, 2018).
Many of these veterans go to DGMC for surgical procedures due to the availability of surgical
services provided in this organization. The aging population of patients 65 years and older are
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among the groups that may require post-surgical care after hospital discharge due to geographical
location, non-compliance with treatment, health illiteracy, lack of resources, and inability to
travel for surgical follow-up. Due to Federal restrictions of DGMC, I was unable to obtain
statistics report of reported infection rate postoperative. However, the Center for Disease
Control reported an estimated 718,616 surgical site Infection event occurred between 2008-2014
("CDC," 2019). The California of Public Health (2017) reported 3,676 surgical site infection and
the surrounding rural community of DGMC including Sacramento and San Francisco county
areas are among area with hospitals ranking worse than national average in surgical site infection
("CDPH," 2017). Establishing a telehealth program that focuses on postoperative complications
and pressure ulcer prevention particularly on proper wound care to prevent surgical site infection
will be the focal point of the program. Prevention of further surgical site infection incidents can
be achieved with proper assessment and patient education using telehealth and telenursing.
Thirdly, finding out the number of veterans who have access to digital technologies will
support the necessity to facilitate the telewound program. According to the National Center for
Veterans Analysis and Statistics (2018), a survey data conducted in 2016 found that 79.9% of the
veteran population have internet access, 97.9% own smartphones, and 78.3% have computer.
Patients who have access to digital technology are likely to agree with the concept of telehealth.
According to a survey conducted by the Advisory Board (2017), 77% of respondents agrees to
the idea of telemedicine and virtual health, and 19% of that consumers were already enrolled and
using virtual health (Executive Research Briefing, April 27, 2017).
Diffusion of Innovation theory
Organizational implementation of a telehealth program requires a theory as basis and
guide analysis to start a program. The theory I selected for the startup of this telewound program
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is the Diffusion of Innovation theory because it requires the organization feedback and
acknowledgement prior to launching the program to the community. This theory explains how
individuals respond to a new innovation telehealth in a society and in an organization will be
considered a determinant factor whether the proposed idea is accepted or rejected within the
organization (Nelson & Staggers, 2018, p. 29). The acceptance of an innovation into an
organization is driven by the adaptability of both the individual and the organizations’ perception
and readiness to the new idea. The main components of Diffusion of Innovation theory are
categorized into five attributes that may influence the facilitation and adaptation of new ideas,
process, and technology into an organization: relative advantage, compatibility, complexity,
trialability, and observability. Relative advantage refers to the organizations’ notion if the
proposed innovation is an improvement to the current approach or not. DGMC currently does not
provide a telewound program. Therefore, facilitation of this innovative idea will attract people’s
attention and will be considered as an advancement towards addressing the health needs
assessment of the rural communities. Nurse informatics may be able to provide data analysis and
evidence-based approach to appeal to the organization regarding the new idea of telewound
program. Compatibility refers to the range to which an innovation is consistent with current
values, system, and individual expectations. This is an important attribute to consider if the
facilitation of the new application will create a change in task from one department to another.
Application of a new system within an organization that will create a shift in the current
workflow may be difficult to accept to some people (Petrou, Demerouti, & Schaufeli, 2018).
Complexity refers to the degree of intricate and difficulty of how an innovation is understood,
practice or implemented. Introduction of a complex system may be challenging to some users
and may see the program as disadvantageous regardless of its benefits to the organization and
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health outcomes. Individuals may see complexity as an additional work rather than an
opportunity to advance and learn. Informatics nurses are specialists who are able to train and
educate staff in program operations. Trialability is the ability of an innovation to be tested or
tried before implementing the program prior to making any commitment. The availability of the
innovation on a trial basis will give users the time to explore and experiment with the new
technology and study its flaws and make recommendations on how to improve the program
design before completely committing into the program. Lastly, observability is the degree to
which the benefits of innovation can be visible to others. The innovation diffusion theory
considers a decision maker that is able to assess the attributes to make decision on whether to
adopt innovations or not. The diffusion of innovation theory is important for this program to
establish a baseline of both the individual and the organizational acceptance and readiness of the
proposed telehealth program.
Role of informatics and nurse informatics
Implementation of a telehealth program in an organization requires both health and nurse
informaticians to create digital infrastructures design to cater to the health needs of a telehealth
program. Health informatics is capable of enhancing patient care, promote quality health care,
collect and gather data for prevention of illness and disease, reduce health care cost, and improve
patient safety (Holden, Binkheder, Patel, & Viernes, 2018). Nursing informatics is a subset of
informatics specific to integration of clinical nursing practice, computer science, and information
science that can help address the gap between technology and clinical nursing practice (Nelson &
Staggers, 2018, p. 613). To describe the role of nurse informaticians in facilitating a telewound
program, nurse informaticians will be responsible for collecting remote captured data for clinical
assessment, treatment, and evaluation of wounds, coordination of care within the healthcare
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interdisciplinary members, and continuous monitoring of patients’ wound status from distant
locations. Nurse informaticians will also conduct staff training and technical support within the
organization on the new program, assess the needs for program improvement, utilize evidence-
based nursing practice applicable to wound care management, creating organizational policies
and evaluation of the program process (Darvish, Bahramnezhad, Keyhanian, & Navidhamidi,
2014). A study was conducted to evaluate the effectiveness of telehealth system for wound
management and concluded that the system improved patient outcomes, reduce financial health
care cost, appropriate recommendation of wound dressing selection, reduce emergency
department visit from postoperative wound complications, and reducing the amount of patient
referral (Ye et al., 2016). This telewound program is not only a great tool in providing wound
care management remotely but it is also an advancement in the way we deliver care to patients
and family at home.
Conclusion
The of world of healthcare continues to evolve and the advancement of technology in
healthcare will only progress. The use of digital technologies in delivering patient care is no
longer a concept but now a part of healthcare. People are gradually embracing the future of
healthcare technology. Nurses must be competent in demonstrating the utilization of healthcare
technologies. Nurse informatics plays a critical role in the implementation of telehealth program
to help design an infrastructure amenable to the clinical nursing practice, provide education and
training to healthcare providers, develop policies, and analyzing and managing the program
outcomes.
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References
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Telemedicine supported chronic wound tissue prediction using classification approaches.
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