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Informatics Program: Needs Assessment for Telehealth
Nicole L. Gardner
Nursing Issues, Informatics and Technology
Liberty University
Author Note
Nicole Gardner
I have no known conflict of interest to disclose. Correspondence concerning this article should
be addressed to Nicole Gardner. Email: nlgardner@liberty.edu
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Informatics Program: Needs Assessment for Telehealth
Telehealth is a type of healthcare that is provided to patients through the use of
telecommunication such as the radio, television, and internet (Nelson & Staggers, 2018). As
technologies are advancing around the world, telehealth is becoming more and more popular as
well as cost effective for healthcare facilities to implement. It can include services such as
communication, education, triage, diagnosis, disease management monitoring, caregiver support,
provider consultations, research, administration, and management (Nelson & Stagers, 2018).
Telehealth is an important part of healthcare because it allows health information, education, and
services to be available to individuals 24/7. Telehealth has become increasingly popular as the
usage of computers and cellphone has developed into a common everyday option of
communication which has resulted in convenient access to health needs. This becomes
extremely important for those individuals who may need a specialty health consult or that live in
rural communities which require longer travel time or unable to do so.
Telehealth and the term telemedicine are often used interchangeably. The concept of
telehealth has been around for centuries, but the use of hospital-based telehealth started in the
late 1950’s (Dorsey & Topol, 2016). Per the CDC, the use of telehealth is a favorable public
health tool (Prevention, 2020). It lists four benefits from the use of telehealth, those being 1)
significant impact on underserved populations, 2) increasing prevalence, 3) increase provider-
patient relationship, and 4) saving the healthcare facilities billions of dollars (Prevention, 2020).
According to the textbook, two of the most success telehealth programs were implemented by
the United States Army and the U.S. Department of Veteran Affairs. The U.S. Department of
Veteran Affairs found that the use of a telehealth program reduced long term care bed days and
inpatient hospital admissions. It also had a significantly high level of satisfaction from the
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participants that used it (Nelson & Staggers, 2018). This paper will focus on the aspect of
implementation of a telehealth program in rural areas.
Rural Areas
Health disparities exist in the United States. According to the Healthy People 2020
initiative, the ultimate goal is to eliminate these disparities and improve overall health for all
humanity. Individuals living in rural communities have been shown to be at an increased risk for
suffering from these health disparities. Twenty percent of the U.S. population lives in rural
communities, but only nine percent of physicians practice in these areas (Lee, Black, & Held,
2019). Besides the lack of physicians, there is also limited health care facilities, specialized care,
and other services needed. Studies have shown that telehealth is bridging the gap for healthcare
in the rural populations (Lee, Black, & Held, 2019). A recent study in the Yukon community of
the telehealth system usage looked at the current level of use, the challenges, and the
opportunities for expansion. During a survey, it was found that there were many opportunities as
well as challenges in the system that was already in place. They worked on streamlining
workflows, updating equipment, and expansion of specialty services. This allowed them to
provide efficient, safe, convenient, and cost-effective care to that community (Seto, Smith,
Jacques, & Morita, 2019).
Rural communities are often behind in healthcare due to evidence based practices and
processes changing so frequently. Most rural communities also lack the funding and resources
that it takes to make the constant changes in order to keep up with the ever-changing healthcare
knowledge advancements and demands. An opportunity to provide those up-to-date services are
realized through convenient and immediate access and use of telehealth services. Since most of
the population in these communities uses technology such as a computer, laptop, smartphone,
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and or tablet, a telehealth program could greatly benefit individuals who are looking for a more
convenient way to access healthcare and especially those who are unable to be transported
conveniently to see a physician. This opportunity would bridge the gap between rural
communities and healthcare.
Implementation
Prior to an implementation of a telehealth program a lot of thought and planning needs to
go into the formation. The Vice President or someone in upper management would initially form
an executive team to supervise and oversee the project. Initially, the executive team, typically
consisting of a director manager and front-line staff would need to develop a systematic set of
specific project goals, the projected budget, as well as a system to track progress, and monitor
growth (Nelson & Staggers, 2018). According to the textbook there are three phases that need to
be followed to implement a telehealth program. First, the preimplementation phase. This phase
is extremely critical to the success of the program. A variety of major and extremely important
decisions need to be established as to what type of telehealth program to offer, what type of
physician specialists are willing to provide remote assessment and advice, and the selection of
the proper equipment to provide the needed services. Part of this phase may be the process of
visiting other organizations that have implemented telehealth programs in and around the area.
Visiting others can and will help you expand your knowledge on different opportunities that are
out there and help get a solid plan in place of what is needed for the implementation process.
Next, the implementation phase will involve equipment and software development and testing.
Piloting is key during this phase in order to make certain that all processes are have been put in
place and that there are no longer any “bugs” that need to be worked out. Sample patients are
identified and routine exams are recommended so that providers become knowledgeable with
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their baseline overall health condition and more comfortable using the telehealth tools with these
patients. Finally, the postimplementation phase is used to evaluate the finished project that has
been put in service. Finally, project evaluation is of utmost importance and is needed for process
improvements and for the overall long-term success of the implementation (Nelson & Staggers,
2018).
Licensure and Regulation
Telehealth is currently regulated by The Joint Commission, Centers for Medicare and
Medicaid Services (CMS), and the Affordable Care Act. Licensing, Credentialing, Malpractice,
and reimbursement are however regulated at the state level (Nelson & Staggers, 2018).
Licensure for nursing and physicians also have to be taken into consideration. Nursing licenses
are required in the state that the nurse is practicing in. This process is becoming slightly easier
with the implementation of the compact license. This license allows nurses to hold one license
but to be able to practice in multiple states. It is important for practitioners to know the laws and
regulations that are in effect which needs to be complied with based upon the patient’s location
(Nelson & Staggers, 2018).
Resources & Reimbursement
Even though telehealth is considered cost effective, the implementation itself has a hefty
price tag. If possible, grants and charitable contributions are often solicited and obtained in order
to help defray the capital expense. Billing for telehealth visits are often provided at a discounted
rate than if the patient was having a face-to-face visit in the physician’s office. Reimbursement
amounts are currently dependent on your state of residency. The United States gives each state
the option on whether or not to cover telehealth services to Medicare patients. In 2012, Medicare
first allowed telehealth visits if the patient originated in a rural health Professional Shortage Area
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(HPSA) or in a county outside a Metropolitan Statistical Area (MSA) (Nelson & Staggers, 2018).
Medicaid and private insurances are all in the process of expanding their coverage of telehealth
visits.
Framework/Theory
Informatics is based around multiple frameworks and theories. Informatics defined is the
study of the structure, behavior and interactions of natural and engineered computational systems
(Nelson & Staggers, 2018). These guide health professionals in their practice. The theories that
the textbook focuses on are vital to understanding and managing the challenges and decisions
faced by professionals and informatics specialists. The learning theory is one that can work well
with the implementation of a new telehealth program. The learning theory focuses on
implementing educational programs to teach healthcare providers how to use the new systems.
There are a number of ways that people learn and understand the information given to them.
Everyone has a unique method in which they learn best such as audio, visual, kinesthetic, or
teach-back with demonstration. Informatics nurses have to be able to understand the importance
of how not only the patients learn, but also how the staff learn in order for the telehealth
implementation to succeed (Nelson & Staggers, 2018).
For the health care professionals using telehealth, they need to learn how to not only use
the technology and software but also be able to communicate to the patients in a way that they
understand. Diversity of people then results in a diversity of communication techniques which
often makes it more difficult to analyze and interpret the best type of learning methods. Multiple
different learning styles are explained in the textbook. No learner is alike. Knowing the
different learning styles help explain the differences and help in the planning and instructional
stages of implementation (Nelson & Staggers, 2018).
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Informatics Nursing
Informatics nurses are a vital part to the successful implementation of any telehealth
program. Healthcare is increasingly driven by information and the need for complete and
accurate information to be readily available to both the healthcare providers and patients.
Having nurses that are specialized in informatics allows healthcare facilities to be proactive in
the appropriate changes that need to occur to better enhance the environment, not only for the
nursing department but also the patients. Nurses are in the frontlines of dealing with the patients
and their understanding and knowledge is key when developing a successful program (Darvish,
Bahramnezhad, Keyhanian, & Navidhamidi, 2014). Along with the advancements in technology,
the role of nursing has evolved as well. Initially nurses were only able to provide counseling and
education over the phone, they now have been trained and are enabled to monitor patients more
closely and accurately and interact with them in different technological settings. Having nurses
that specialize in informatics can successfully work two-fold. They can instrumentally work
behind the scenes and develop a successful program because of their history and knowledge of
the environment and setting. But additionally they can also work directly with the patients using
the advanced technology that is available (List et. al., 2019).
Conclusion
Telehealth/Telemedicine is projected to increase in usage and continue to expand as
technology advances are realized and as patients begin to see the convenience and simplicity of
using this type of health service. Implementing a telehealth program from its infancy has many
challenges but the long-term benefits can be profound. Having this in place will greatly improve
access to convenient quality care, ease of accessibility, continued patient education and cost
reduction both for the patient and the implementing facility.
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As Christian nurses, we are called to serve those around us with a focus on compassion.
In the new world of telehealth/telemedicine compassion and care can and must be performed just
as effectively via a phone conversation as it can in a face-to-face visit. The goal of providing the
best quality of healthcare to patient’s continues to be of utmost importance as we service them.
My responsibility as a nurse is to demonstrate and promote healing in both my care and attitude
as I display kindness and compassion. Psalms 119:103 “How sweet are your words to my taste,
sweeter than honey to my mouth!” (NIV). As we provide care for our patients in this new world
via websites and phone calls, we need to choose our words wisely, demonstrate patience and
allow Jesus to guide us.
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References
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informatics on promoting quality of health care and the need for appropriate education.
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Lee, S., Black, D., & Held, M. L. (2019). Factors associated with telehealth service utilization
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Prevention, C. D. C. (2020). CDC | Telehealth and Telemedicine. Centers for Disease Control
and Prevention. https://www.cdc.gov/phlp/publications/topic/telehealth.html
Seto, E., Smith, D., Jacques, M., & Morita, P. P. (2019). Opportunities and challenges of
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The Holy Bible: New international version. (2011). Grand Rapids, MI: Zondervan.
