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Informatics Program: Telehealth Implementation Plan
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: Telehealth Implementation Plan
Telehealth is a type of healthcare that is provided to patients through the use of electronic
devices such as cell phones or computers to be used in messaging and communication with
healthcare providers (Nelson & Staggers, 2018). As technologies continue to advance around the
world, telehealth is becoming increasingly popular as well as cost effective for healthcare
facilities to implement as it allows access to health information, education, and services to
individuals 24/7 (Nelson & Staggers, 2018). The beauty of this type of service is that it is a
convenient opportunity for patients to obtain answers to health care questions and receive quality
healthcare without having to leave their home. When an organization has made the decision that
having a telehealth program will be a beneficial addition to their service platform, this addition
often becomes a valuable resource for rural communities. The initial development process begins
with a needs assessment and pre-implementation design phase to assess the overall project
requirements, and once that has been completed, a go/no go implementation decision is
determined. After deciding to continue the project an executive team is then formed to supervise
the project and manage adverse situations that might be encountered in order to achieve
successful completion. The purpose of this paper is to discuss the implementation of the
telehealth program all while assessing the Quality and Safety Education for Nurses (QSEN)
graduate competencies, needed IT policies, and telehealth ethical considerations.
Implementation
When the decision is made to implement a new telehealth program, multiple steps must
to be accomplished in order to get the project started. The executive team that was formed in the
pre-implementation phase will develop a project plan which includes critical milestones, tasks,
and target dates of completion (Nelson & Staggers, 2018). Initially, an action plan consisting of
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required metrics needs to be established in order to track progress and confirm when targeted
goals are realized. The implementation process requires detailed planning, and the collaboration
of team members as well as using some type of project tracking tool as a quick way to stay
updated and allow for changes needing to occur as the project encounters unexpected issues.
Success of the telehealth program will be defined as a decrease in emergency room (ER) visits
with exacerbations from common chronic illnesses such as Congestive Heart Failure (CHF) and
Chronic Obstructive Pulmonary Disease (COPD).
Marketing the telehealth services plays an extremely valuable part of the implantation
phase. Communication of services that soon will be provided, as well as other additional
benefits of the telehealth program, can be achieved by utilizing social media and other internet
avenues. Video and image sharing is undoubtedly the most beneficial use of social media. You
Tube is the most popular video-sharing website that is currently being used (Nelson & Staggers,
2018). Most video-sharing sites are free and are accessible by a wide variety of electronic
devices. This platform can be used for education, marketing, as well as branding. Educational
videos are extremely important when instructing individuals on how to use the telehealth
program, they allow the patients the convenience to view whenever questions arise (Nelson &
Staggers, 2018). The success of the project is dependent upon it becoming a convenient, easily
assessable and viable tool for medical information.
Training of staff, consisting of nurses who will be working with the program, is the
fundamental nucleus of the implementation process. The goal of having a well-educated, well-
functioning workforce requires that minimal qualification requirements be established. Staff,
who will primarily be utilizing this telehealth program by assisting patients, need to have a
complete understanding of how to operate the system, including troubleshooting in order to help
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patients learn to navigate. Guise and Wiig (2017), found that “staff should be provided with
structured, needs-based training as part of telecare implementation process, to facilitate the
knowledge, skills and attitudes required for new ways of working and to ensure the quality and
safety of telecare services.” Practical, hands-on, in person led classes will be required for all
staff conducting the telehealth appointments. Simulation of these appointments will also occur
prior to go-live to get any last-minute bugs or kinks out of the system (Nelson & Staggers, 2018).
Equipment, software development implementation and testing will also be occurring
during this phase. Piloting is key in order to ascertain that all processes which have been
implemented are working as designed. Sample patients are then identified and routine exams are
recommended to establish a baseline of information so that providers become knowledgeable
with each individual’s overall health condition(s). This baseline medical knowledge becomes
extremely helpful when using the telehealth tools with these patients (Nelson & Staggers, 2018).
Having complete updated medical information allows that the patient is being provided the best
healthcare at the current time given their current situation. Upon completion, Nelson & Staggers
recommend using the Big Bang Approach when the telehealth system is ready for launch (2018).
There is no such thing as over trained staff during a project implementation. This approach has
super users and instructors in close proximity to answer questions or help with technical issues
that may arise (Nelson & Staggers, 2018). Skilled personnel providing efficient and effective
solutions to questions and issues are known as subject matter experts, they will help minimize
potential frustrating situations as patients learn how to successfully use this new tool.
The postimplementation phase is used to evaluate the finished project. Project evaluation
is of utmost importance and is needed for process improvements and for the overall long-term
success of the implementation. In order to achieve long-term success, continued evaluation of
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the telehealth tool is required. Upgrades will occasionally need to occur over time in order to
enhance the structure and expand processes of the program (Nelson & Staggers, 2018).
Quality and Safety Education for Nurses (QSEN)
Quality and Safety Education for Nurses (QSEN) were developed to help with the
education of nurses. It is based upon teaching nursing skills that are patient-centered, teamwork
and collaboration, evidence-based, quality improvement, safety, and informatics. The QSEN is
an important tool that is used to determine if the nursing education is and continues to be
successful. In each category, key areas of focus include knowledge, skills, and attitudes (KSAs).
The goal of the graduate QSEN is to provide competencies to establish and measure a variety of
different skill sets in order to put forth a guide and core values for the work nurses do in the areas
of quality and safety (QSEN Competencies, n.d.)
Patient-Centered Care
One of the core QSEN competencies is the delivery of patient-centered care. Patient-
centered care puts the patient and their needs first, this means actively listening to the patient’s
needs, having them verbalize and provide accurate details of their current situation while at the
same time showing them respect, compassion and concern. Providing quality care is of the
utmost importance in order to develop a trusting relationship that helps achieve effective results
(QSEN Competencies, n.d.). By implementing the use of a telehealth program, the hospital is
performing patient-centered care and focusing on the patient needs, all the while offering them
convenience.
Teamwork and Collaboration
Analyzing the team member’s skillset become important when working with patients in
need, which is what the telehealth program is all about. Teamwork is critical, acknowledging
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and identifying the skills of each team member helps the project function well. Identifying the
skillset of each team member will then result in allowing that member to work with patient
conditions that they are best equipped to assist. Successful results occur when communication
and effective teamwork work in tandem with each other. As we identify goals for the individual
patients and populations, collaborate to provide education which teaches health improvement
processes, with our main focus being to decrease their ER visits. Communication between both
team members and patient’s is key. The goal is that all personnel will learn to work up to their
full potential; nurses, advance practice nurses, physicians. We must also collaborate and
communicate among providers to minimize risks associated with handoffs of care (QSEN
Competencies, n.d.).
Evidence-Based Practice
Evidence-based practice looks at what the best practice is at the current time and then
making sure that the programs are utilizing those best practices along with supplying the most up
to date information to each of these participates. According to the Graduate QSEN there are five
basic steps to forming the evidence base for clinical practice: 1) Ask the burning clinical
questions, 2) Collect the most relevant and best evidence, 3) Critically appraise the evidence, 4)
Integrate all evidence, personal experience, patient preference, and values in making the clinical
practice or change, and 5) Evaluate the practice decision or change (QSEN Competencies, n.d.).
Evidence-based practice must be incorporated in the development on the telehealth program.
Constant monitoring and improving the program must occur to advance quality and patient
outcomes. The key to this process is the assessment of the patient’s symptoms, the research
results on their particular medical condition and the patient’s goals and preferences in their
overall treatment.
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Quality Improvement
Quality improvement is essential in all healthcare settings. This is a national initiative
that includes Joint Commission of Hospitalization Accreditation standards and Centers for
Medicare & Medicaid Services (CMS). Constant monitoring and opportunity for improvement
will occur. The use of data to monitor the outcomes of the telehealth program will be used to
provide enhancement opportunities that will continuously improve the quality and safety of the
program (QSEN Competencies, n.d.).
Safety
Safety in a key priority to any healthcare organization. We as healthcare professionals
strive to reduce anything that could potentially harm the patient and workers. Important QSEN
KSAs under safety include creating a culture of safety which includes being cognizant of ones
surrounding effectively aids in the prevention of harm to patients and staff, as well as a focus on
the importance of prevention of conflict, harm prevention, and prevention of loss of dignity for
patients (QSEN Competencies, n.d.). If any of these errors or issues are found while using the
telehealth program, they are to be reported, upon which an immediate investigation will ensue
and the findings brought forward for any quality improvements that may be required.
Informatics
Informatics is the use of information and technology to communicate. The use and
development of the telehealth program is what informatics is all about. Healthcare is
increasingly driven by information and the need for it to be complete, accurate and accessible is
vitally important to both the healthcare providers as well as patients. The use of technology
helps promote access to patient care information for those providing the care. We as healthcare
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professionals need to comply and value the confidentiality of all patient information and abide by
HIPPA regulations while working with the telehealth program (QSEN Competencies, n.d.).
Health IT Policies
With any new program a detailed Health Information Technology policy must be created
and ready to be put into place prior to the projects implementation. Policies must provide
guidance to manage the delivery of quality healthcare information. Information technology
personnel develop and establish systems that house the healthcare information of all patients.
The creation of electronic record systems and its functioning support is key to this department as
these systems store pertinent patient-related personal and medical details. As computer systems
access and exchange information, it is extremely important that HIPPA be adhered to in the
telehealth systems. With the doctor-patient video conferences becoming mainstream, the concept
of what comes next is an important technology consideration.
According to Edmunds et al., policy framework of a telehealth program needs to involve
multiple sections: policy context, payment policy, delivery, modality, and outcomes (2017).
Putting all of these in place leads to increased acceptance of the program and a promising future.
Ethical Considerations
Breaches of patient privacy is a major concern with the use of a telehealth program.
Critics express concern with the privacy and confidentiality of electronically mediated
interactions for physical examinations (Chaet et al., 2017). Health Insurance Portability and
Accountability Act (HIPPA) is a federal law that sets privacy standards for the projection of
patient information’s and must be followed by providers, hospitals, and health plans. Disclosure
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of individual identifiable health information can result in criminal charges (Rivera-Romero et al.,
2020).
Another possible ethical concern would be in correlation with the patient and
nurse/doctor relationship. According to the American Nurses Association (ANA), the nursing
code of ethics is a guide for “carrying out nursing responsibilities in a manner consistent with
quality in nursing care and the ethical obligations of the profession” (2021). The nurse must
follow the same guidelines presented in the ANA guidelines regardless of the telehealth modality.
Telehealth Program Benefits
Telehealth has multiple benefits, mostly by bringing convenience to the patients and
families as well as the possibility of allowing them to stay out of the hospital. This service
provides the patient the opportunity to become more involved in their care regiment. With an
increase in chronic health conditions, using telehealth for remote monitoring is just one way that
medical providers can improve outcomes while cutting costs which can result in budget
adherence. Telehealth can also increase clinical workflow efficiency. It can help with quicker
prioritization of care delivery, triaging each case and improving communication by capturing,
storing, and using patient data for better medical decision-making (Gajarawala & Pelkowski,
2021).
Conclusion
Implementation of this telehealth program provides the community with a healthcare
improvement tool. Although this project will take a lot of initial work and pose many challenges
along the way, the long-term benefits can be profound when healthcare improvements become a
reality. Having this program in place, especially in a rural area will greatly improve access to
convenient quality care, increase accessibility, and cost reduction both for the patient and the
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implementing facility. Adapting the QSEN competencies will improve the quality and safety of
our patients and promote excellent nurses to promote health in the patients that utilize the
telehealth program.
As Christians, our primary goal is to remember that God is completely in charge and has
full control of all that is going on in our world. As new technology emerges, we know that
knowledge is a gift from God and is to be used for the well-being of mankind and God’s glory.
Due to modern technology, God has given us knowledge that allows us to live longer, healthier
and more comfortable than our ancestors did. Proverbs 2:6 says “For the LORD gives wisdom;
From His mouth comes knowledge and understanding” (NIV) this means that all wisdom is
given by God, it is not derived from mankind.
References
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American Medical Association, & o behalf of the Council on Ethical and Judicial Affairs
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The Holy Bible: New international version. (2011). Grand Rapids, MI: Zondervan.
