Running Head: TELEHEALTH PART 2
Telehealth for Morongo Basin Part 2: The Pros and Cons
Emma Larson
Liberty University School of Nursing
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Abstract
Morongo Basin is a rural area in Southern California that lacks the resources necessary
for healthcare. With only one small hospital in this area, there are not a lot of doctors and
specialists in the area to help the patients. Telehealth has been shown in multiple studies to
help bridge the gap for patients. In this paper, there will be discussion about the QSEN
competencies, IT policies, and ethics regarding telehealth with studies to show the
breakthroughs and barriers that have been found through studies.
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QSEN Competencies, IT Policies, and Ethics in Telehealth
The Quality and Safety Education for Nurses (QSEN) Institute has six different
competencies for graduate levels: patient-centered care, teamwork and collaboration, evidence-
based practice, quality improvement, safety, and informatics (qsen.org, 2020). When it comes to
new technologies and software such as telehealth, the same criteria has to be met in order to
have an efficient and successful program in a hospital, office, or clinic. Telehealth for a rural area
such as Morongo Basin would be able to meet all the QSEN competencies for the people in this
area.
There are also many questions regarding the policies and ethics with such new
technology like telehealth being used. This leads to a major barrier for patients, which is the
refusal of using telehealth due to fear. With laws such as HIPAA and the HITECH Act, they help
maintain patient safety and maintain the ethical standards necessary for patient-provider
confidentiality and promote software that help provide quality healthcare.
Patient-Centered Care
Telehealth was created for patients to get the care they need if they are unable to go see
a doctor or for hospitals that are unable to staff specialized providers. Telehealth has been
providing opportunities for increased access to primary and specialized providers, a chance for
patients to save money for hospital or office visits and has been consistently showing improved
patient outcomes for the conditions they have (Hoyson, 2019). With the significant increase of
patients using technology across the United States, including the rural areas (Hoyson, 2019),
more patients are leaning towards the convenience of telehealth, which makes telehealth a
great form of patient-centered care.
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Teamwork and Collaboration
Not only does this have to work well for the patients. This also has to work well for the
staff that will use the telehealth technology and software to make it a successful transition.
Patricia Hoyson, a Doctor of Nursing Practice (2019), reviewed multiple studies to see how
prepared nurses are for the transition of telehealth in hospitals and private offices. Hoyson’s
research has shown the importance of readiness by the staff and the impact of strong
leadership to help guide the staff toward telehealth. Through strong leadership, the staff will be
more willing to learn and understand the process of telehealth, therefore making the transition
into telehealth more successful (Hoyson, 2019).
Barriers
There are, however, a couple of barriers that need to be considered when making this
transition. The first barrier is the willingness of the staff to learn a new system. Many healthcare
workers, especially the older healthcare workers, are not keen on changes, especially when it
comes to technology. This could prevent a smooth transition into telehealth due to staff being
unwilling to make the changes necessary in the ever-changing world of healthcare.
The other barrier is whether that staff is “fluent” in technology and software. The word
fluent in this form means understanding or able to catch on with technology and software that
is being used now. Some staff members are gifted with technological savviness and are able to
learn and adapt fast to new technology and software, while others are either unable to catch on
or are unwilling to learn a whole new system than what they already know.
Evidence-Based Practice and Quality Improvement
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Telehealth Services for Cardiac Patients
In Morongo Basin, the local hospital recently started a new Telecommunication system
called Telecardiology, which would be used on the weekends, when the hospital’s lone
cardiologist would not be there. Kyungmi Woo and Dr. Dawn Dowding from New York City
(2018) performed a study to determine the compliance of telehealth for patients with heart
failure. Overall, according to the study done, patients that have used telehealth to speak to their
cardiologists have had a positive experience with telehealth.
There is, however, one barrier that has been an issue with telehealth in the New York
area, and that is compliance by the patients when it comes to telehealth (Woo & Dowding,
2018). Patients are refusing to use telehealth more than use it, which makes it more difficult for
patients to get the continued care they need with a condition such as congestive heart failure. If
patients were shown how to use telehealth or if the hospitals were to ask the patients the best
way to contact them, then telehealth could be more effective for the patients and the staff.
Telehealth in Behavioral Health
In a rural area like Morongo Basin, there are very few resources regarding mental and
behavioral health. In fact, the Emergency Department in their local hospital sometimes has to
hold patients for the 5150 holds for the full 72 hours because the psychiatric facilities closest to
the hospitals are full. There are even patients that have stayed for even longer because they
came over the weekend and there is no staff member except one social worker who can write
the 5150 hold on the patient until Monday morning.
Telehealth has been considered for behavioral health patients to help them get the
initial care they need. Dr. Fairchild and her research team (2019), performed an observational
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matched cohort study to determine the effects of telehealth for patients with behavioral health
problems in underserved towns in the Midwest region of the United States. The studies done by
this research team showed the efficiency of telehealth for behavioral health in the Emergency
Department, where the psychological evaluations and 5150 holds for patients could be written
much sooner on patients (Fairchild, et al, 2019). The same barrier from the study on telehealth
for heart failure patients, however, has been brought up in this study as well. Patients with
behavioral health problems are also refusing to do the telehealth follow-up with a behavioral
health specialist so they can get the continued care they need.
Safety & Ethics from HIPAA
For many patients, one of the main worries they have about telemedicine is if the
patient’s information that they trust to tell their providers during telemedicine would be mad
public or find a way to spread to others. With the Health Insurance Portability and
Accountability Act (HIPAA), patient’s health information will be protected, no matter how the
visits are done or where they take place. In fact, Dr. Zhou and his colleagues from the University
of Pittsburgh’s Department of Health Information Management (2019), had providers who use
telehealth fill out a questionnaire about patient privacy. The study showed that the providers
were very careful about information security regarding their patients and worked with
information technology specialists and patients to ensure patient privacy is being maintained
(Zhou, et al, 2019).
Informatics & HITECH Act
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Telehealth is the main technology and software that informatics nurses and information
technology specialists are trying to push into hospitals, clinics, and private practice offices.
Nurses and providers are having constant changes in the world of informatics, whether it is
documentation software or new technology being introduced to help ease their workload
(Forman et al, 2019). In fact, the Health Information Technology for Economic and Clinical
Health Act that was created by United States federal government in 2009 was created to
promote informatic in healthcare and provide quality care, safety, and efficiency (healthit.gov).
The software that is being used is also getting more complex, which means nurses,
healthcare providers, and patients have to be more technologically savvy than ever. In fact,
according to a study done by Tracia Forman and her colleagues from the University of Texas in
Rio Grande (2019) found out from their study that students in nursing programs wish they were
given a better background in informatics before going into clinical rotations and officially on the
job. This means new nurses coming into their field of work want to be more technologically
savvy and have a better understanding of how to work all the informatics software systems for
the betterment of their jobs.
Conclusion
In Morongo Basin, the use of telemedicine could benefit the rural area immensely,
especially when it comes it efficiency, affordability, and convenience for patients. Even though
patients are afraid of their information being brought out to the public due to new technology
and software, federal laws and acts have been created to lower those risks. Even though studies
have shown great effectiveness, it is a matter of getting the patients and staff to comply now.
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References
Graduate QSEN Competencies. (2020). Retrieved from
https://qsen.org/competencies/graduate-ksas/
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Laws, Regulation, and Policy. (2019, February 10). Retrieved from
https://www.healthit.gov/topic/laws-regulation-and-policy
Fairchild, R. M., Ferng-Kuo, S., Laws, S., Rahmouni, H., & Hardesty, D. (2019). Telehealth
Decreases Rural Emergency Department Wait Times for Behavioral Health Patients in a
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doi:10.1089/tmj.2018.0227
Chaet, D., Clearfield, R., Sabin, J. E., & Skimming, K. (2017). Ethical practice in Telehealth and
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doi:10.1007/s11606-017-4082-2
Forman, T. M., Armor, D. A., & Miller, A. S. (2020). A Review of Clinical Informatics Competencies
in Nursing to Inform Best Practices in Education and Nurse Faculty Development. Nursing
Education Perspectives, 41(1). doi:10.1097/01.nep.0000000000000588
Woo, K., & Dowding, D. (2018). Factors Affecting the Acceptance of Telehealth Services by Heart
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doi:10.1089/tmj.2017.0080
Zhou, L., Thieret, R., Watzlaf, V., Dealmeida, D., & Parmanto, B. (2019). A Telehealth Privacy and
Security Self-Assessment Questionnaire for Telehealth Providers: Development and
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doi:10.5195/ijt.2019.6276
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Hoyson, P. (2019). TELEHEALTH AND THE ADVANCED PRACTICE NURSE. Case Western University
Francia Payne Botlon School of Nursing.
