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Informatics Paper: Part Two
Telehealth utilizes advancing technologies to provide access to quality healthcare
regardless of the patient’s location (Nelson and Staggers, 2018). The organization has already
concluded that a telehealth program would be beneficial for a rural community with significant
health problems. The pre-implementation phase has been completed by forming an executive
team to oversee the project. The purpose of this paper is to discuss the implementation and
benefit of the telehealth program while evaluating the QSEN (KSA) graduate competencies,
health IT policies, and ethical considerations.
Implementation of the Telehealth Program
After the decision has been made to implement a new telehealth program the first step is
to define the project and what it means to be successful. For this program, success will be
defined as a decrease in emergency room visits with exacerbations from chronic illnesses such as
congestive heart failure, chronic obstructive pulmonary disease, and urinary tract infections.
Secondly the executive team, which is formed in the pre-implementation phase, creates a
detailed project plan that includes critical milestones, tasks, target dates, and assigned resources
(Nelson and Staggers, 2018). From a marketing stand point this team must choose a slogan or
color scheme to use throughout the implementation process, including activities and materials
such as posters and flyers. This helps to engage users and gain support from all areas of the
telehealth team and the patients that will use this resource.
Extensive training is an integral part of the implementation process. Guise and Wiig
(2017) found that, “staff should be provided with structured, needs-based training as part of
telecare implementation processes, to facilitate the knowledge, skills and attitudes required for
new ways of working and to ensure the quality and safety of telecare services.” For a new
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telehealth program an instructor led class, and all equipment necessary to perform the providers
duties will be demonstrated. By doing this, instructors are able to reduce complications in the
program and clarify any questions (Nelson and Staggers, 2018).
Once training is complete, Olsen and Thomas (2017) suggest that the service should be
tested from start to finish thereby addressing any technical issues that might arise. It is also best
to test the new technology in the environment it will be used and includes all of the devices
within the telehealth program (Nelson and Staggers, 2018). After completion of all the testing,
the program is ready for the “Go-Live” event. Most commonly, the Big Bang Approach is used,
this is when we launch all the applications at one time. When this is done, super users and
instructors will be in close proximity to answer any questions and IT support will be on call for
any technical issues that may come to the surface in the initial weeks that follow (Nelson and
Staggers, 2018). After the system has been accepted and running with no issues for three to four
months it has entered the maintenance phase of the implementation process and will begin
quality testing and continuous assessment for upgrades.
QSEN
The Quality and Safety Education for Nurses (QSEN) is a project made to prepare future
nurses who will have the knowledge, skills, and attitudes (KSAs) to progress the quality and
safety of the healthcare areas they will work. Utilizing the Institute of Medicine (IOM) aptitudes
the QSEN organization developed six competencies for nursing to improve quality and safety
through the enhancement of knowledge, skills, and attitudes. These six competencies include;
patient-centered care, evidence-based practice (EBP), quality improvement (QI), safety,
informatics, teamwork and collaboration.
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By implementing the use of telehealth, the hospital is performing patient-centered care
and focusing on the patient and respecting their autonomy. Patient-centered care revolves around
allowing the patient in to make decisions about their care by respecting their preferences and
values, healthcare is improved through their eyes (Sherwood and Zomorodi, 2014). By
acknowledging that a telehealth program is an essential part of meeting patient-centered care
competencies.
Evidence-based practice (EBP) is the incorporation of the highest standard of care proven
through research, clinical expertise, and patient or family preferences (Sherwood and Zomorodi,
2014). Although telehealth is in the early stages of development and discovery, research is
ongoing into the best care with utilizing telehealth applications. Each member of the telehealth
team must monitor their own practice and must continuously improve their practice as new
knowledge becomes available to improve quality and patient outcomes (Sherwood and
Zomorodi, 2014).
Quality improvement is essential in all healthcare settings. Improvement methods can be
used to adjust endlessly to improve quality and safety of the telehealth system. For example,
recognizing the differences between local care and evidence-based practice. We will be able to
make changes in the healthcare setting in order to improve patient care and safety (Sherwood and
Zomorodi, 2014).
Safety is the utmost priority in healthcare. Healthcare professionals strive to reduce
everything that could potentially harm the patient, and it is the duty of every healthcare worker.
An important job of the telehealth team is to analyze errors, report these errors, and design way
to improve the system.
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The implementation of a telehealth program is the exact definition of the informatics
competency. Sherwood and Zomorodi (2014) defines informatics as, “the use of information and
technology to communicate, manage knowledge, mitigate error, and support decision making.”
Technology is rapidly advancing, and healthcare along with it. Healthcare professionals must
value these technologies and strive to continuously learn and make advancements on these
technologies. As mentioned above, telehealth is new on the market in communication
technologies. Telehealth is used to coordinate care for patients, and all healthcare providers
should participate in its development.
Communication is key to all teamwork and collaboration efforts within a telehealth
program. The patient and their family are important members of the telehealth team and should
be treated as an active participant (Sherwood and Zomorodi, 2014). Within this competency the
team member must be aware of the system barriers of the telehealth program and clarify any
questions that might come up with effective communication tools. Also, involved with this
aptitude is the ability to solicit input from individuals outside the telehealth team and knowing
when to advance the level of care.
Health IT Policies
With any new technology and program detailed policies must be made and in place
before implementation. All policies must provide guidance to manage quality healthcare delivery
and accomplish specific goal sets (Nelson and Staggers, 2018). The federal government sets
many of the policies for care delivery and these policies affect reimbursement to healthcare
facilities. Tuckson, Edmunds, and Hodgkins (2017) said that the private insurers are increasingly
covering telehealth care, Medicaid has no restrictions for state coverage, and Medicare is now
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reimbursing for rural sites. This leads to the conclusion that the telehealth program should be
fully reimbursed for our program if all quality measures are met.
Ethical considerations
There are many ethical considerations when it comes to telehealth. Patient privacy and
confidentiality is an important factor when considering this approach to medicine. Although the
necessities for informing the patient about their privacy rights are the same as in-person care
questions might arise about control of personal information (Nelson and Staggers, 2018). Mort
et. al (2015) takes this issue a step further stating that with in-home care who would have access
to the data and that sharing this type of information could change care relationships.
A second ethical issue has to do with the aging population and the desire to stay at home.
By utilizing a telehealth program whether it be to monitor at all times or just a checkup it runs
the risk of turning patients’ homes into “institutions” (Mort et.al, 2015). Attention must be paid
to what the user or patient wishes and how they would like to utilize the technology to make their
life easier and care better. This is the only way to get the patient to actively participate which is
critical for the telehealth program.
Another consideration would be that with this new technology attention must be paid to
prevent negative incidents. Acceptance of a new program is very difficult especially among the
older generation, if problems should arise support must be available to quickly correct the
problem. Otherwise, questions will arise if the technology is worth the time, installation, and
effort (Mort et. al, 2015).
In conclusion, implementing new telehealth programs have many positives and negatives,
but the concept is needed to improve access and quality care for rural communities. The
implementation process is made easier by having an executive team to oversee all aspects of the
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detailed project plan. By applying the six competencies of the QSEN to telehealth program, it
will improve the quality and safety of all the patients who utilize the program. Although, with all
new technologies, ethical issues might arise. These must be considered and corrected if a
problem might arise from it.
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References
Guise, V., & Wiig, S. (2017). Perceptions of telecare training needs in home healthcare services:
A focus group study. BMC Health Services Research, 17(1), 164. doi:10.1186/s12913-
017-2098-2
Mort, M., Roberts, C., Pols, J., Domenech, M., Moser, I., EFORTT investigators, & The
EFORTT investigators. (2015). Ethical implications of home telecare for older people: A
framework derived from a multisited participative study. Health Expectations, 18(3), 438-
449. doi:10.1111/hex.12109
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
Sherwood, G. and Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN
competencies redefining nurses’ roles in practice. JONA: The Journal of Nursing
Administration, 44(10 Suppl), S10-S18. doi:10.1097/NNA.0000000000000124
Tuckson, R. V., Edmunds, M., & Hodgkins, M. L. (2017). telehealth. The New England Journal
of Medicine, 377(16), 1585-1592. doi:10.1056/NEJMsr1503323
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