Telenursing…the Future Is Now Paper

Telenursing is the use of any technology to manage and relay nursing care and conduct nursing practice in a meaningful way (McConell, 2013). For many decades, the government made an effort to hasten the practice of electronic medical records (EMRs) and the technologies that supports it, in an effort to curb the rising costs of health care. Finally, on September 2011, President Obama proclaimed the National Health Information Technology (HIT). This technology proclaimed that it connects doctors, patients, and other medical and non-medical staff in a way that is universal when all phases are complete. Many useful commands like prescriptions that is printable and other medical record notes help providers and the patients to connect with each other and obtain information more readily and efficiently. This technology can have significant effect on patient care, increase cooperation and communication between medical staff, and can double check the interaction and side effects of a dangerous medication. It can also be used to prevent disease by recognizing early signs through an either automated computer program which recognizes abnormal numbers or a review of data when the patient encounters a visit with a qualified health care provider. My goal in this paper is to explain the basics of EMR, give Mr. Manual an overview of what it is and how can we make sense out of this information, and to give pros and cons of the process.

The National Legislation and Regulations run by the federal government has placed standards on how the charting should be done on EHRs. One of the major terminology effecting every aspect of patient care is call “Meaningful Use” (Murphy, 2010). This regulation enforces the term Meaningful Use with a financial incentive-penalty system for hospitals and other medical facilities and enforces the efficient use of EHRs. The Obama administration provided HITECH Act to help providers with assistant during emergencies, for training and equipment’s, and for better public communication. All of these programs builds a foundation for every individual to benefit to a maximum stent form EMRs “as part of a modernized, interconnected, and vastly improved system of care delivery" (ONC, 2011). It is designed to establish programs to improve health care promotion and adoption of EHRs, advanced information technologies with a secure transfer of medical information across the health care spectrum. With this act, Medicare and Medicare will pay the eligible medical providers and hospitals with payments if they practice the set recommendation of the act providing and proving its objectives, i.e. Meaningful Use. One of the other regulation that has been passed identifies the technical capabilities required for certified EHR technology. Medical facilities have to report to CMS a required summary information on 38 clinical quality measures through an electronic mean.

An effective transition to the use of health information technology (HIT) is crucial for improvement of health care quality, efficiency of practice, improving home health and prevention, and handling emergencies, including disaster-related situations. All of the above are especially important in accomplishing when it comes to core measures such as CHF. EHR has revolutionized health care delivery for these patients and their families. EHR Provides a continuous health care flow data especially important for these group of people who need their test result to be available on demand. When patients move from one place to the other, a simple click could make a test result available. EHR can also enhance communication between two cardiology specialists to manage a case such as in Children’s hospital in New York (Expedited transmission of MRIs or X-rays for a second opinion, www.childrensHeathFund.org). A radiologist reviews a spiral CT scan of a patient in California who has about 3000ml of fluid around his heart and relays the information via EMR, which confirms his diagnosis legally, and the surgeon reviews it instantaneously in New York to decide whether to do surgery or not (New York Children Hospital, 2011). So far the CHF foundation has over 500 providers who are connected to each other for the best care of their patients.

EHRs and advanced information technologies have many good uses. A growing number of patients and consumers seek health care and disease information that are made automatic in the clinical applications to patients and medical staff with specific information targeted their use and their role in that specific situation has the potential to improve and probably detect a decline in patient health status and to improve patient satisfaction. For instance, patient portals that have the capacity to allow patients to interact with the health care providers and ambulatory care practices via the internet, often have better outcome when compared to a traditional office visits (Hebda, 2013). Certainly, EHR reduces documentation time especially when certain things are automated. More time spent with patient result in more patient satisfaction especially when patient receive comprehensive explanation of their condition. During this precious time, the clinician can remember to cover all points regarding a complicated disease if the health record is accessible in clicks and patient can receive relevant information with a click if needed. In many EHR, the patient can make flow sheets of activities on their charts anywhere with an internet access and record their clinical data such as blood sugar, fluid intake amount, their daily weight and etc. Patients can ask their physicians through a click about medications, side effects, and any recommendations whenever and wherever they are. This increase patient compliance and more personal and stronger relationship between patients and doctors. EMR also give a privacy assurance to the patient when HIPAA rules are flowed which aim to prevent private or secure medical document from being leaked. In long run, EMR is more advantageous to every aspect of medical field and improves compliance, satisfaction, productivity, and improves the medical community image (Hebda, 2013).

Despite the conveniences, Telenursing still has its share of downsides as well. According to Hebda, 2013, there are three most common area of this sort. The first being electrical glitches which the technology lies on its reliability. Research show that nurses should be the major part of EMR because majority of charting done by RN’s (Technology informatics Guiding Educational Reform, 2012). When feedback is not received in full from the sender, the data reliability decreases especially when the nurse have little computer knowledge and about how it interacts. Most nurses are basics clerks entering data and Hebda, 2013, blames it on under staffing and overwork issues. When data is unreliable, the second challenge takes over which is physician resistance and acceptance of the data. Many times I have been asked ‘are you sure this data entry is correct’. Majority of responsibly lies on the physician who takes care of the patient and nurses usually get away with mistakes. Also, physicians do not trust nurses 100% due to the fact that most nurses use common language rather than medical terms to describe a situation and do not diagnose. Patient care needs specifics to direct a symptom to a diagnosis. For these reasons, doctors do their own assessment and work and leave the general patient care such as inserting of IV, patient hygiene, and other simple tasks. My personal experience as a nurse tells me that even though I have a MD degree, I still do not use enough medical terminology to describe, document, and relay medical data to another physician and I blame it on the nursing profession and its practices. The third factor that is important in patient care is also not being practiced in its full extend is assessment. Most nurses and medical staff rely on the previous data to prescribe or manage an issue. Many times physical therapist and respiratory therapist ask me or look at my charting to decide and treat. They are simply a machine performing a task. Certain non-verbal cues might slip through the cracks if not enough time is given to do a complete assessment. Worse of all is when a doctor treat a patient sole on his EMR record without even touching the patient. From my reading somewhere I can’t remember which said "I don't think you can start an IV with it. There are places where we still have to have people touching people. But it brings a higher level of care … than we've been able to provide before." It is true that EMR has all the information, data, analysis, and MAR but it cannot be compared to a human touch.

The Term Meaningful use has major criteria’s that each has to be met and those include: Coordination has to show improvement, public health and the rest of the public has to show improvement in quality of health, ensure privacy, security, and stability of medical records, families has to be involved in care, and finally and most importantly quality, efficiency and health disparities has to show a reduction. Nurse informatics are the key player in constructing the bridge in between the transition to EMRs. Murphy's article states that this is the time and opportunity to increase our knowledge and understanding of better research, evidence based treatment and therapies, innovations, and use of new technology to better care for patients and for a better outcome (Murphy, p. 286, 2010). Manuel will pay a major role in this transition by relaying the relevant information to the proper group so they can fix and improve the system better. Nurse informatics will continue to be very important in planning and construction a solid ground for the EMR process and without that foundation, the potential for having mistake will be high. Most often nurses are the main player of patient care and therefore super critical to entering data and improving Electronic medical records. They can help by gathering data for examining evidence-based practice, for creating logarithms of care best suited for unique situations and to overall advance. "Nurses need to be prepared to practice nursing in the digital age and become meaningful users of EHRs (Hebda, 2013). Current research has found that nurses' perceptions of the overall quality of care and improvements in the quality of the care delivered was positively related the number of Telenursing present in their perspective unit (De-soches, 2012). Technology Informatics Guiding Educational Reform (TIGER) recommends the practice of informatics competencies to all nurses and nurse in trainings to fully utilize and engage in the unfolding of digital era in healthcare (http://www.tigersummit.com).

References:

Center for Medicare & Medicaid Services. (2011). HER incentive. Programs. Retrieved from https://www.cms.gov/EHR/incentivePrograms.

Donelan, K. (2011). Health information technology in the workplace: Findings from a 2010 national survey of registered nurses. Journal of Nursing Administration, 41(9), 357-364.

Hebda, T., & Czar, P. (2013). Handbook of informatics for nurses & healthcare professionals (5th Ed.). Upper Saddle River, NJ: Pearson

Murphy, J. (2010). Journey to Meaningful Use of Electronic Health Records. NURSING ECONOMIC, 28(4), 283-286.

National Institute of Nursing Research. (1993}. Report of the NCNR Priority Expert Panel 011 Nursing Informatics; 1993, volume 4; NIH Publication, 110. 93-2419.

National Library of Medicine. (n.d.). Evaluating Internet health information: A tutorial from the NLM. Retrieved from http://www.nlm.nih.gov/medlineplus/webeval/webeval_start.html

Obama, B. (2011). Presidential Proclamation-National Health Information Technology Week Retrieved from http://www. wltitehouse.gov/the-press-office/2011/09/12/presidential-proclaimation-national-health-information-technolgoy-week.

Technology informatics Guiding Educational Reform (TIGER). Retrieved from http://www.tigerswnmit.com.