HIM 301 Introduction to Health Informatics Presentation

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Prepare a four to five minute audio-visual presentation or a PowerPoint of at least 10 to 15 slides on one health informatics topic from the provided list.
Topic

During this course we explore many different components of health informatics. For this project, choose a topic of interest to you to prepare your presentation. The context of this

presentation is that it will be a staff educational session on your selected topic. Your presentation should reflect new information and not recap or use previously graded content in this course or another course.

In this assignment, you will prepare a 10-15 slide PowerPoint presentation with detailed speaker’s notes of 100-150 words per slide. The slide count does not include the title and reference slides. Select one of the health informatics topics from the list below to address in your presentation. Please see the HIM301 PowerPoint Instructions Download document for expanded information on expected detail in your presentation.

Findings show that religious engagement among students declines during college, but their spirituality shows substantial growth. “Students become more caring, more tolerant, more connected with others, and more actively engaged in a spiritual quest.” (“Cultivating the Spirit – Spirituality in Higher Education”) The authors also found that spiritual growth enhances other outcomes, such as academic performance, psychological well-being, leadership development, and satisfaction with college. The study also identified a number of college activities that contribute to students’ spiritual growth. Some of these–study abroad, interdisciplinary studies, and service learning–appear to be effective because they expose students to new and diverse people, cultures, and ideas. Spiritual development is also enhanced if students engage in “inner work” through activities such as meditation or self-reflection, or if their professors actively encourage them to explore questions of meaning and purpose. (“Cultivating the Spirit – Spirituality in Higher (Alexander W, 2010)”). By raising public awareness of the key role that spirituality plays in student learning and development, by alerting academic administrators, faculty, and curriculum committees to the importance of spiritual development, and by identifying strategies for enhancing that development, this work encourages institutions to give greater priority to these spiritual aspects of students’ educational and professional development.

Step 1: Choose one topic from the following list:

Evidence-based practice and informatics

Telehealth

Public health informatics

The evolving ePatient

International efforts, issues and innovations related to informatics

Simulation in health care

Analytics and design-led innovations and management

Big data: challenges, opportunities, and realities

Incorporating mobile devices and sensors into daily routines

The potential impact for mHealth is enormous; an individual might spend 15 minutes or less per year with a primary-care physician, whereas the same person has nearly constant contact with a mobile device.
Applying clinical care guidelines on, and within, mobile platforms
Gathering and using data, particularly intensive longitudinal data, to study effectiveness of an mHealth intervention
Consumer informatics
Applications of social media in health care
Biomedical applications based on sensor data
Chronic disease management and preventative solutions
Step 2:
Define your topic and explain its relevance to health informatics.
Describe any ethical issues associated with your topic.

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Describe any associated laws, regulations, or voluntary standards relevant to the topic.
Explain how the topic relates to or impacts health care delivery, administration, education, data administration or research.
Summarize associated data capture tools and technologies.
Describe a specific example of your topic in use in health care.
The Final Project PowerPoint:
Must be 10-15 slides in length not including title and references slides) and formatted according to APA Style (Links to an external site.) as outlined in the Writing Center’s How to Make a PowerPoint Presentation (Links to an external site.) resource.
Must include a separate title slide with the following:
Title of presentation in bold font

Space should be between the title and the rest of the information on the title page.

Student’s name

Name of institution (The University of Arizona Global Campus)
Course name and number
Instructor’s name
Due date
Must include images and text that tastefully conveys the message presented on each slide.
Must cover all the requirements listed in steps 1 and 2 above.
Must utilize academic voice. See the Academic Voice (Links to an external site.) resource for additional guidance.

Must include an introduction and conclusion paragraph. Your introduction paragraph needs to end with a clear statement that indicates the purpose of your presentation.

For assistance on writing Introductions & Conclusions (Links to an external site.) refer to the Writing Center resources.

Must use at least five scholarly, peer-reviewed, or credible sources (one of those may be the course text).
The Scholarly, Peer Reviewed, and Other Credible Sources (Links to an external site.) table offers additional guidance on appropriate source types. You may also want to review What Is CRAAP? A Guide to Evaluating Web Sources (Links to an external site.). The University of Arizona Global Campus Library is a great place to find resources. If you have questions about whether a specific source is appropriate for this assignment, please contact your instructor. Your instructor has the final say about the appropriateness of a specific source for a particular assignment.

To assist you in completing the research required for this assignment, view this Quick and Easy Library Research (Links to an external site.) tutorial, which introduces the University of Arizona Global Campus Library and the research process, and provides some library search tips.

Must document any information used from sources in APA style as outlined in the Writing Center’s Citing Within Your Paper (Links to an external site.) guide.

Must include a separate references slide that is formatted according to APA style as outlined in the Writing Center. See the Formatting Your References List (Links to an external site.) resource in the Writing Center for specifications.

Review the Writing Center’s Presentation Tips (Links to an external site.) to maximize your results.

Abstract

Rapid advances in technology development and telehealth adoption are opening new opportunities for healthcare providers to leverage these technologies in achieving improved patient outcomes. Telehealth provides access to care and the ability to export clinical expertise to those patients who require care, regardless of the patients’ geographic location. This chapter presents telehealth technologies and programs as well as telehealth practice considerations such as licensure and malpractice challenges. As telehealth advances, healthcare providers will require competencies and knowledge to incorporate safe and effective clinical practice using telehealth technologies into their daily workflow.

Introduction

Rapid advances in technology development and telehealth adoption are opening new opportunities for healthcare providers to leverage these technologies in achieving improved patient outcomes. Before we discuss these technologies and outcomes, it is important to explore the definitions of telehealth-related terminology.

Telehealth encompasses a broad definition of telecommunications and information technology–enabled healthcare services and technologies. Often used interchangeably with the terms telemedicine, ehealth, or mhealth (mobile health), telehealth is “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration.”1 Telehealth is being used in this text to encompass all of these other terms. Telemedicine is the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care, treatment, and services.2 Telenursing is the use of telehealth technology to deliver nursing care and conduct nursing practice.3,4

Telehealth enables the delivery of clinical care to those who are in need regardless of the geographic location of the patient or the healthcare provider. Well-established telehealth programs and evidence-based research supports the effective use of telehealth across most disciplines and specialties within healthcare (i.e., teleradiology, teledermatology, telepathology, telenursing, etc.).5–10 Telehealth services provide access to health assessment, diagnosis, intervention, consultation, supervision, and information across distance.11 As a result telehealth is now being integrated into routine care delivery of patients around the globe. Figure 8-1 depicts how telehealth can change healthcare delivery. Telehealth services can be classified as clinical or nonclinical. Clinical telehealth services include but are not limited to diagnosis, patient communication and education, disease management, triage and advice, remote monitoring, caregiver support, and provider-to-provider teleconsultations. Nonclinical telehealth services include but are not limited to distance education for healthcare consumers or clinicians, video conferencing or conference call meetings, research, healthcare administration, and healthcare management.

Providing care to underserved populations can be a challenge, especially in rural areas or where there is a shortage of healthcare professionals. Patients may face physical, financial, geographic, and other barriers to accessing care. However, telehealth can overcome many of these barriers. Telehealth proponents seek to improve quality, access, equity, and affordability of healthcare in the United States and throughout the

FIG 8-1 How telehealth changes healthcare delivery.

world by using telehealth.11 Healthcare professionals who use telehealth can export their clinical expertise to patients regardless of geographic location.

Telehealth technologies include configurations as simple as a telephone conversation between a healthcare provider and a patient or as sophisticated as a doctor performing robotic surgery on a patient across continents. Telehealth technologies include but are not limited to telephones; facsimile machines; email systems; cellphones; video conferencing; web-based, remote patient monitoring devices; transmission of still images; and Internet applications (ehealth) including patient portals, remote vital signs monitoring, continuing medical education, and direct consumer applications such as online physician consultations via the Internet.

Telehealth is used in a variety of settings, among which are rural hospitals, home health agencies and patients at home, prisons, dialysis centers, and nursing homes; telehealth is also used to provide care to astronauts in space.11,12 The benefits of remote monitoring, diagnosis, and intervention have been proven in numerous scientific studies and include increased access to care, decreased costs of healthcare and increased healthcare provider productivity, and a high level of patient satisfaction.3,13 Furthermore, the advantages of telehealth to patients are numerous and include the following:

•Decreased travel time or distance and removal of travel barriers

•Immediate access to care

•Early detection of disease processes or health issues

•Ownership of healthcare and feelings of empowerment

•Long-term health and independence

•Caregiver reassurance

•Patient satisfaction with healthcare

Examples of Successful Telehealth Programs

The following three examples of telehealth programs demonstrate the wide range of such programs currently providing services to patients at a distance.

•Rochester General Health System, Rochester, New York, developed a clinic-based telehealth program in 2008. Its healthcare providers use a video conferencing system for live patient consults with remote physician specialists. They have the capability to send video images and 12-lead digital electrocardiograms. The Director of Telehealth coordinates and schedules 34 physicians and 5 midlevel healthcare providers who see patients remotely. Rochester General’s telehealth program developed a rigorous 1-day training session for all end-users.

•Sea Coast Mission Telehealth Program, Bar Harbor, Maine, provides seagoing health services to islanders living on four islands with no healthcare providers available.14 Daily use of live video conferencing from a 72-foot boat called the Sunbeam V occurs with the support of a boat crew that includes a nurse. The telehealth program coordinator, an early adopter of telehealth, described herself as “technically challenged” during the site’s implementation. Since then she has developed excellent clinical and technical skills to work proficiently in an austere environment. In this setting attention to a patient’s health condition can at times be urgent, requiring immediate diagnosis and treatment. The goal is to diagnose sick patients in a timely manner so that they can be transferred off the island for access to a higher level of medical care on the mainland. Maine Sea Coast Mission’s most recent project has been to implement health centers with video conferencing systems on four islands (Frenchboro, Matinicus, Swan’s Island, and Isle au Haut), thereby providing access to remote health and education services year-round (Sharon Daley, RN, personal communication, March 2010).

•University of Miami, Miller School of Medicine, Miami, Florida, provides both live video conferencing and store-and-forward capability as part of its telehealth program. Its program reached out in 2010 to provide medical support after the earthquake in Haiti. One unique program is the Teledermatology Program for private cruise ships. The program uses expert dermatologists to evaluate an array of skin problems such as lesions, burns, infections, and rashes seen by emergency physicians on board cruise ships. The Clinical Telehealth Coordinator provides online training to cruise ship staff for using a digital camera and image capturing and transmission via a dermatology software application. Images are then reviewed by the dermatologist and patient reports with diagnosis and recommendations are sent back electronically to the emergency physician within a specific time frame.15

Telehealth Historic Milestones

In contrast to the common perception that telehealth is new and futuristic, it actually has a long history. The first documented report of healthcare delivery at a distance dates back to 1897 in The Lancet, when a case of croup was diagnosed over the telephone. In the United States modern telehealth programs began in 1964, with a closed-circuit television link between the Nebraska Psychiatric Institute and the Norfolk State Hospital for teleconsultations. Shortly thereafter, in 1965, a cardiac surgeon in the U.S. transmitted a live video feed of a surgical case to spectators in Geneva, Switzerland, via satellite. The surgeon discussed his case and answered live questions from the spectators in Geneva.16

The National Aeronautics and Space Administration (NASA) led telehealth initiatives in the 1960s with the transmission of physiologic signals from astronauts in space to command centers on Earth. NASA also funded several telehealth research programs in the late 1960s and early 1970s that contributed to the profession as a whole.17 A landmark study completed by Kaiser Permanente in 1997 concluded that “technology in healthcare can be an asset for patients and providers and has the potential to save costs; therefore, this technology must be a part of continuous planning for quality improvement.”18(p45) The researchers were emphatic about the benefits of telehealth, inspiring many of today’s telehealth programs.

From July 2003 to December 2007 the U.S. Department of Veterans Affairs (VA) conducted a home telecare program analysis to coordinate care of chronically ill veterans and reduce long-term care admissions. The program evaluation was highly successful, realizing a reduction in long-term care bed days and inpatient hospital admissions among participants. Further, the veteran participants reported a high level of satisfaction. Costs to provide the program were and are substantially less than other VA programs or nursing home care. The program is now known as Care Coordination/Home Telehealth (CCHT) and is a routinely offered VA service to support aging veterans with chronic conditions.19

In the United Kingdom the Whole System Demonstrator (WSD) program was launched by the National Health Service in 2008 in order to determine the effectiveness of telehealth. As of its start date, the study was the largest randomized controlled trial of telehealth in the world, involving more than 6000 participants. The study confirmed that telehealth promotes well-being and should be a part of any complete healthcare system.20

Leading Telehealth Organizations

Starting in the 1990s, a number of professional, industry, and government organizations have provided the leadership needed to initiate effective telehealth programs. These leaders include the American Nurses Association (ANA), United States federal government agencies, the American Telemedicine Association (ATA), and the International Council of Nurses (ICN).

American Nurses Association (ANA)

With the advent of technology and rapidly emerging telehealth practice in the twentieth century, healthcare professionals sought guidance on incorporating telehealth into their care offerings. Multidisciplinary standards were needed to create a cohesive unity for telehealth across professions. To address the expansion and to create unified definitions and policies and a standard of care, the ANA brought together the Interdisciplinary Telehealth Standards Working Group. This group was composed of 41 representatives from different healthcare organizations and professional associations. The report of the interdisciplinary team, Core Principles on Telehealth, represents a “sense of the profession” as a whole.21 The purpose of the core principles is to create a baseline standard of care in order to provide quality care as well as protect patients from harm.

United States Federal Government Agencies

NASA, the VA, the U.S. Department of Defense (DOD), and other government agencies have continued to lead the U.S. in telehealth research and programs. As an early adopter of telehealth, the VA operates the nation’s largest telehealth program. The widespread adoption and positive research findings led the U.S. government to establish the Office for the Advancement of Telehealth (OAT), a division of the Office of Rural Health Policy within Health Resources and Services Administration (HRSA) at the U.S. Department of Health & Human Services (HHS). OAT promotes the use of telehealth technologies for healthcare delivery, education, and health information services and increases the use and quality of telehealth delivery through the following activities:

•Fostering partnerships within HRSA and with other federal agencies, states, and private sector groups to create telehealth projects

•Administering telehealth grant programs

•Providing technical assistance

•Evaluating the use of telehealth technologies and programs

•Developing telehealth policy initiatives to improve access to quality health services

•Promoting knowledge exchange about “best telehealth practices”1

American Telemedicine Association (ATA)

The American Telemedicine Association (ATA) is a nonprofit organization founded in 1993 and headquartered in Washington, D.C. The mission of ATA is to “promote professional, ethical and equitable improvement in healthcare delivery through telecommunications and information technology” through education, research, and communication.22 ATA is a mission-driven, nonprofit organization that seeks to incorporate telehealth seamlessly into healthcare so that it is not necessarily a separate program but integrated into healthcare delivery as a whole.

International Council of Nurses (ICN)

Representing more than 200 national nursing organizations, including the ANA, Canadian Nurses Association, and associations of more than 198 other countries, the ICN initiated the Telenursing Network in 2008. As telenursing advances, this virtual collaboration is serving to share competencies and other jointly developed telenursing resources.

Telehealth Technologies

Telehealth technologies enable the exchange of all types of data (i.e., voice, video, pictures of wounds, pathology or radiology images, device readings, etc.) between patients and healthcare providers or between healthcare providers on behalf of patients. Early telehealth technologies were “stand-alone” systems in which a telehealth encounter occurred and data were stored in a telehealth system database. With the increasing adoption of electronic health records (EHRs), telehealth technologies are being increasingly integrated with the EHR. Telehealth services can be delivered using two overarching types of technologies: synchronous (or real-time) technologies or asynchronous (or store-and-forward) technology.

Synchronous or “Real-Time” Technologies

Synchronous, real-time telehealth uses live, interactive telecommunications technology and/or patient monitoring technologies to connect a healthcare provider to a patient for direct care, to other healthcare providers for consultation and collaboration, or to a combination of the two.23 The most commonly used synchronous telehealth employs video conferencing or telephone-based interaction.

Video Conferencing

Video conferencing integrates audio, video, computing, and communications technologies to allow people in different locations to electronically collaborate face to face, in real time, and share all types of information, including data, documents, sound, and picture. Use of interactive video conferencing in telehealth allows for patient–healthcare provider consultations, healthcare provider–specialist discussions, and health education. The technology requires live presence of the healthcare provider and patient or healthcare provider and medical specialist in an interactive environment.

A real-time live environment can include the following:

•Video conferencing units with a codec (compressor–decompressor) capable of encoding and decoding the video conferencing stream.

•Peripheral cameras such as high-definition cameras that have remote control pan, tilt, and zoom (PTZ) features.

•Video display devices such as computer monitors, television sets such as HD Plasma or LCD displays, and LCD projectors. These display devices are used to show the images received from the video conferencing codec.

•Audio components (microphones and speakers), a network connection, and the user interface. Prior to the availability of high-bandwidth Internet connections, signals were carried over point-to-point connections established via Integrated Services Digital Network (ISDN) lines and plain old telephone service (POTS). The Internet has now simplified some of the connectivity issues and the high-bandwidth requirement of video conferencing.

Patient Monitoring Technologies

Patient monitoring technologies, including home telehealth (also known as telehomecare), use devices to remotely collect and send biometric data to a home health agency or a remote diagnostic testing facility (RDTF) for interpretation by a healthcare provider. Such applications might include a specific vital sign device, such as blood glucose monitor, digital scale, thermometer, heart electrocardiogram (ECG), blood pressure monitor, pulse oximeter, or peak flow meters, or a variety of monitoring devices for homebound patients. Such services can be used to supplement the use of visiting nurses.3 Use of monitoring devices will also allow patients to become more involved in and in many cases to oversee the monitoring process.24

Patient monitoring technologies for home telehealth consist of two major components: hardware and software. The hardware includes a base station where the patient interacts by entering data and answering questions and applies various medical devices that are used to gather patient data. The software enables healthcare providers and technicians to configure the hardware, receive data, and monitor the patient.

The telecommunications used can be wired, such as POTS or direct service line (DSL), or wireless, such as cellular (sometimes seen as code division multiple access, or CDMA), broadband, satellite, Bluetooth, infrared (IrDA), WiFi (or IEEE Standard 802.11), mobile broadband wireless access (MBWA or IEEE Standard 802.20), or Worldwide Interoperability for Microwave Access (WiMAX or IEEE Standard 802.16). mhealth and mobile health are umbrella terms that incorporate mobile or wireless telecommunications for transmitting telehealth-related data and services. Both the

FIG 8-2 Personal health ecosystem. BB, Broadband; PERS, Personal Emergency Response System; POTS, plain old telephone service.

telecommunication and the hardware can be incorporated in the medical device.

Figure 8-2 provides a diagram of the components of a telehealth system.

1.Personal health devices monitor basic vital signs such as blood pressure, weight, pulse, oxygen level, and blood sugar values and transmit data via a wired or wireless connection via devices or sensors.

2.The aggregation and computation manager is a critical component of the connected health system, enabling individual monitoring devices to log data in an EHR for personal and clinician review. The aggregation manager collects and transmits data from an individual’s personal health devices to a server using wired or wireless connections. The aggregation manager itself can be a cellphone, a personal computer, a dedicated device, or a personal health record (PHR).

3.The health service center is a physical location where a patient’s digital information is collected, stored, analyzed, and distributed. It can be the doctor’s office, the home of a family member, or another type of healthcare-related facility.

Asynchronous or “Store-and-Forward” Technology

“Store-and-forward” technology allows for electronic transmission of telehealth-related information, video, images, and audio files. It can be used when healthcare providers and patients are not available at the same time. The sending healthcare provider or patient prepares an electronic consult package, which includes the patient’s history, related diagnoses, and digital images such as x-rays, video, and photos. This package is either emailed or placed on a web server for the receiving healthcare provider to access when his or her schedule allows. The receiving healthcare provider then reviews the package, follows up with clarification questions, and provides a diagnosis, recommendations, and a treatment plan. The receiving healthcare provider’s response is transmitted electronically back to the sending healthcare provider or patient. Store and forward technologies can be used in dermatology, radiology, pathology, dentistry, cardiology, wound care, home monitoring, pediatrics, and ophthalmology as well as other areas.

A store-and-forward technical environment can include the following:

•A personal desktop, laptop computer, tablet, or smartphone for the sender

•A personal desktop, laptop computer, tablet, or smartphone for the receiver

•Telecommunication technologies such as local area network (LAN), wireless communications, etc.

•Digital peripheral medical devices such as digital cameras, x-ray equipment, glucometers, vital sign monitors, and wearable sensors embedded in T-shirts or wristwatches

•Software such as a web-based application, encrypted email, specially designed store-and-forward software, an EHR, a PHR, and an electronic data repository

Technical Standards in Telehealth

Until recently the demand for telehealth-based medical devices was not sufficient to create unified, global technical standards. However, technical standards that were developed for associated markets have benefited telehealth. For example, use of American National Standards Institute (ANSI) H.32x standards has enabled wide-scale video conferencing interoperability, which led to further growth in nonhealthcare businesses. Not only has telehealth benefited from the video conferencing standards, but it is also benefiting from a reduction in the cost of equipment as well as the improved ability to conduct interactions between parties independent of the particular hardware used. In addition, development of Health Level Seven (HL7), which provides global interoperability standards for health information technology (health IT), and Digital Imaging and Communications in Medicine (DICOM) standards for imaging has also been of great benefit for telehealth.3

In 2006 the Continua Health Alliance was formed by a group of healthcare technology industry companies to establish interoperable personal telehealth solutions and to develop technical design guidelines. The goal is to agree on a set of common technical guidelines that will enable vendors to build interoperable sensors, home networks, telehealth platforms, and health and wellness services. The Continua Health Alliance also has developed a technical certification program based on these guidelines. Technologies that are certified by Continua Health Alliance have been technically tested and validated to work together and be interoperable.25

An example of such a standard is ZigBee/IEEE 802.15. This standard is targeted at applications that require a low data rate, long battery life, and secure networking. ZigBee/IEEE 802.15 has become a useful wireless connectivity standard for home or facility-based telehealth. ZigBee is a low-powered network capability that allows telehealth devices and sensors to operate longer and with smaller power sources, enabling miniature sensors to transmit health data. ZigBee is also a very low cost and easily installed network capability, providing usability and requiring minimal technical support. The ZigBee Alliance offers two specifications (ZigBee and ZigBee RF4CE) that serve as the base networking system to facilitate its interoperable market standards.26

Telehealth and Health Information Technology

A need exists to integrate all relevant medical device images and data from the telehealth technology with the patient’s EHR. The interoperability of these systems could dramatically streamline a healthcare provider’s workflow and improve the healthcare.

A key to telehealth success is healthcare providers’ access to patients’ health records at the time of a telehealth encounter—just as it is with in-person care. Telehealth networks serve to establish a link between provider EHRs, and securely moving health-related information that is exchanged among patients, hospitals, and healthcare providers as needed for care and treatment. Telehealth in HIE initiatives is expected to lead to the next generation of interoperability for health IT across and among healthcare enterprises. Existing telehealth infrastructure will also serve as a highway for EHRs and information exchange between and among rural and remote areas.27

Telehealth Clinical Practice Considerations for Healthcare Professionals

Healthcare providers have used the telephone as a communication tool for patient interaction for decades. Adding to the complexity of remote care delivery today, it is becoming increasingly common to use computers, remote monitoring devices, and interactive audio and video conferencing for patient interaction. With expanding telehealth technology capability, new and more efficient models of care are facilitated, allowing for removal of time and distance barriers.

Equal to or Better Than In-Person Care?

Telehealth is considered to be so effective that in 1997 the World Health Organization (WHO) announced that it has become part of the WHO’s “health for all” strategy and should be made available to all people.28 Physician–patient encounters via telehealth have been supported by research to be as effective as standard face-to-face visits held in a physician’s office or clinic. In 2008 Dr. Gregory Jicha, assistant professor of neurology at the University of Kentucky’s Sanders-Brown Center on Aging, led a study called Telemedicine Assessment of Cognition in Rural Kentucky. “The goal of the project was to adapt and validate the UDS [National Institute on Aging’s Uniform Data Set, a standard set of questions asked of every patient being screened for Alzheimer disease] and other measures for diagnosing mild cognitive impairment (MCI) and early dementia in the telemedicine setting. An important aspect of the goal was to determine whether the telemedicine consultations were as effective as face-to-face meetings with a doctor.”29(p32) Jicha stated that “developing and validating this telemedicine approach for diagnosing and treating MCI and early dementia will become a model for clinician-researchers at other centers serving rural populations.”29(p32) Per Jicha’s perception of using telemedicine to expand healthcare resources, “the bottom line is, our goal is to ensure that though telemedicine is not better than an in-person evaluation, it’s as good as an in-person evaluation.”29(p34)

Beginning in 2008, two studies (one in the United Kingdom and the other in Quebec, Canada) concluded that “telemedicine is increasingly seen as an efficient and cost-effective means for improving clinical outcomes and increasing patient involvement in their own care.”30(p59) Both studies demonstrated two important factors that influence healthcare professionals’ acceptance of telemedicine: training and support.

Telehealth Clinical Competency

As healthcare providers’ use of ever wider and broader technological tools increases, so does the need to ensure telehealth competency to provide safe and optimal patient care. As healthcare further embraces telehealth to gain efficiencies, improve access to care, and reduce costs, there must be a focus on educating and preparing healthcare providers in telehealth technology, techniques, skills, coordination, and “on camera” communications. A telehealth clinical encounter involves multiple new components and competencies, including coordinating healthcare provider and patient scheduling, knowledgeable telepresenting skills (i.e., steps needed to facilitate a telemedicine encounter between a patient and remote healthcare provider), the exchange of prior medical record and new telehealth information, and an understanding of video and audio technology.

From initial academic preparation through ongoing continuing education requirements, healthcare providers practice in a dynamic field with ongoing changes in care delivery. All healthcare providers are required and expected to maintain and update clinical competency in the care they render to patients. Telehealth also requires competency for optimal healthcare delivery. A number of professional associations have stepped forward to identify the specific competencies required. As described earlier in this chapter, the ANA and 41 major healthcare provider organizations developed and endorsed core principles for telehealth delivery in 1998.21 A year later the ANA created and published Competencies for Telehealth Technologies in Nursing.31 In 2001, with further expansion in telehealth, the ANA endorsed the development of telehealth protocols.32 These protocols were developed to encompass the needs and concerns of both clients and practitioners. On an international level the ICN published the research-based, validated International Competencies for Telenursing based on an international survey of practicing telenurses in 36 countries around the globe.4

The National Initiative for Telehealth Framework of Guidelines (NIFTE Guidelines) was a critical milestone in development of telehealth not just for those who authored the guidelines in Canada, but globally.33 This highly important and superbly designed framework was developed in Canada by a multistakeholder interdisciplinary group. The NIFTE Guidelines are designed to assist individuals and organizations to develop telehealth policies, standards, and procedures. NIFTE examines and offers principles and suggested guidelines for five overarching content areas related to telehealth:

•Clinical standards and outcomes

•Human resources

•Organizational readiness

•Organizational leadership

•Technology and equipment

In addition, Canadian nurses have provided more than a decade of telenursing leadership and developed extensive practice guidelines for nurses who are becoming or presently in the role of telenurse.34

In November 2011 the ATA developed an expert opinion consensus document on interactive video conferencing. The Expert Consensus Recommendations for Videoconferencing-Based Telepresenting defines the requirements for serving as a telepresenter in a live, synchronous telehealth encounter. As with all patient interactions, processes for patient registration, consent, clinical information, reimbursement information, and privacy are applicable to telehealth encounters.35 The ATA has also developed Telemedicine Standards and Guidelines for Diabetes, Telemental Health, Teledermatology, Home Telehealth, and Telepathology.

Confidentiality, Privacy, and Informed Patients

Patient confidentiality and privacy are paramount when using technology for the transmission of health data and live video presentation of the patient to geographic environments at a distance from the patient’s location. The requirements for ensuring confidentiality, privacy, and informing patients receiving care via telehealth are the same as for in-person care. This is particularly true when the possibility exists of others being present in a room but off-camera. Attending to the presence of others at either the sending or receiving locations is an additional, important privacy task for healthcare providers using telehealth. Another important concern is ensuring that patients are being adequately informed and educated regarding telehealth consultation and assessment and evaluation via video conferencing technology.4,32

Scope of Clinical Practice

For healthcare professionals the use of technology does not alter or change the practitioner’s inherent standards of practice, ethics, scope of practice, or legalities of practice.32,34 Healthcare professionals may use telehealth for patient consultations or for consultation with other healthcare providers. When telehealth is used for patient consultations, the healthcare professional’s credentialing and clinical privileges at the site where the patient is located must be completed. The practitioner will need education, training, and technical support for the necessary technologies before, during, and after telehealth consultations.

The decision to refer a patient to a healthcare professional for consultation via telemedicine or telehealth is determined by multiple factors. Referrals for a telehealth consult need to consider the following factors:

1.Does the service requested provide telemedicine or telehealth access as an option?

2.What is the level of the practitioner’s expertise and comfort with telemedicine or telehealth?

3.Is the patient’s diagnosis appropriate for telemedicine or telehealth consultation?

4.Going forward, who will manage the patient’s plan of care and how will this be managed?

As with any in-person patient encounter, documentation is of major importance. Appropriate documentation for telemedicine consults at both the sending and the receiving sites is essential for providing accurate and optimal continuity of care for the patient. Both sites need current patient demographic information, billing information, and consultant notes. Referring practitioners need consultant notes in a timely manner to carry out the patient’s plan of care. After a telehealth consult, evaluation of telehealth processes and patient satisfaction is essential. The quality assurance and evaluation processes identify how to improve telehealth procedures, safety, effectiveness, and quality of care.32

Types of Clinical Telehealth Applications

In the past 15 years, telehealth specialty areas, such as telecardiology, teledentistry, teledermatology, home telehealth and remote monitoring, teleICU, telemental health, teleopthalmology, telepediatrics, teleradiology, telestroke, telewoundcare, and teletrauma, have been successfully developed and implemented in a variety of healthcare settings. Other telehealth programs outside the hospital setting include emergency preparedness, disaster response, correctional telemedicine, forensic telemedicine, telerehabilitation, and school telehealth.

A complete remote physical examination can be achieved by viewing images and hearing sounds. Healthcare providers can assess and treat a variety of health care problems such as cardiac or respiratory illnesses by listening to digital heart, lung, or bowel sounds live; by sending the data over a video conferencing system; or by using a computer with Internet connection to the computer of another clinician, who can then assess the information. The healthcare provider can use video scopes to conduct ear, nose, throat, oral cavity, eye, pelvic, or rectal exams; cameras or microscopes for skin examinations; radiology images to diagnose orthopedic injuries; and computed tomography (CT) scans of the head to rule out bleeding, brain injuries, or skull fractures. Teleradiology is one of the most commonly used and accepted telehealth applications, where digital images are captured and transmitted to the radiologist, who makes a diagnosis, sends a report, and stores the image. Healthcare providers can send complete readings for a 12-lead digital electrocardiogram to a cardiologist to diagnose heart problems or send a digital spirometry reading to a pulmonologist to diagnose respiratory lung capacity.

Telehealth Operational and Organizational Success Factors and Barriers

Despite the advancements in telehealth technologies, significant barriers and gaps exist in the successful implementation of robust, integrated healthcare technology delivery systems.

B.E.L.T. Framework

In planning for implementation of telehealth technology, four main components must be considered: bandwidth, education, leadership, and technology (B.E.L.T.). The B.E.L.T. framework (Fig. 8-3) is a metaphoric representation of these four interrelated components and may be used to guide planning at macro, meso, or micro levels of implementation.

Bandwidth includes elements of telecommunication technology, including information transmission and connectivity to move and store digital data. Infrastructure and telecommunication architecture in some geographic areas may limit use of telehealth applications and have direct implications for access to and delivery of healthcare. This is particularly problematic for rural, isolated, and underserved regions.36

Education encompasses the preparation of both the existing workforce and future healthcare providers in developing

FIG 8-3 The B.E.L.T. framework.

(Copyright McGill University School of Nursing. Montreal, Quebec.)

competencies in the adoption and use of telehealth technologies. Although research has been done in some areas of competency development, particularly in healthcare informatics and telenursing, scant research has been done in the broader use of telehealth technology to inform curriculum development and education of healthcare providers.4,37 Patient safety in telehealth technology use is one aspect of healthcare delivery that is essential to professional practice and relates to competencies in clinical decision making.

Leadership reflects a broad range of management, change theory, and policy aspects that affect operationalizing telehealth technologies. Barriers to successful telehealth adoption frequently relate to factors such as resistance to technology, information security, stakeholder support, reimbursement, and financial commitment.36,37

Technology spans a large number of considerations such as the types of telehealth software, hardware, and devices available for care delivery and the choice of appropriate telehealth technology. To date, telehealth platforms have limited capacity to address the range of health conditions experienced across the population lifespan, resulting in a narrow focus on overall individual health, fragmentation of care, and duplication of effort for data retrieval and documentation. Since many current telehealth technologies are not interoperable and cannot be integrated into a single environment to support holistic care, data silos are created where information on the same individual may be contained in different systems and cannot be accessed in an efficient, seamless manner. This further fragments care, leads to duplication of services (e.g., repeat of blood work, diagnostics, or information retrieval), and creates unnecessary cost to the patient and to the healthcare system. Another limitation is that most current telehealth technologies focus on direct delivery of clinical services to individuals and do not readily support the broader goals of primary healthcare, such as enhancing health promotion, prevention opportunities, or generating necessary epidemiologic data needed to evaluate and inform healthcare delivery.

Operationalizing Telehealth

Several important steps exist for the success of telehealth programs and services. The first is planning, which includes a needs assessment and analysis to define patient populations and healthcare problems in which telehealth services can have a positive impact. A workplace environment with staff prepared to implement telehealth using specific standards and guidelines is the second important factor for success. Technology preparedness is a third factor for successful telehealth services. For successful telemedicine implementation, appropriate “user-friendly” technology that allows for creative use and quality as well as responsive and accessible technical support are crucial factors.38 The final, critical step is learning how to implement, manage, and support a telehealth project or program. This becomes more complicated when more clinical specialties are involved. New telehealth programs should begin with one focused specialty application, such as teledermatology, and not add other specialties until the initial program has been implemented successfully. Specific procedures are listed in Table 8-1, and project steps are outlined below.

Telehealth Acceptance and Training

Technology education trends have moved toward online courses or certificate education programs in telehealth to reach out to more healthcare providers throughout the United States and globally. Online and on-site telehealth training courses are available through several Telehealth Resource Centers (TRCs), federally funded by OAT. Additional information about these resource centers can be found at www.telehealthresourcecenter.org. The ATA located at www.americantelemed.org provides annual meetings with scientific research presentations, special interest group meetings, educational webinars, educational products, training program accreditations, and white papers and policies.

According to Duclos et al. “the acceptance of a telehealth program by providers who use it is crucial to its success.”39 Healthcare providers who use telehealth in their practice should know how telehealth technologies work and should understand their capabilities in providing patients with better access to healthcare services.

Opportunities abound for clinicians to become adept at using telehealth technologies beginning with a basic proficiency in using room-based video conferencing systems on personal computers (PCs) and mobile video conferencing systems on iPads and smartphones. It is advantageous for healthcare providers to learn to use medical devices with video scopes attached for patient assessments and video or digital cameras for exams. Healthcare providers need to be comfortable using a variety of audio, video, and medical device tools, video conferencing systems, and computer hardware and software applications. New technical challenges often emerge for clinicians, such as using a video ophthalmoscope to view retinal images inside the eye and on a display monitor. Hearing new heart sounds from a digital stethoscope with different high- and low-pitched sounds due to magnification can be another challenge. Clinicians may encounter workflow changes with telehealth software applications in paperless environments, such as digital ECG and spirometry readings that identify patients’ heart rhythm and lung measurements. Technology literacy training may also be required for clinicians. Technology literacy includes knowledge of basic computer skills and communication technologies, basic skills to navigate the Internet for up-to-date health information, and the ability to access web-based telehealth software applications. For example, healthcare providers who are fluent in using digital cameras to take dermatology images and who are Internet savvy can access online resources to identify a skin lesion or obtain the latest treatment for the lesion online.

In the 2005 International Telenursing Survey, telenurses were found to have various job skills and to work in more than 30 clinical telehealth settings ranging from nurse call centers to urban and rural hospitals, public and private health clinics, schools, prisons, community health centers, military facilities, native tribe reservations, and private physician and nurse practitioner practices.40 Specific telehealth knowledge regarding equipment, workflow, clinical processes, and technology training is different for each clinical setting.

TABLE 8-1 Telehealth Procedures

1. PREPARATION

2. PROVIDER AND PATIENT “REAL-TIME” TELEHEALTH ENCOUNTER

3. FOLLOW-UP, QUALITY, AND SAFETY

Provider credentialing completed at patient site and remote site

Provider is knowledgeable and competent in healthcare needs being addressed during patient-to-provider telemedicine visit

Review plan of care conveyed by provider or consultant and instructions provided regarding treatment plans, with time for patient and family questions and answers

Referral reviewed as appropriate for specialty service and accepted by telespecialist

Introduce patient to all individuals that will be in the patient room and to any individuals at the evaluating physician’s location

Complete any necessary forms (e.g., patient consent to treat form; HIPAA forms) and share reimbursement information with both patient and physician sites

Knowledgeable regarding scheduling procedures and policies of facility and scheduling resources

Identify camera and microphone locations to patient and explain any potential for audio or video delay

Provide patient and family with consulting physician contact information, as needed for follow-up

Obtain and review preconsult clinical information and testing

Presenting site provider is knowledgeable of exam requirements, including patient preparation, patient positioning, and use of peripheral devices (i.e., electronic stethoscopes, Doppler, digital cameras, etc.)

Schedule follow-up appointments, treatments, etc. as ordered by physician

Obtain reimbursement information, such as copies of insurance cards, Medicare cards, etc.

Provide support to patient and family and be alert to nonverbal body language

Provide the referring primary care provider with the telemedicine encounter documentation

Provide patient with the appropriate forms for “consent to treat” and HIPAA compliance information

Provide time within the clinical visit for patient and family questions and answers

Evaluate outcomes of the telemedicine encounter, quality of encounter, and patient satisfaction and assess for improvements for future telemedicine encounters; clinical effectiveness is one of the factors associated with success in telemedicine

Contact patient to explain a telemedicine encounter and provide directions to the telemedicine site

Educate patient and family of their right and ability to terminate the telemedicine clinical visit at any time

Ensure that equipment and technology has been tested and is in safe working order, provider and patient have clear audio and video of each other, extraneous noises are reduced, and any necessary peripheral devices and supplies are accessible at time of encounter

Assess and prepare for cultural, language, or disability issues

Establish a backup plan and be prepared to enact it in the event of technical problems

Scheduling dedicated time for healthcare providers’ telehealth training is an obstacle and is one of the major barriers to a successful telehealth program. Actual hands-on training is beneficial, using telehealth case scenarios similar to those the healthcare provider would typically encounter. As mentioned earlier, clinical workflow is modified when telehealth technologies are implemented. Healthcare providers can adjust by continuing to use the same patient exam rooms for the telehealth patient, using similar medical devices for in-person and telehealth exams, training with telehealth technologies, and interacting with the same physicians and specialists for telehealth consultations as for in-person referrals.

Telehealth Implementation

There are three phases for successful telehealth program implementation: preimplementation, implementation, and postimplementation.

Preimplementation Phase

Implementing telehealth technologies in any clinical setting is no different than implementing other twenty-first century technologies. As with any informatics project, a team effort is critical to its success. Clinicians will first need to decide what types of telehealth programs provide access to remote healthcare specialists for their patients. Important preimplementation steps are listed in Box 8-1. Forming an administrative or executive team is advisable to oversee the project goals, budget, progress, and growth. The facility may already have a formal committee in place to oversee all IT projects and, if so, can tailor the governance to incorporate telehealth. The executive team should include the following:

•Hospital or facility administrator

•Clinical director (often a physician)

•Chief information officer

•Director of information technology and/or director of education

•Telehealth and telecommunications administrator

•Vendor account managers (may be only at the operational level below)

A second level of management for the telehealth program is a more operational interdisciplinary team including the following:

•Project manager

•Clinical champion (often a physician)

•Telehealth director or program manager

•Information technology engineer or support technician

•System administrator (if software is involved)

Super users and vendor trainers will also initiate, train, and support new staff for the telehealth project. The interdisciplinary teams are the change agents that assist in developing policies, procedures, project evaluation criteria, and permission forms prior to beginning the telehealth program.

Box 8-1 Telehealth Preimplementation Steps

• Identify remote physician specialists and other clinical consultants who are willing to provide remote assessment and advice for treatment

• Meet standards and requirements for safe use of telemedicine equipment: installation in designated telehealth rooms; biomedical and electrical engineering help may be required

• Select appropriate telehealth equipment to use for telehealth examinations, including disposable accessories such as nonlatex gloves, gel, measurement tapes, alcohol wipes, gowns and cover sheets, and extra camera batteries

• Identify electrical and cable sources for power outlets and secure Internet access

• Designate telehealth exam rooms or areas

• Identify 24/7 technical support for clinicians at both sending and receiving sites

• Develop policies and procedures

• Train interdisciplinary team and staff end-users on telehealth equipment

• Set up and test telehealth scenarios prior to beginning telehealth consultation

Implementation Phase

Once the equipment is configured or tailored, the implementation phase involves equipment and software testing with mock telehealth patients and remote specialists and then piloting the project by identifying a patient needing a teleconsult. Equipment testing with mock patients should encompass all staff testing all of the telehealth equipment available. Equipment testing should also be conducted periodically after the initial implementation. After identifying differences between standard and telehealth patient encounters, daily use of telehealth equipment for routine patient exams is recommended so that providers become knowledgeable and comfortable using the various telehealth examination tools (electronic stethoscope, video otoscope or ophthalmoscope, digital ECG or spirometry software, video exam camera, telehealth software applications, and audio or video conferencing systems). The goal is for a clinician to present a patient, capture and send patient data, retrieve patient information from stored telehealth software applications, and respond to cases and add patient encounters if needed.

Postimplementation Phase

As with any other informatics project, evaluation criteria address adequacy of training; implementation, equipment, technology, or training issues; and program outcomes. A program of quality assurance and process improvement should be part of the evaluation process so that iterative progress toward implementation phase telehealth program success can be achieved.

Telehealth programs of any size experience similarities in success and failure. Table 8-2 lists common success factors and barriers to successful telehealth program implementation.

Telehealth Challenges: Licensure and Regulatory Issues for Healthcare Professionals

Telehealth enables physicians, advanced practice registered nurses (APRNs), nurses, pharmacists, and other allied health professionals to offer their clinical services remotely. State lines and geographic boundaries have no effect on the potential of the technology to deliver telehealth services. For example, radiologists can read x-ray reports from other countries, mental health professionals can provide care telephonically or with real-time video, and chronically ill patients can be monitored from a distance with telehealth. Despite technological advances, legal and regulatory challenges exist. Provider licensure and the credentialing and privileging processes in facilities remain the biggest hurdles to telehealth adoption in the United States.

TABLE 8-2 Success Factors and Barriers to Telehealth Implementation

KEY SUCCESS FACTORS FOR TELEHEALTH

BARRIERS TO SUCCESSFUL TELEHEALTH IMPLEMENTATION

High-level organizational members (board of directors, administrator, medical director, champion physician, nurse administrator, nurse educator, program director) who have identified a need for telehealth and are able to provide support and finances throughout all phases of implementation, training, and maintenance of the telehealth program

No designated or dedicated project manager; not enough time or resources dedicated to manage project

Designated and dedicated telehealth project manager or coordinator

Interdisciplinary team not designated or prepared properly

Designated interdisciplinary telehealth team

Funding limited

Adequate facility network infrastructure to support the telehealth system or method selected and prepare setup for the telehealth program prior to installation

Lack of communication between administrative management, interdisciplinary team, and participants

Project management to include and allow time for professional telehealth education and refresher training classes, including participation for professional telehealth conferences, telehealth webinars, telehealth video training, and provision of telehealth resource information

Failure to identify remote clinical partners to whom to refer patients or to provide telehealth services; may be due to reimbursement issues, lack of understanding as to how telehealth works, practice and licensing issues in that state

Initiate telehealth program at local facility and then introduce to affiliated remote facilities

Poor telehealth equipment selection for specialty; poor quality and usability of telehealth equipment purchased

Provide staff with educational tools such as workflow diagrams, charts, digital photos, manuals, and descriptive pathways for how to initiate an urgent or nonurgent telehealth consult

Missing parts of equipment and supplies during installation or patient encounter

Provide education, training, and program development for teleconsultants

No designated telehealth area due to limited room availability

Schedule appointments for follow-up teleconsults with dates and times for physician and patient

Ergonomically poor placement of equipment, limited connectivity or lighting in telehealth area, poor cable management, limited counter size, small room, no storage cart for equipment, equipment not secure

Patient privacy and confidential information forms should be completed prior to teleconsult

No pretraining on telehealth system prior to telehealth installation

Provide on-site dedicated technical support throughout all phases of implementation and provide online support for main site, remote site, and teleconsultants

Healthcare providers not familiar with computer literacy (i.e., basic use of keyboard, personal computer, mouse, navigating software, data, or handling images captured)

Training not formalized, no schedule confirmed to allow for all participants to be trained, not enough time provided for hands-on training or practice of case scenarios

Staff resistant to training, no incentives, and no understanding of telehealth or technology advantages

Off-hour shifts not trained or invited to participate in training sessions

Licensure

Both the 1997 and 2001 Telemedicine Reports to Congress by OAT identified licensure as a major barrier to the development of telemedicine and telehealth.41 The cost and procedural complexity of current professional licensing policies precludes widespread adoption of telehealth. Currently, many health professionals must attain separate licenses in each state where services are rendered. Licensure authority defines who has the legal responsibility to grant a health professional the permission to practice his or her profession.42 Under Article X of the U.S. Constitution, states have the authority to regulate activities that affect the health, safety, and welfare of their citizens.42,43 Regulating the delivery of healthcare services is one such activity. Exceptions to state licensure requirements include physician-to-physician consultations, educational and medical training programs, border state recognition programs, government employees practicing in military or federally funded facilities such as VA hospitals and clinics, and natural disaster and emergency situations.42,43

Legislation such as the 2011 Servicemembers’ Telemedicine and E-Health Portability Act (STEP Act) facilitates the provision of telemedicine and telehealth services. The STEP Act removes the individual state licensing requirements to allow a licensed medical professional in one state to treat a patient in another.41 As of this writing, the STEP Act rules apply only to military and federal personnel, although it is a beginning in terms of advancing telehealth services into the mainstream. Fortunately, major advancements are occurring to streamline licensure requirements. These regulatory alternatives include licensure by endorsement, state compacts and mutual recognition, reciprocity, registration, and limited licensure (Table 8-3).

Nursing has been the most successful healthcare provider group to adopt the mutual recognition model, referred to as the multistate Nurse Licensure Compact.42 The Nurse Licensure Compact law became effective on January 1, 2000, with three states initially participating. As of February 2013, 24 compact states existed. Compact status applies only to registered nurse (RN) licensure. If an RN holds a license in one of the 24 compact states, he or she may practice in any of the 24 compact states, greatly facilitating telehealth interactions across state boundaries. International nurses on a visa who apply for licensure in a compact state may declare either the country of origin or the compact state as the primary place of residency. If the foreign country is declared as the primary place of residency, a single-state license will be issued by the compact state.44 A mutual recognition model is being discussed for APRNs at the time of this writing. The target date to complete that work is 2015. However, currently, APRNs who practice using telehealth across state boundaries must first apply for RN licensure (or endorsement) in the distant state and then apply for advanced practice status, which involves extensive credentialing and privileging processes.45

TABLE 8-3 Telehealth Professional Licensure Options

LICENSURE OPTION

DESCRIPTION

Endorsement

Allows a state to grant licenses to health professionals licensed in other states that have equivalent standards. States may require additional documentation or qualifications before endorsing a license issued by another state.43

Mutual recognition

The distant state’s licensing board accepts the licensing policies of the health professional’s home state.45 Federal healthcare agencies operate under this type of system. An analogous licensing system would be the mutual recognition of driver’s licenses between states.

Reciprocity

A process in which two states voluntarily enter into a reciprocal agreement to allow the health professional to practice in each state without having to become licensed in both states. It does not involve additional review of the health professional’s credentials, as endorsement does, and it does not require the participating states to agree to a standardized set of rules or procedures, as mutual recognition does. The negative aspect of this model is that it leaves the healthcare provider subject to different regulations in each state and therefore subject to different sets of laws. This can lead to legal issues of liability and wider exposure to potential malpractice opportunity.46

Registration

The health professional licensed in one state informs the authorities of other states that he or she wishes to practice in those states part-time. The provider is licensed in the home (originating) state but still is accountable to uphold the legal stipulations and regulations of the guest (distant) states. Similar to reciprocity, the provider would still be subject to the guest state’s malpractice rules as well as the home state’s rules and regulations.

Limited licensure

The health professional obtains his or her medical licensure in the home state and then obtains a second “limited” licensure in the guest state. The limited license allows for specific scope of services to be delivered under particular circumstances.46

National licensure

Individual states would voluntarily incorporate the same set of national standards into their laws. Given that most medical professionals pass the same national exam within their particular discipline, it stands to reason that standards of care and practice guidelines should not differ from state to state. Regulatory processes could be retained at the state or national level. For example, the American Medical Association could take full responsibility for the licensing of all physicians at a national level and similarly nurses could be licensed to practice nationally by their national organization, and likewise with other health professions (pharmacists, dentists, physical therapists, etc.). However, disciplinary actions or other procedural activities could be administered at the state level.

Business has ruled the world in one way or another and will continue domineering in the centuries to come. Business is booming globally, and those who are well-versed with its concepts are better positioned to succeed in this area. I am interested in business analytics (BA) since it involves using data to identify where companies could improve in terms of business and ways to achieve that (Bedeley et al., 2018). BA employs tools in statistical and operations analysis using a specific dataset. Implementation of BA entails using internal and external data to improve operational efficiency and business performance (Yin & Fernandez, 2020). For a business to boom, it needs to solve a particular problem (s) effectively. Therefore, more business professionals with skills in business analytics are needed to make informed decisions that promote organizational success.

Business analytics offers evidence to guide decision-making. According to Yin and Fernandez (2020), business analytics helps organizations substantiate the decision-making process instead of making decisions grounded on experience and assumptions. BA also speeds up the decision-making process. Wang and Byrd (2017) further explain that applying BA helps organizations develop a better understanding of markets and customers to enhance customer services and the quality of customer marketing.

My interest in BA is also due to the high demand for individuals with analytic skills. Power et al. (2018) assert that most employers want to hire employees who can employ tools to analyze data and understand the analyses needed and the meaning of results. People with BA skills understand an organization’s external environment, including customers and principal stakeholders (Yin & Fernandez, 2020). The Master’s in Business Analytics program will offer opportunities for hands-on and real-world experiences. It will equip me with knowledge and skills in various areas, including customer preference management, customer acquisition targeting, credit risk analysis, utilizing real-time location data to target customer offers, and cross-selling/upselling.

HIM 301 Introduction to Health Informatics Presentation References

Bedeley, R. T., Ghoshal, T., Iyer, L. S., & Bhadury, J. (2018). Business analytics and organizational value chains: a relational mapping. Journal of computer information systems, 58(2), 151-161. https://doi.org/10.1080/08874417.2016.1220238

Power, D. J., Heavin, C., McDermott, J., & Daly, M. (2018). Defining business analytics: An empirical approach. Journal of Business Analytics, 1(1), 40-53. https://doi.org/10.1080/2573234X.2018.1507605

Wang, Y., & Byrd, T. A. (2017). Business analytics-enabled decision-making effectiveness through knowledge absorptive capacity in health care. Journal of Knowledge Management. https://doi.org/10.1108/JKM-08-2015-0301

Yin, J., & Fernandez, V. (2020). A systematic review on business analytics. Journal of Industrial Engineering and Management, 13(2), 283-295. http://dx.doi.org/10.3926/jiem.3030