NUR 752 Discussion 2.1: Electronic Visits (e-Visits
NUR 752 Discussion 2.1: Electronic Visits (e-Visits
The patient population I work with is mostly low income, underinsured, uninsured or migrant. Many of these patients are Medicaid recipients and work blue collar jobs with minimal benefits and limited time off from work. The implementation of telehealth for my patient population has been incredibly positive. Patients can take a quick break from work, use their lunch hour, or discuss their health on their commute during a telehealth visit without having to take time off. They can still receive medical advice, have lab work ordered, and even obtain referrals for specialty visits. I respond to asynchronous requests, but I usually like to have a quick telehealth call for a check-in to ensure I meet all patient needs and answer questions. Synchronous visits are the best way to ensure you understand what the patient is asking for. I usually have follow-up questions to advice requests and I often like to check-in on chronic condition management. If a patient could video a skin, eye or other condition that needs to be seen in person asynchronously that would prove useful as well. A barrier to this would be the patients who low or poor access to phones and internet. The population I work with has limited phone minutes and reduced access to quality internet which is a barrier to this visit method (Dhaliwal et al., 2022). There are several benefits and limitations to the use of telehealth in the primary care setting.
For this population it seems like a mix of providers and patients drive the demand for telehealth visits. Providers who might need a remote day, or who are in a facility that is short staffed and cannot support additional in-clinic visits would also benefit from the telehealth option. Patient barriers to care can be removed by adding the option of telehealth, chronic pain or mobility impairment is one-way telehealth can benefit home bound patients (Gajarawala & Pelkowski, 2021). Patients who are dependent on public transportation during the pandemic can drive demand for telehealth visits, or those who walk during inclement weather. Many of our patients have transportation barriers which would also benefit from the option of a telehealth visit.
Consent is always a big issue for any type of medical treatment, advise, or testing. We had to develop a telehealth consent option for patients to give us verbal consent over the phone. Some barriers would be ensuring the person on the phone is the actual patient (Balestra, 2018). Parents often like to complete visits for adult children, which is not allowed. Spouses who have appointments together are often not in the same location so visits cannot be completed without the patient being present. Prescribing controlled substances via these telehealth visits is also a risk because it can be difficult to track when the prescription was last filled. There is a potential for abuse with CS being prescribed over the phone or during a video visit, especially in states where the PMP cannot be reviewed.
Other technologies that can benefit telehealth or remote visits are the implantable glucose monitors. These devices can provide real
time data to a clinician and touchpoints can be based on this data. At home BP monitors with docking stations that can upload the readings into the chart can also support an at home approach to BP monitoring. If the readings are good then the patient can forgo an in-office visit which can be easier on elderly, mobility impaired or patient with transportation barriers. Patient engagement and support are always a potential barrier considering a small percentage of the population utilizes free online resources concerning their healthcare (McBride & Tietze, 2018). We have a Mychart or direct connect option to further encourage patient engagement. With this program patients can see their results, request appointments, obtain letters, ask their healthcare team questions and access previous and current prescription information.
Balestra, M. (2018). Telehealth and legal implications for nurse practitioners. The Journal for Nurse Practitioners, 14(1), 33-39.
Dhaliwal, J. K., Hall, T. D., LaRue, J. L., Maynard, S. E., Pierre, P. E., & Bransby, K. A. (2022). Expansion of telehealth in primary care during the COVID-19 pandemic: Benefits and barriers. Journal of the American Association of Nurse Practitioners, 34(2), 224-229.
Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth benefits and barriers. The Journal for Nurse Practitioners, 17(2), 218-221.
McBride, S., & Tietze, M. (2018). Nursing informatics for the advanced practice nurse (2nd ed.). New York: Springer Publishing Company. ISBN: 9780826140456
Discussion 2.1
Briefly describe your client population. Share with your peers how the clients you interact with might benefit from telemedicine e-visits.
- Would synchronous or asynchronous telemedicine e-visits be ideal?
- Would these be driven by consumers or health professionals?
- What ethical and legal barriers might you need to overcome?
- What other technologies might dovetail into these e-visits?
I work in a Neuro Acute Unit within a large level 1 trauma center and certified stroke center. Our patient population mainly of consists strokes, seizures, brain surgeries, spinal surgeries, and various neurological disorders, such as Guillain-Barre. One way that our patients benefit from telemedicine e-visit is when they are discharged. My hospital cares for many patients that live in rural areas, as well as surrounding states that don’t provide specialized neurological care. Due to this factor many patients are unable to travel back to the hospital for their follow-up appointments. Telemedicine provides them with the option to have their appointments within their own homes.
Synchronous telemedicine is defined by The Office of the National Coordinator for Health Information Technology (ONC) as a live two-way audiovisual videoconferencing between a patient and a care provider (Resnick, 2019). Veteran affairs defines asynchronous telemedicine as acquiring medical data, then transmitting the data to a care provider at a convenient time for offline assessment (Resnick, 2019). I believe that the most ideal form of telemedicine e-visits is synchronous. Synchronous telemedicine visits can improve the effectiveness of a visit due to live communication. Live communication provides real-time assessments and interventions. Take strokes for example. The longer the timeframe is between the onset of stroke symptoms to intervention, the worse the prognosis. With synchronous telemedicine communication that critical time frame will be shortened.
I believe that having synchronous telemedicine visits is driven by both the consumer and health professionals. Having live communication not only benefits the patient, but healthcare provides as well. It benefits the patient by being able to get answers and education quickly. It benefits the providers by increasing the efficiency of communication with their patients and other healthcare providers that might be consulted.
Some legal and ethical issues surrounding the use of telemedicine are different care jurisdictions, privacy, and healthcare disparities. When there is a different standard of care jurisdiction involved it affects the regulation and legal liability of the organization (Dunn, 2004). The fast growth of technology-related healthcare and telemedicine challenges the boundaries of security and privacy (McMcbride, 2019). Healthcare disparities need to be examined when reviewing telemedicine ethical issues. Telemedicine is very useful in rural areas, however, 34% of Americans that live in a rural area lack access to the internet, compared to only 4% of Americans that live in urban populations (Pirtle et al., 2019). Without the internet, telemedicine is not able to be used.
Other technologies that might contribute to the effectiveness of telemedicine related to the neuro patient population are blood pressure machines, glucometers, and wristwatches that send data electronically to the providers, so that it may be analyzed during the telemedicine e-visit. The monitoring of blood pressure, blood glucose levels, and heart rhythm are all key factors to providing preventative stroke care.
References
Dunn, G. (2019). Legal issues confronting 21st-century telehealth. British Columbia Medical Journal. 46(6), 290-292. https://bcmj.org/articles/legal-issues-confronting-21st-century-telehealth (Links to an external site.)
McMcbride, S., & Tietze, M. (2019). Nursing Informatics for the Advanced Practice Nurse. (2nd ed.). New York: Springer Publishing Company. ISBN: 9780826140456
Pirtle, C., Payne, K., Drolet, B., (2019, June 27). Telehealth: Legal and Ethical Considerations for Success. Telehealth and Medicine Today. https://doi.org/10.30953/tmt.4.144 (Links to an external site.)
Richard Resnick. (2019, September 10). The Two Forms of Telemedicine: Synchronous vs. Asynchronous. Cureatr. https://blog.cureatr.com/two-forms-telemedicine-synchronous-vs-asynchronous
Discussion 2.1
My client population ranges from wealthy individuals to low-income families. There is an even mix of races, ethnicities, ages, economic status and religions. In the intensive care unit that I work in, every patient would benefit from telemedicine e-visits. There are patients who come in where this is the first inpatient hospital stay ever and some patients who have been in the ICU many times. Having telemedicine e-visits would be helpful for every ICU patient because of the follow-up care. A patient does not end up in the ICU for nothing. There needs to be something critically wrong in their body and that is why the patient ended up in an ICU setting. Most critical health issues do not resolve quickly and having a healthcare team check-in on a routine basis would be beneficial for every ICU patient.
For patients who have been discharged from the hospital where they spent time in an ICU setting, synchronous telemedicine visits would be more ideal. Synchronous telemedicine e-visits are where there is real-time interaction between a provider and patient via video and/or phone (National Coordinator for Health Information Technology, 2017). A real-time interaction would be more helpful for a provider to assess a patient and determine if there is progress in care or help determine if an in-person or perhaps emergency room visit is needed. For example, if a patient had a stroke, the provider could determine via video chat if a patient was having any of the “Be Fast” symptoms.
I believe that this would be driven more by health professionals. If a patient is readmitted to a hospital for a similar issue, there is a chance that the hospital could lose money. It would be in the best interest for the hospital or healthcare organization to set up telemedicine with patients who have been hospitalized and discharged to help ensure there are no health accidents that result in readmission. There would be some drive from consumers however. Some patients want to stay on top of their health and they would be motivated to learn as much as they can about their condition(s). A telemedicine service is a great opportunity for patients to learn.
It could be difficult for a nurse, provider, or other healthcare professional to determine a patient’s level of pain via video chat. A patient could be searching for additional medications for pain, weight loss, or other personal desires. A provider would need additional information, perhaps from an in-person visit if they were going to prescribe pain medications or other serious prescriptions that require more assessment than a video chat can provide.
Other technologies that could dovetail into e-visits could include pharmacy check-ins. A provider or pharmacist could ensure that a patient has been taking their medications according to the schedule. Perhaps diabetics patients who use an application to measure their blood glucose levels would have their data sent to the provider for observation. Physical therapy could also dovetail into these e-visits. If a patient was to have one virtual meeting every week and each member of the healthcare team could hop in to give their education, then the patient would spend less time preparing for virtual visits.
Reference
National Coordinator for Health Information Technology. (2017). What is telehealth? How is telehealth different from telemedicine?
Briefly describe your client population. Share with your peers how the clients you interact with might benefit from telemedicine e-visits.
- Would synchronous or asynchronous telemedicine e-visits be ideal?
- Would these be driven by consumers or health professionals?
- What ethical and legal barriers might you need to overcome?
- What other technologies might dovetail into these e-visits?
I currently work at an older adult skilled nursing facility. I work on the medicare floor where all my clients come from the hospital for rehabilitation. My clients’ admitting diagnosis ranges from falls to respiratory distress to heart failure exacerbation, etc. My clients would benefit in many ways from telemedicine e-visits. A lot of my clients have physical limitations and it’s very hard to see their doctors, whether its their orthopedic/general/cardiovascular doctor, and telemedicine e-visits has made it possible for them to stay in our facility but be able to communicate with their doctor through the iPad we provide them. The doctor that the client would have their e-visit with would have all the necessary documents and information thanks to the electronic health record.
According to Nursing Informatics for the Advanced Practice Nurse, Asynchronous telemedicine involves exchange of data between two or more individuals at different times; whereas, synchronous telemedicine requires the involved individuals to be simultaneously present for immediate exchange of information (McBride & Tietze, 2019). In my opinion, I believe that synchronous tele-visits are better because there’s an active conversation and the individuals can talk about all the issues they are having currently instead of having to wait for each individual to respond at different times.
Next, in my opinion, I feel that telemedicine e-visits would be driven by consumers. My reason for this is because I feel that consumers have to take the initiative to learn about tele-visits and be comfortable with technology before healthcare professionals start trying to persuade individuals to do tele-visits.
Next, there are some ethical and legal barriers needed when thinking about telemedicine e-visits. One barrier is patient privacy and confidentiality, also known as HIPPA. When patients are going to be talking with their doctor, they need to make sure that they are in a private setting where others won’t be able hear their conversations with the doctor. Also, doctors and other healthcare professionals need to make sure that the program they use to conduct these tele-visits are secure and private, and they can access the EHRs of patients easily so that they can properly assess and know the patients’ conditions when talking with them.
Finally, when thinking about telemedicine, there are other technologies that might impact e-visits. One of these factors would be the EHR system; in order for a doctor to know a patient’s history, assessments, and medications, they would have to access the EHR prior and during the e-visit. Next, according to the High Tech Aging: Improving Lives Today video, the main character, Alma, talked about certain technologies that were able to help her doctor know information about her during their telemedicine e-vists such as home sensors to detect if she’s declining or needs assistance and a sleep monitor which helps detect problems early. With all the advances in technology, telemedicine e-vists will be impacted but it would be for the best in regards to monitoring the patient.
References:
McBride, S., & Tietze, M. (2019). Nursing Informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism. Springer Publishing Company.
My client population consists of acutely ill geriatric patients. I believe telemedicine might be beneficial for the patients I interact with by promoting ease of access for appointments. An example that would promote ease of access is the virtual format allowing the appointment to take place within their home. This will eliminate the need to travel to a different facility – which for some, may be a long drive. I believe synchronous telemedicine e-visits would be ideal so the patient would be able to ask the provider any questions they may have in the moment and get an instant response. By having it a synchronous format, they can converse naturally – mimicking the in-office experience the most. These would need to be driven by both consumers and health professionals.
Health professionals would need to advertise the benefits of a telemedicine e-visit and expand their availability to ensure the patients are able to make an appointment with them. Moreover, consumers would need to be responsible for scheduling and attending the appointment which requires a 50/50 relationship for it to be successful. A legal barrier we might need to overcome is the potential for a HIPAA violation. If the appointment takes place within their home, there is no guarantee a visitor, family member, or friend isn’t present during the appointment. This poses a risk for a HIPAA violation by discussing important patient sensitive information with individuals other than the patient. They may overhear any patient sensitive information while being in the same room – therefore, ensuring privacy is secured is critical in establishing HIPAA protocols.
Another technology that might dovetail into e-visits are e-screenings. The other day, I saw a commercial for an automated COVID-19 at home tester. It was an electronic machine that can automatically upload results of a positive or negative result. If we can join e-screenings into the e-visit, we can have a more productive appointment with the patient. We will be able to confirm a diagnosis, or delve into further understanding ones symptoms.