An evaluation of the use of Telehealth within palliative care settings across Scotland

There is a lack of evidence-based research in the use of Telehealth within palliative care in the UK, particularly in Scotland. The aim of this project was to evaluate the current use of Telehealth applications within palliative care across Scotland, and how these and future applications are perceived by patients, carers and professionals. This paper reports on the qualitative findings from focus groups with patients and carers in three geographical areas in Scotland, and individual interviews with key stakeholders from across Scotland, who currently work within areas of high and low Telehealth activity. The key findings indicated that Telehealth initiatives are welcomed by patients and carers but that these should be an adjunct to clinical care rather than an alternative. The stakeholder interviews revealed several notable differences between those working within areas of high and low Telehealth activity. Principally, areas of high Telehealth activity appear to be driven by national and local policy and seem to benefit from a greater level of investment in Telehealth equipment and facilities than in the more central, and hence accessible, parts of Scotland.     

Real-time syndrome surveillance in Ontario, Canada: the potential use of emergency departments and Telehealth.

OBJECTIVE: The purpose of this paper is to review new bioterrorist and emerging infectious threats to public health in Ontario, Canada, and to propose a means of integrating a telephone-based health information service and emergency department triage with a first-line real-time, 24-h a day syndrome surveillance system. This automated system could be beneficial in detecting a bioterrorist threat as well as in detecting and monitoring disease outbreaks such as influenza, Norwalk, West Nile virus, Escherichia coli 0157 or severe acute respiratory syndrome. METHOD: The Medline PubMed database was searched for articles relating to bioterrorism and syndromic surveillance from 1997 onwards. The websites of the Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Public Safety and Security, Centers for Disease Control and Canadian Population and Public Health Branch of Health Canada were searched for articles relating to bioterrorism and syndromic surveillance. Interviews were conducted with key informants from Telehealth staff, the public health services of Ontario and the Centers for Disease Control and Prevention, Atlanta, GA, USA. RESULTS: Real-time syndrome surveillance is a new means of detecting disease outbreaks or possibly acts of bioterrorism at the first contact with the healthcare system. It has been used successfully to detect influenza outbreaks at an early stage. The system that is proposed would be a province-wide integrated early warning system for both bioterrorist events and emerging infections. It would use clusters of symptoms tied to temporal, demographic and spatial data to increase sensitivity and specificity. CONCLUSION: Real-time syndrome surveillance is an evolving science. Emergency departments and Telehealth in Ontario lend themselves as first contacts to the healthcare system as excellent opportunities to perform syndrome surveillance. They offer the opportunity properly to identify at-risk patients for emerging infections by including contact and travel data into the symptom complex. This could identify at-risk patients early and lead to appropriate public health measures. The benefit of using Telehealth in Ontario is the provincial accessibility of Telehealth and the extensive data collected on one computerized system. Emergency departments should also have a uniform computerized triage data collection system to facilitate surveillance.     

Optimizing the Personal Health Record with Special Video Capture for the Treatment of Autism

Improved imaging techniques and the increased need for a personal health record platform suggest that a Telehealth based system has an excellent potential for improving patient care and providing a high capacity for information storage and retrieval. New video-capture technology will allow parents, schoolteachers, and caregivers to capture a child’s behavior for subsequent evaluation by specialists worldwide even during a time of crisis. Experience in a recent hurricane disaster illustrated the advantages of merging these two entities, especially when addressing the needs of displaced families who have a child with autism. It is clear that Telehealth based systems can shorten the time for diagnosis, potentially increase diagnostic accuracy, reduce costs, and contribute to an improved status of personal health records.     

Building a telehealth network through collaboration: the story of the nebraska statewide telehealth network

With the recent governmental focus on increasing broadband capabilities throughout the nation, with rapid advances in technology, and with other regulatory and reimbursement barriers falling, a great number of sites across the United States are in the process of either initiating or expanding their Telehealth capabilities. The Nebraska Statewide Telehealth Network, one of the most comprehensive networks in the nation, is no exception. Built through a collaborative effort of hospitals, health departments, the Nebraska Hospital Association, and other organizations, the Network's members include nearly every hospital and health department in the State. The Nebraska Statewide Telehealth Network has been awarded more than $1.4 million in grant funding since 2008 and, last year, provided 3633 clinical consultations to rural residents across the State.Among its many benefits, Telehealth increases access to specialty care for patients in rural areas; decreases travel time and saves money for patients and caretakers alike; provides the potential for earlier disease intervention; enhances clinical support between specialists and primary care providers; and serves as a medium for easy access to professional education, training, and collaboration. And, now, this technology is becoming increasingly mobile, allowing practitioners the opportunity to connect anywhere. In a rural state dominated by Health Care Professional Shortage Areas and Medically Underserved Areas, Telehealth has the opportunity to help patients receive care at home.     

Telehealth in a rural school-based health center.

Telehealth is a new technology for the delivery of health care that allows a provider to deliver health care to a client at a remote setting via full, real-time video and audio interaction (American Nurses' Association, 1996). Telehealth does not change traditional health care standards or practice. School-based health centers are designed specifically for children and offer a continuum of preventive and acute care interventions that few other health care entities can provide (School-Based Adolescent Health Care Program, 1993). Telehealth and a school-based health center were joined together in a pilot project to demonstrate the efficacy of primary care via telehealth and to determine the value of this technology to the school and community. The telehealth capability enhanced the role of the school nurse and increased access to primary care for the students. The students were quick to adapt to the technology. The role of the school nurse was essential to the success of this project.     

Telehealth Benefits and Barriers

Telehealth includes health care services provided using audio and video technology. Telehealth was originally developed to provide basic care to rural and underserved patients. Higher rates of use of telehealth are now standard in many practices since the coronavirus disease 2019 pandemic. Increasing emphases on patient satisfaction, providing efficient and quality care, and minimizing costs have also led to higher telehealth implementation. Patients and providers have enjoyed the benefits of telehealth, but widespread adoption has been hindered by regulatory, legal, and reimbursement barriers. Recent legislative initiatives have advocated for further telehealth advancements, especially with the rapid implementation of telehealth in the times of coronavirus disease 2019.     

New home telehealth toolkit available

A new Home Telehealth Toolkit is available for those interested in establishing a new home telehealth program or improving an existing one. Developed by members of the American Telemedicine Association's (ATA) Home Telehealth Special Interest Group (SIG) contains guidelines, procedures, and sample protocols that can be adapted for all phases of a home care telehealth program.     

Telehealth Education of Nurse Practitioner Students

Telehealth is rapidly becoming a viable mode of health care delivery. Telehealth education of nurse practitioners (NPs) is recommended during their academic careers to increase confidence in the use of this technology. On the basis of competencies developed by the National Organization of Nurse Practitioner Faculties and using the Multimodal Framework as a guide, telehealth was integrated into an NP curriculum. This article provides a high-level overview of the structure, process, and outcomes of how telehealth was integrated into an NP program of study, inclusive of didactic, experiential, and clinical components.     

Transition of Nurse Practitioner Faculty Practice and Student Clinicals to Telehealth: Response to the COVID-19 Pandemic

The COVID-19 pandemic forced the US health care system to evaluate alternative care delivery strategies to reduce the risk of coronavirus transmission to patients and health care providers. Telehealth modalities are a safe and effective alternative to face-to-face visits for primary and psychiatric care. Federal policy makers approved changes to telehealth reimbursement coverage and allowed flexibility of location for patients and providers. This article describes the transition of patient visits to telehealth by nurse practitioner faculty at an academic medical center to maintain continuity of care of underserved patient populations. This pivot facilitated resumption of clinical learning experiences for nurse practitioner students.     

The Implementation of an Emergency Medicine Telehealth System During a Pandemic

BackgroundIn March of 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19)—a disease caused by a novel coronavirus—a pandemic, and it continued to spread rapidly in the community. Our institution implemented an emergency medicine telehealth system that sought to expedite care of stable patients, decrease provider exposure to COVID-19, decrease overall usage rate of personal protective equipment, and provide a platform so that infected or quarantined physicians could continue to work. This effort was among the first to use telehealth to practice emergency medicine in the setting of a pandemic in the United States.DiscussionOutside the main emergency departments at each of 2 sites of our academic institution, disaster tents were erected with patient care equipment and medications, as well as technology to allow for telehealth visits. The triage system was modified to appropriately select low-risk patients with symptoms suggestive of COVID-19 who could be seen in these disaster tents. Despite some issues that needed to be addressed, such as provider discomfort, limited medication availability, and connectivity problems, the model was successful overall.ConclusionsOther emergency departments might find this proof of concept article useful. Telehealth will likely be used more broadly in the future, including emergency care. It is imperative that the health care system continues to adapt to respond appropriately to challenges such as pandemics.     

Telehealth as a tool for enhancing care for patients with cardiovascular disease

Telehealth refers to the use of telecommunication technology to remove time and distance barriers in the delivery of healthcare services. Telehealth can help nurses provide education and counseling, social support, disease monitoring, and disease management reminders to cardiovascular patients in their homes. As a result, patients gain more flexibility in scheduling healthcare visits, have easier and more convenient access to healthcare, may have fewer time-demanding clinic visits, receive care in a location that does not require the burden of transportation, and in an environment that is less threatening than a clinic or emergency department. Cardiovascular healthcare may be enhanced through diverse telehealth applications, including sensor technology and wearable monitoring systems, Internet-based peripheral monitoring devices, videophones, interactive voice response systems, and nanotechnology. Although telehealth enhances care, legal, human, and environmental factors need to be considered before implementing a telehealth program. Additionally, more evidence that is obtained through large multicenter controlled trials about the potential benefits and cost effectiveness of telecardiovascular health is needed.     

The Role of Telehealth During the COVID-19 Pandemic Across the Interdisciplinary Cancer Team: Implications for Practice

ObjectiveThis literature review aims to explore the role of telehealth during the COVID-19 pandemic across the interdisciplinary cancer care team.Data SourcesElectronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and gray literature were searched using Google Scholar up until September 2020.ConclusionAlthough the safe and effective delivery of cancer care via telehealth requires education and training for health care professionals and patients, telehealth has provided a timely solution to the barriers caused by the COVID-19 pandemic on the delivery of interdisciplinary cancer services. Globally, evidence has shown that telehealth in cancer care can leverage an innovative response during the COVID-19 pandemic but may provide a long-lasting solution to enable patients to be treated appropriately in their home environment. Telehealth reduces the travel burden on patients for consultation, affords a timely solution to discuss distressing side effects, initiate interventions, and enable possible treatment additions and/or changes.Implications for Nursing PracticeGlobal public health disasters pose significant and unique challenges to the provision of necessary services for people affected by cancer. Oncology nurses can provide a central contribution in the delivery of telehealth through transformational leadership across all domains and settings in cancer care. Oncology nurses provide the “hub of cancer care” safely embedded in the interdisciplinary team. Telehealth provides a solution to the current global health crisis but could also benefit the future provision of services and broad reach clinical trials.     

Coronavirus Disease 2019’s Shake-up of Telehealth Policy: Application of Kingdon’s Multiple Streams Framework

Providing care by telehealth has been an aspiration for many health care practices. However, regulatory barriers often prevented its implementation. The emergence of the COVID-19 virus provided a window of opportunity for federal policy change in telehealth during a national state of emergency. Telehealth policy is examined using Kingdon’s multiple streams (policy) framework.     

Telehealth Billing for Nurse Practitioners During COVID-19: Policy Updates

Telehealth is a growing valuable strategy to assist patients accessing needed care when unable to get to a health care setting for one of several reasons. During the coronavirus disease 2019 (COVID-19) pandemic of 2020, many health care practices were forced to implement telehealth services to meet patient and practice needs. In 2020, several temporary waivers, exceptions, and telehealth policy changes emerged across the nation. Many telehealth policies are state or federal specific. This report provides a general overview of essential telehealth policies and legislative updates along with resources and websites to guide and support nurse practitioners with contemporary regulations regarding telehealth billing.     

Communication skills for telehealth interactions

Telehealth technologies provide a challenging new home care approach. Through the use of cameras, video display services, and telephone lines, nurses can interact with patients located several miles away. In delivering services from a distance, the ease of equipment operation and installation, picture, and voice quality are important. Of equal importance are the nurse's communication skills in conducting telehome visits.     

Nurse Practitioners in Telehealth: Bridging the Gaps in Healthcare Delivery

There is no denying that many changes must be made in the health care delivery system in order to meet the needs of all people and improve the health of our nation. Because of advances in technology over the past 2 decades, telehealth has greatly improved patient access to health care and equipped providers with innovative tools to provide quality health care to a larger population. The health care climate demands an innovative approach to health care delivery with an attention to scalable and sustainable models. Telehealth, and the use of nurse practitioners, will be an integral part of these new models.     

Exploring telehealth opportunities in domestic violence shelters

PURPOSE: To determine the degree of interest in using a computer for the purpose of accessing services from a nurse practitioner (NP) at domestic violence shelters (DVSs); and to identify issues of privacy and confidentiality that might arise from participation by victims of intimate partner violence (IPV) in a Telehealth intervention. DATA SOURCES: Focus groups with 19 women residing in two DVSs. Interviews were recorded, transcribed and themes were identified that answered the questions posed in the interviews. CONCLUSIONS: Most of the women understood the term NP and were favorably inclined to seek services from one. Over half of the women were not familiar with computer use, but were willing to learn in order to receive health care services, both for episodic needs and for maintenance of chronic conditions. After learning of the method proposed to allow them to access an NP through the internet while still protecting their privacy and confidentiality, the women felt comfortable with this approach to meeting their health care needs. IMPLICATIONS FOR PRACTICE: Results from this study can be used to support the development and testing of Telehealth interventions for these victims of IPV.     

Connecting Kids to Care: Developing a School-Based Telehealth Program

School-based telehealth is an efficient and effective way to overcome barriers to care and improve health equity for children in rural and underserved communities. Empowering health care providers, such as nurse practitioners, to develop successful, sustainable programs may contribute to improved access to care and improved health outcomes for the children served. Using a structured framework for program development is essential to successful implementation when connecting school-age children to care through a school-based telehealth program. The Telehealth Service Implementation Model provides a robust structure with requisite components to develop and implement a successful school-based telehealth program.