Improving Telehealth in the Home Health Setting

What is Telehealth

Telehealth is a shared technology device that involves healthcare professionals and patients so patient self-monitor of their health and clinical signs can be remotely monitored in the comfort of their home without having to travel to a healthcare facility (Sewell, 2016).  In my agency, telehealth is mainly used in the management of chronic diseases such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM).  This shared technology device is used by the patient to obtain their blood pressure, pulse, respiratory rate, weight, pulse oximetry, blood sugar, and well as clinical signs and symptoms such has shortness of breath (SOB) on a rating scale, lower extremity swelling, chest pain, level of anxiety, and understanding and compliance of their medication regimen.  Once the patient has navigated through the steps on an electronic device provided by our home health agency, the information is remotely transmitted to our telehealth team's central location to look for any "red flags" that need to be addressed to the patient's health care provider for immediate intervention.

 Advancing Telehealth in Home Health

Most home health agencies have implemented traditional telehealth as previously discussed; however, have not implemented home telehealth equipment that is more interactive.  Telehealth was introduced to my home health agency not only for the patients to be able to self-monitor themselves at home but to decrease the nurse-patient visit frequency thus decreasing costs.  However, since my home health agency is utilizing only the traditional telehealth, visit frequencies have not decreased.  Instead, they have increased by not incorporating other equipment and software as in digital imaging and video conferencing.  Home-care nurses may not be able to get to the patient's home as quickly as they or the patients would like. Going beyond traditional telehealth will allow patients to connect to their healthcare providers for visible symptoms and a thorough in-home examination (Sewell, 2016).  Even though the most common telehealth users are the ones mentioned previously, other patients require more frequent monitoring as well.  For example, patients who encounter chronic wounds, post-surgery patients, cancer patients, transplant patients, to name a few.  For instance, if a patient, who is not scheduled for a nursing visit that day, calls the nurse out in the field about a wound or incision they are concerned about, the nurse usually cannot get to the patient's home immediately due to other scheduled patients and the travel times between patient homes. It could be hours before the home health nurse arrives. Also, patients whose telehealth stats that were transmitted may have been normal but who are experiencing other issues may decide to wait until their next home care visit with the nurse which can be another two or three days when the problem should have been addressed immediately.  I recently was completing a supervisory visit with another nurse when an email came through to this nurse about a patient who has multiple sclerosis and had not been able to urinate for two days.  The patient was requesting for this nurse to come as quickly as possible that morning.  The nurse was an hour away, and after speaking to the patient, she informed the patient to go to the emergency room.  The patient never did follow this nurse's instructions, and the nurse did not find out until later that afternoon.  The nurse did end up going to the patient's home, but it had already been five hours after they had spoken.  With an interactive home health video system, patients can discuss their current issue and acquire what the next step should be with their health care provider or staff almost immediately. 

Recommendations for Improvement

To upgrade from traditional telehealth to two-way communication with voice and video feed, a programmer would need to write the software.  The servers would need to be upgraded to a larger one to make a faster connection by improving connectivity and allowing for a more significant flow of patient traffic.  Once the software is installed, the health care provider puts a direct link on the notebook or laptop for the patients.  Since physicians' free time can be limited, stand-by nurses can be scheduled to watch the live-time feed.  These nurses can determine if the patient's situation warrants a home health nurse, and emergency room visit, an ambulance, or just a physician appointment which can be completed during real-time communication utilizing this advanced telehealth technology. 

  
Benefits to Nursing and Patient Outcomes

Since productivity has decreased with traditional telehealth by having to go to patients' homes more frequently increasing nurse-patient visits per day, these recommendations for improvement can have a positive impact on the home health nursing profession by increasing productivity by reducing patient contact.  Also, job satisfaction will increase staff retention.  The recommendations provided above will also open the door for more job opportunities.  

Benefits the patient will experience of more interactive equipment and software previously discussed are:

• real-time communication between patient and healthcare provider
• possible prevention of having to be seen in the emergency department or the physician's office eliminating travel time and out-of-pocket costs
• alerting healthcare providers of possible complications
• intervention and treatment of acute occurrences and disease management
• digital photograph transfer during a real-time communication (Sewell, 2016)

Telehealth having the ability to perform visual components will result in better patient clinical outcomes with rapid assessment and treatment, and early diagnosis before the potential health concerns lead to costly emergency department visits or re-hospitalization.  Patients also will become more knowledgeable and involved in the management of their disease when they feel more connected to their physicians and staff with more frequent visual interaction (Sewell, 2016).  

Ethical and Legal Considerations

Unfortunately, implementation of such technology can create security challenges so there is always a concern for patient confidentiality.  Health information must remain private; therefore, telehealth technology must provide a secure internet connection for patients and healthcare providers to establish shared connections during telehealth appointments to meet HIPAA requirements.  Receiving informed consent, written or verbally, from the patient or primary caregiver, is of priority.  Also, it is essential to explain its purpose thoroughly and how data is transmitted and stored making them aware security protocols could fail to cause unauthorized users to access electronic storage of medical data possibly and digital images causing a breach of confidentiality. A breach of confidentiality can cause some legal ramifications as in employer termination, fines, and lawsuits (Sewell, 2016).  This conversation between both parties should be documented in the patient's record.  

Barriers to Consider

Not everyone is technology literate especially the elderly population.  In order for this telehealth technology to be successful in the home setting, its design needs to be user-friendly so the patients or caregivers can manage technology efficiently improving their experience of care and reducing stress (Narasimha, Madathil, Agnisarman, Rogers, Welch, Ashok, Nair, & McElligott, 2017).  The design should be formulated to be simplified that a child could use it.  For instance, every button should have a direct link (e.g., button to click for video, a button to click for picture) so they are not continually scrolling through the notebook or laptop.  They should also be provided with the appropriate training by a telehealth technician.  Other considerations are the vision and hearing-impaired patients.  The telehealth system provided to the patients should be of high video and sound quality (Narasimha, 2017).

 
References


Narasimha, S., Madathil, K.C., Agnisarman, S., Rogers, H., Welch, B., Ashok, A., Nair, A., & McElligott, J. (2017).  Designing telemedicine systems for geriatric patients:  A review of the usability studies.  Telemedicine and E-Health, 23(6).  doi:  https://doi.org/10.1089/tmj.2016.0178

Sewell, J. (2016).  Informatics in nursing:  Opportunities and challenges (5th ed.).  Philadelphia, PA:  Wolters Kluwer

Recommended Video Links:

https://www.freshpatents.com/realtimetouch/?id=mbl
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https://www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/Health+services/Telehealth/

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