NR 361 Week 5 Graded Discussion: Trends in Informatics
Select one of the following trends and discuss your understanding of this trend in healthcare and
... [Show More] its potential impact on your practice as a nurse. What are the legal, privacy, and ethical considerations of this trend?
• Nanotechnology
• Consumer health informatics (CHI)
• Telehealth (or telenursing)/virtual healthcare
• Social media healthcare applications
• Health-focused wearable technology
• eHealth
ANSWER
Telehealth is something that strikes me as interesting and can be very useful for case managers. Currently we are trialing a new system that allows the case manager to visit a patient once in the home and then complete every other aspect of our role with the patient over a smartphone that we provide to the patient. We give each patient a smartphone and we use this phone to communicate with them via phone calls, text messages, video chats and by them answering questionnaires weekly that are based upon their health conditions. The weekly questionnaires allow the case manager to gauge their patient’s health status weekly and determine what things they may need to work on that week. These smartphones are loaded with additional health maintenance applications that can assist with everything from smoking cessation to depression management. I live in a big city, that is densely populated, however as you move toward the center of the state it is much more rural, which is why this technology is so important to develop. Here in the city it is relatively simple to send a case manager out to a person’s home to meet with them and help manage their health, however as you move into more rural settings the distance between homes and patients are a barrier to how many patients can be seen or worked with in a day. By using this telehealth technology, case managers can still see their patients face to face via video chat and are able to see many more patients each day. Telehealth has many benefits including decreased drive times between patients, less down time between patients, and it improves relationships between patients and their providers (Hebda, Hunter & Czar, 2019). As with anything there are some downfalls of solely using telehealth to work with patients. One of the major downfalls I have discovered is that you aren’t able to assess their surroundings such as the home, neighborhood, and safety concerns. Each time I enter a home, I am automatically assessing my surroundings and looking for safety issues that the patient may not even realize are a safety concern. I also find out things about my patient that I may not have known if I wasn’t in the home. For example, I was working with a woman that had severe asthma and her home was not very clean and the amount of dust within the home was making it difficult for me to breathe and I don’t have asthma. By entering the home, I was able to assess this situation and notify her physician that perhaps the home conditions where a contributing factor in her severe asthma attacks. If I were using a telehealth approach I may not have known this information. Another issue with telehealth is connectivity issues in these rural areas. In some of our more rural outskirts of Pittsburgh, there are areas that have awful cellular reception, and this can prove very troublesome if you are trying to work with someone over a cellular device. Finally, one of the biggest issues in using some of this technology is that some of our patients just don’t understand how to use the smartphone. We give them a brief overview of the phone during our initial meeting, however they are usually too overwhelmed with all the information they have received during our first face to face visit that they just can’t process everything. Often time we end up having to send a tech support person out to work with the individual to help them get a better understanding of the phone and how to use it.
Using telehealth technology presents new issues with privacy considerations. I have called a patient on a video call and they are out in public, which can be a HIPAA concern because typically we would be discussing their personal information via the phone video call. At this point, I end the call and tell the patient to call me back once they are home or in a private place where it is more appropriate for us to talk. Another security concern is the texting of PHI. This also creates issues with sharing health information via text. I am always very careful regarding what I text to my patients and usually reserve the discussion of PHI for face to face or phone calls. Before enrolling a patient in a telehealth program, it is imperative that the risks of using this technology be explained to them (Payne, 2018). Although there are safeguards in place to protect information, there is always the risk of data breach and patients must be informed of this. An ethical issue related to telehealth is the lack of face to face meetings. Working with patients through a telehealth system requires excellent listening and communication skills by the provider combined with problem solving and critical thinking skills (Payne, 2018). The nurse must also be able to develop a trusting relationship with the patient using the telehealth approach which can also prove to be very difficult (Payne, 2018).
References
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6st ed.). New York, NY: Pearson.
Payne, K. (2018). Ethical telehealth practice. Tennessee Nurse, 81(2), 15. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=130037784&site=ehost-live&scope=site [Show Less]