Exploring Telehealth Access and Nursing Informatics Integration

Technology has become a necessary an integral part of healthcare that aids in the assessment, monitoring, and treatment of patients and their conditions. Nursing informatics uses nursing and technology to promote positive patient outcomes. Lee (2014) believes informatics will enhance nursing practice, allow for quicker access to patient information, and improve overall efficiency.

This paper will discuss telehealth access specifically for mental health patients and address the rationale for the topic selection. It will also include negative and positive impact to practice along with pros and cons, and how informatics skills and knowledge were used to develop this paper.

Rationale for Topic Selection

Mental Health is an area of healthcare where state funding is generally cut before other areas of healthcare. Access to mental health services can be challenging for patients depending on where they reside and what services are available for that area. The advancement of technology in nursing could be particularly beneficial to patients in rural areas and those who are suffering a mental health crisis. Communication between patients and members of the healthcare team is essential to improve quality care, patient outcomes, and should not be restricted by rural living.

Telehealth or telemedicine is a growing area of healthcare that allows patient remote access to nurses and physicians via computer, tablet, or smartphone. Telehealth is live, real-time communication where according to Gallagher-Lepak, Scheibel, & Gibson (2009) nurses generally are the health care point of contact, serving as a patient monitor for this new and exciting technology. Telehealth affords the nurse an opportunity to assess the patient’s condition and act accordingly. According to The Center for Connected Health Policy (n.d.) telehealth is a two-way interaction between a person (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology. Telehealth is viable option for patients that need medical intervention and allows for the flexibility to receive medical advice or intervention from the comfort and safety of their home. Wennberg (2020) stresses that with provider shortages in mental health care, telehealth serves as an effective modality to address the rural shortage.

Medicaid will reimburse many states where telehealth is utilized. Centers for Medicare and Medicaid Services (n.d.) reports that for purposes of Medicaid, telemedicine seeks to improve health by permitting two-way, real time communication between patient, physician or practitioner at the distant site. Therefore, allowing patient needs to be met if they choose to seek help and not have the extra burden of wondering or worrying if the telehealth visit will be covered.

Positive or Negative Impact to Practice

As with any topic there are pros and cons that must be taken into consideration in order to determine if there is a true benefit. Starting with the pros the argument can be made that access to telehealth for mental health patients could decompress emergency departments, minimize wait times, and allow faster access to a nurse or physician.

Patients who present to an emergency department with a mental health crisis often wait several hours to days before they are evaluated by a psychiatrist. In addition, the patient will often be involuntarily committed to ensure they cannot leave the facility prior to that evaluation. Lawes-Wickwar, Mcbain, & Mulligan (2018) write that telephone support was found effective in improving medication adherence and reducing the severity of symptoms and inpatient days. During an admission the patient will have a 1:1 observer ordered to ensure the patient does not harm themselves or others, this is not pleasant for the patient or cost effective to the organization. Often times the patient is medically cleared taking an inpatient bed while awaiting transfer to a psychiatric facility or for community services to be arranged. Pratt, Naslund, Wolfe, Santos, & Bartels (2014) believe that telehealth intervention supported by nurse health care management is beneficial for improving psychiatric illness management and reducing acute services. If a patient can utilize telehealth services, there is a high probability the patient can receive outpatient treatment without the added inconvenience of a lengthy hospital stay that may also include loss of wages for the patient.

Telehealth according to Finnegan (2020) allows patients to speak with a physician, request prescription refills, and promote patient wellness by active participation in their care. The knowledge that a nurse or physician is accessible from the patient’s home can provide the patient with an added sense of security in the event they suffer from a mental health crisis.

Cons to telehealth could be limited internet and cellular service as they may not be accessible in the patient’s area especially if rural or monetary reasons may prevent the patient from owning these services. Mehrotra et al. (2016) write that rural beneficiaries who received a telemedicine visit lived in a poorer community compared with those who did not receive a telemedicine visit.

There could also be a lack of technological ability on behalf of the patient since not everyone possesses the same skills when it comes to computer or smartphone usage. Nurses are not exempt from this either, there are a great many nurses who struggle with technology as it becomes more integrated into their practice. In a study conducted by Koivunen and Saranto (2017) they found barriers which were related to nurses’ skills and attitudes, nurses’ work and operations, organizational factors, patients and technology.

Another larger concern to telehealth is the severity of the patient’s crisis. If it becomes apparent to the nurse or physician that the patient is in imminent danger of self-harm, there is the added burden of summoning help to the patient’s location. Whereas if the patient was present steps are taken to ensure the patient’s safety.

Telehealth’s negative impact to practice is the lack of patient to nurse or patient to physician physical interaction as it is more impersonal than being face-to-face. The positive impact to practice is the ability to remotely monitor the patient, and the adherence to ordered treatment and drug regimens.

How Informatics Skills and Knowledge Were Used

The informatic skills and knowledge used in the development of this assignment began with the Fundamentals of Nursing Informatics course. During this course the online readings and assignments have furthered developed knowledge of nursing informatics.

To prepare for the writing of this paper the FierceHealthcareIT website was accessed via a link provided in the required readings. The FierceHealthcareIT website provided many articles related to healthcare technology and nursing informatics. Once a topic of the week was chosen the Chamberlain College of Nursing library and NC Live through the local library website were searched for scholarly articles using several key words to yield results that would support the topic of the week.

As the needed sources were obtained Microsoft ® Word for Office 365 was the application opened and used for the writing of this assignment. Throughout the writing the document was checked for spelling, grammar, and writing suggestions using the available tools within the software. Upon completion the assignment was saved to a file that corresponds to NR512 Fundamentals of Nursing Informatics.

Conclusion

To date nursing informatics has changed the face of nursing and has provided nurses with access to data and systems that support the practice by making the workflow quicker and most importantly safer. As nursing informatics has advanced telehealth has been recognized as an important part of delivering prompt nursing care and is gaining in popularity.

In cases where an emergency room visit is unavoidable for patient’s experiencing a mental health crisis telehealth is also used on site where available when an in-house psychiatrist is unavailable. When access to an in-person doctor’s visit or community resources are not feasible telehealth can ensure needed care is provided without delay.

Telehealth is cutting edge technology and is being offered by more private pay insurance companies on a 24/7 basis. This technology has proven to reduce emergency room visits, re-hospitalization of patients, and in some cases, interventions have saved lives.

References

1. Lee, A. (2014). The role of informatics in nursing. Department: Ask an Expert The Role of Informatics in Nursing Lee, Andrea BSN, RNAuthor Information Nursing Made Incredibly Easy!, 12(4), 55. doi: doi: 10.1097/01.NME.0000450294.60987.00
2. Gallagher-Lepak, S., Scheibel, P. & Gibson, C. (June, 2009). Integrating Telehealth in NursingCurricula: Can You Hear Me Now? Online Journal of Nursing Informatics (OJNI), 13, (2). Available at http:ojni.org/13_2/GallagherLepak,pdf
3. About Telehealth. (n.d.). Retrieved from https://www.cchpca.org/about/about-telehealth/live-video-synchronous
4. Wennberg, D. (2020, January 14). Industry Voices-2020 should be the year we invest in mental health as health. Retrieved from https://www.fiercehealthcare.com/tech/industry-voices-2020-should-be-year-we-invest-mental-health-as-health
5. Telemedicine. (n.d.). Retrieved from https://www.medicaid.gov/medicaid/benefits/telemedicine/index.html
6. Lawes-Wickwar, S., Mcbain, H., & Mulligan, K. (2018). Application and Effectiveness of Telehealth to Support Severe Mental Illness Management: Systematic Review. JMIR Mental Health, 5(4). doi: 10.2196/mental.8816
7. Finnegan, J. (2020, February 6). Technology is changing the way doctors practice from televisits to remote monitoring, AMA Survey Finds. Retrieved from https://www.fiercehealthcare.com/practices/technology-changing-way-doctors-practice-largest-increases-telehealth-visits-and-remote
8. Mehrotra, A., Jena, A. B., Busch, A. B., Souza, J., Uscher-Pines, L., & Landon, B. E. (2016). Utilization of Telemedicine Among Rural Medicare Beneficiaries. Jama, 315(18), 2015. doi: 10.1001/jama.2016.2186
9. Pratt, S. I., Naslund, J. A., Wolfe, R. S., Santos, M., & Bartels, S. J. (2014). Automated telehealth for managing psychiatric instability in people with serious mental illness. Journal of Mental Health, 24(5), 261–265. doi: 10.3109/09638237.2014.928403
10. Koivunen, M., & Saranto, K. (2017). Nursing professionals experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scandinavian Journal of Caring Sciences, 32(1), 24–44. doi: 10.1111/scs.12445