Telehealth Applications: A New World

By Guest Blogger Rhonda Hertwig, BSN, MSN, PNP-C

While I have been hearing the word for a number of years now, I’m sure it has been a term that is familiar for anyone in the healthcare field as well. The basics of the meaning is from the Greek language meaning “far – reaching over a distance, carried out between two remote points, performed or operating through electronic transmissions”. The Health Resources and Services administration (HRSA) defines telehealth as the use of electronic information and telecommunications technologies to support and promote long distance clinical health care, patient and professional health relation education. You can also think of it as telemedicine or virtual office visits. Telemetry within our hospitals, are loaded with machinery so that we can monitor our patients from a main work station, without being directly at the bedside.

Why the need?

Even before the worldwide Covid-19 crisis, more health care facilities (brick and mortar), from providers offices to hospitals, including military medicine, were integrating this technology in order to treat patients and improve outcomes. From patients in our rural areas to our astronauts in space, the need is growing. For good or bad, it took this pandemic to thrust our nation into rethinking health care. Federal and state laws have been initiated and opened the door to a welcomed need for change in our current state of health care delivery. This flexibility will open up the ability for patients to finally have access to health care, and in a more timely manner.

So how do we practice telehealth?

1) Technology adoption in most patient populations is sufficient for telemedicine.

I’ve always found that although many patients may not have a personal computer, it is amazing how most have a smartphone.  You may be wondering how we assure safety and privacy, just as we would with in-office visits with the many telehealth platforms. HIPAA compliance is built into these programs.

2) Think of the technology as a tool to provide care the way you always have, but without the patient physically in the office. 

We already know from our course work, back to our basic Physical Assessment classes, that at least 80% of our diagnosis arises from our good history taking skills – not our physical assessment. That can start from your observations via a smartphone or a computer – just as when we begin our observations when we perhaps see a patient interacting in our waiting areas, or when we start viewing and talking via the video technology. Let’s think about our respiratory assessment – are able to talk in complete sentences? Are they posturing? What is their effort in breathing showing us? Is there audible wheezing? Presence and nature of coughing? You can ask them to take a few deep breathes. By now you already have made a decision that they need a higher level of care and have referred them to the office or to the ER. They can assist in other parts of an exam just by instructing them how to do so. For instance, asking them to open their mouth for an oral exam or instructing on how to feel for lumps or bumps.

3) Telehealth increases patients ability to consume health, benefitting you as a provider and the patient. 

Research has shown that patients are happy to be a partner in this care modality.  Much of what we do, depending on the type practice, doesn’t have to be face to face. Research has already established there are a number of common illnesses that are well suited for virtual visits. As mentioned earlier, mental health as well as behavioral health, is in great need of change in the way we destigmatize and offer much needed treatment. Most of any visit is spent establishing rapport with our patient and facilitating self-management skills, so that there is a shared desire to improve the issue. For years, I documented with the words “non-compliant”. I think most of know now that this was a huge barrier and disservice to our patients. We now have learned there are many cultural, belief and behavior systems that have to be accounted for in order to sustain treatment. We are now receiving these skills in our NP/PA programs, such as motivational interviewing, cultural competence, ACE (adverse childhood events)/domestic violence screening, etc., which allow us to understand the whole patient. Maybe soon, we won’t be seeing “non-compliant” in our notes. To repeat a quote by Scott Sells, “People don’t care how much you know until first they know how much you care”. Patients need to be supported, not blamed for “non-adherence”.

What are some limitations to virtual visits?

Just like practicing in person visits, you have to know your limitations and when to refer out.  From that good history taking, we move to the physical exam. And with our observation skills, we already know if a patient is in distress and needs a new level of care. But this would be no different if you were seeing a patient face to face or even a telephone call. Although I am new to telehealth, my research shows that patients who choose to have virtual visits, are more than willing to assist you in any way. You set the stage by letting them know you will be asking them to assist you and always ask permission. Again, this allows them to be in control and having choices. Some of the issues already being identified by research is that we need better clinical training in our programs that include both didactic and clinical components and we need advocacy in the area of legislation to support further applications and reimbursement.

Expanded Roles and Opportunities: So how do you prepare? 

Most students are pretty tech savvy having started in grade school levels and continued into the work settings. We’re already using EMR, telemetry, and many other tech tools utilized within a healthcare setting. Coming into the workforce with those skills, means we just have to transfer those skills into feeling comfortable seeing our patients by way of a computer screen. PA’s and NP’s provide highly reliable health care in any setting.

Virtual health care will allow you to provide the same level of care, the same level of interprofessional collaboration, the same level of team work, and to an increased level of satisfaction, so that you are utilized even more as an integral team member improving patient access and outcomes. You may be the newbie at your next job, who can help facilitate the practice of telehealth that will increase efficiency, decrease costs, and enhance patient satisfaction to a whole new level. You have the ability to do the continued research needed in the area of affordable and safe care. You will all go into your practice settings with many strengths. Unleash those passions, transfer those skills, don’t be afraid to ask, go with your gut feelings, and truly LISTEN to your patients before attempting to change them. Telehealth is here to stay. Let’s maximize the benefits to both the providers and our patients by integrating telehealth intervention into our programs and/or practicums. Maybe even consider your research project related to its use!

Like telehealth, ThriveAP covers many professional development topics during our 12 months of post-graduate, training and education. For more information on professional development, contact us at info@thriveap.com.

Rhonda Hertwig is a recently retired Pediatric Nurse Practitioner (PNP) but still an RN working in several arenas (student med records for studies abroad; grant reviews; telehealth asthma coaching) while living in Western North Carolina. She has her BSN, MSN in Pediatric Nursing, and worked the last 16 years as a CPNP. She has a huge interest in school based nursing as well as advocacy work in the area of DMST.