Telehealth was first practiced by Alexander Graham Bell in 1876 after he invented the telephone. He accidentally spilled battery acid on himself and asked for assistance over the phone line. The Lancet carried an article in 1879 discussing the use of the telephone to reduce avoidable office visits. This was the first time delivery of healthcare over the telephone was noted in the literature.
In the 1970s and 1980s, Health Maintenance Organizations (HMOs) were introduced as well as a capitated reimbursement system (a fixed amount is paid per enrollee to cover a defined scope of services). The need to contain costs, so as not to exceed the capitated rate, led to nurses taking on the role of triaging patients and providing advice over the telephone; in essence, they became the gatekeepers to the time, place, and mode to access care.
During this same time, hospitals developed nurse call centers as a public relations tool. The role of the nurse was to support marketing initiatives, such as health fairs, physician referrals, and provide health education and advice. Eventually, the nurse triage and advice nurse function evolved into these hospital-based nurse call centers as well as in HMOs.
In the 1990s, telephone triage registered nurses (RNs) were recognized for improving access to healthcare, improving the efficient use of resources, and positive clinical outcomes. Additionally, these nurses provided patient education, and increased physician, patient, and nurse satisfaction while providing effective quality care.
The American Academy of Ambulatory Care Nursing (AAACN) established standards of care specific to telehealth nursing and endorsed a national certification for Telephone Nursing Practice from 2001-2007. In 2007, it was determined that telehealth was not a sub-specialty of nursing, but rather an integral component of ambulatory care nursing. It subsequently became part of the Ambulatory Care Nursing Certification Exam.
The invention of the telephone was key to the early practice of telehealth nursing, but the invention and growth of the Internet and other technologies is moving the practice forward. In addition, the Affordable Care Act of 2010 funded Accountable Care Organizations that created new roles for nursing in care coordination and transitions management. The new roles rely heavily on telehealth technology. Chronic illness and rising healthcare costs have increased the focus on the quality of care and have influenced the development of services that incorporate telehealth nursing as a care delivery strategy.
Today, telehealth continues to push us to reimagine nursing practice across the continuum. Because of the spiraling costs of healthcare, the growing number of chronically ill patients, and the need to provide access to those in rural and underserved areas, telehealth nursing continues to evolve to meet these demands.
The pandemic has given rise to telehealth emerging as a mode for delivering healthcare that is convenient, mitigates the provider and nursing staffing shortages, increases efficiencies, reduces cost, and increases customer, provider, and nursing satisfaction. Telehealth is here to stay and the endless possibilities of how we can develop a new healthcare delivery model are exhilarating.
Authored by Cindy Ebner, MSN, RN, CPHRM, FASHRM and Colleen Harris Marzilli, PhD, DNP, MBA, RN-BC, CCM, PHNA-BC, NEA-BC, FNAP
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