The Science and Art of Telehealth Nursing Practice

Video Transcription

Telehealth, or telemedicine, is the practice of using telecommunication technology to provide health care and health related education remotely. Telemedicine is governed by guidelines similar to that of a typical health care setup. Overall, these guidelines are in accordance with the Health Insurance Portability and Accountability Act, or HIPAA, and are set by the Federation of State Medical Boards, or FSMB. The nurse needs to be aware of the existing telehealth laws where both the practice and client are located.

Firstly, most states require the physician to be licensed in the state where the client resides. Next, a physician patient relationship must be established, which is done when a health care practitioner agrees to treat the client and the client agrees to be treated, regardless of whether an in-person encounter has occurred or not. Some states require a pre-existing relationship and an in-person physical examination before the virtual encounter.

Strict standards must accompany telemedicine procedures, and the nurse must introduce themselves with their credentials, verify the client's identity and location, and obtain informed consent. The nurse should be aware that a significant concern with telemedicine is the privacy and security of health information. For this purpose, the law requires that the technology used to exchange health information should support fully encrypted data transmission, be guarded against cyber attacks, and not store the video and audio.

Also, inform clients regarding backup plans, in case of technology or equipment failures during the telemedicine encounter, or should the client require emergency medical attention.

When prescribing medications via telemedicine, the health care providers should be aware of the physician's state board's safety recommendations, availability of medications in the client's geographical location, and other providers caring for the patient. Care should be taken, especially while prescribing medications like anticoagulants that need close monitoring, or that could lead to acute changes in a patient's condition, particularly if the patient is not near an emergency health facility.

Finally, the medical records and informed consent for telehealth sessions should be meticulously maintained and be available to the client to share with their other health care providers.

Now, with the rules in place, the scope of telemedicine is vast and continues to expand. However, it's no replacement for traditional medical practice, since it lacks the ability to provide physical exams and interventions. The nurse should be aware of conditions that are beyond the scope of telemedicine and request a direct appointment before giving medical advice.

There can also be problems with the technology used in telehealth. One such issue is e-iatrogenic errors, which occur through faults in information and communication technology. For instance, a certain hospital has an automated system that usually alerts the nurse about clients' abnormal lab values, alerting them to schedule a telehealth checkup visit.

One day, a technology error occurs and fails to alert the nurse that a client's white blood cell count is critically low. As a result, the client wasn't scheduled for a checkup, developed an infection, and became critically ill. It's essential that the nurse is aware of potential e-iatrogenic errors and be aware of potential harm to patient care.

As a quick recap, the standards of practicing telehealth is set by the FSMB according to the HIPAA guidelines. They have guidelines in place regarding the physician's license, encounter with the client, informed consent, technology used for health information transmission, prescription of medication, and maintenance of medical records.

Although the scope of telehealth is vast, it's no replacement for traditional medical practice. It's limited by the lack of physical interventions, security and privacy issues, and technological malfunctions called e-iatrogenic errors.