Telemedicine and Nursing

Fifty years ago, it was common for doctors to make home visits to care for their patients. Fast-forward to today when home visits aren’t common anymore, but an ill patient can still receive medical treatment from the comfort of his or her own home virtually thanks to telemedicine. Health care has come a long way since the days of personalized home visits from physicians. The advancement of telemedicine has drastically changed the delivery of health care.

What is Telemedicine?

Telemedicine allows delivery of near instantaneous communication between patient and provider—or in many cases, provider-to-provider consultations. The technology has evolved so much that a provider can communicate with a patient in real-time with the use of audio and video, which is how many people believe telemedicine is delivered, but in reality telemedicine takes many forms.

One form of telemedicine one may not consider is the transmission of information from provider-to-provider such as electrocardiograms (ECGs) and radiologic images for consults. Telemedicine has made consultations between providers millions of miles away possible. Providers can also use telemedicine to get real-time information from their patients like blood glucose, blood pressure, and other vital data to coordinate effective care.

Early telemedicine applications were developed due to concerns of limited access to remote populations of health services rather than the convenience it’s used for today. Forms of telemedicine have been around since the invention of the telegraph in the mid 1800’s. Telegraphs and telephones pioneered telemedicine, since health care consults were delivered through these means among providers. The concept of the virtual consult we are accustomed to today was astonishingly predicted by a magazine entitled “Radio News” in 1924. The magazine published a prophetic cover depicting a “radio doctor” who could see and be seen by patients through the television screen decades before the technology existed.

The most common form of telemedicine that comes to mind when discussing telemedicine today is the virtual provider-to-patient consultation. Providers are able to diagnose and prescribe to patients who can’t make it to the doctor’s office when they are ill. Systems are so advanced now that patients can download an app and set up a consult with a provider over their cell phone in minutes. Applications and uses of telemedicine vary depending on the setting.

How it Benefits Nursing

Natasha Prevost, FNP-BC, provides telemedicine services for a Dallas-based wellness company providing corporate biometric screenings and heart disease prevention education. “I am responsible for providing each health plan member with a consultation in regards to their biometric screening results. I also provide education in regards to modifiable risk factors and disease prevention, specifically metabolic syndrome and heart disease.”

The ability to provide care in a virtual manner to isolated communities is a way for nurses to reach people who may not otherwise be able to get medical help. Telemedicine also offers convenience for the nurse and patient alike when one is unable to leave their home due to illness or transportation issues. Prevost’s company switched to virtual consults early this year and, though there was backlash at first, the patients and providers have embraced the change for the better. “This mode of care delivery has been well received with our population,” say Prevost. “Providing services via telemedicine has been a highly effective avenue for use to reach increased volumes of patients living in remote areas. In this way, we are able to spend an adequate amount of time promoting prevention and wellness comfortable and privately to a diverse population.”

Implementing virtual consults can offer many benefits; it can save money, allow for greater time with patients, allow more flexibility for scheduling, and allow more patients to be seen since multiple providers can consult at the same time. Telemedicine is a convenient alternative to the typical doctor’s vision offering convenience to both the patient and the provider. Some telemedicine applications can be accessed from home by the provider allowing less missed work time if the provider cannot be on-site. Remote sites can also be covered when the conditions are not favorable or when there is a shortage of nurses in the immediate area.

The Challenges

Although it can provide many benefits, telemedicine is not without problems. One issue is that providers cannot do a consult across state lines unless the provider is licensed in the same state the patient is located. The ability to reach certain populations is limited based upon how many state licenses a provider holds.

Another issue is in regards to billing—some insurance companies will only pay for face-to-face consults; over the phone consults don’t count. Telemedicine carried out through a virtual manner with audio and video would be considered a face-to-face consult and can be billed, but a grey area could arise when the audio portion of the virtual consult is working, but the video is not. How would a company be able to bill then? In addition, IT issues that may arise with a virtual consult could ultimately affect the patient experience, lowering patient satisfaction scores.

The types of conditions addressed vary among the companies who have forged ahead in virtual medicine. Some companies actually diagnose and prescribe virtually, while others only offer consultations through telemedicine. Prevost’s company employs nurse practitioners to communicate with patients regarding their risk factors for metabolic syndrome—all while the patient is at work. The company is known for completing worksite evaluations, but just recently transitioned to the remote format earlier this year. “Because my company simplifies processes for our consultations, both the patients and providers have been highly satisfied,” she says. Patients connect with a nurse practitioner—who must be licensed in the state in which the patient is located—to review risk factors after they have undergone a series of biometric screenings at their place of employment. The whole process, including the consult with the nurse practitioner, takes about 45 minutes from start to finish.