Tele-medicine, tele-nursing, nursing informatics,e nursing

2. TELEMEDICINE

3. DEFINITION
• According to World Health Organization, telemedicine is defined
as,
“The delivery of healthcare services, where distance is
a critical factor, by all health care professionals
using information and communication technologies
for the exchange of valid information for diagnosis,
treatment and prevention of disease and injuries,
research and evaluation, and for continuing
education of healthcare providers, all in the interests
of advancing the health of individuals and their
communities”.

4. CONT…….
• Telemedicine is defined as any health care
provided to patients via technology across a
distance. (Remmes, Thomson and Williams;
1996).

5. TYPES OF TELEMEDICINE

6. Store- and- forward (asynchronous)
Remote monitoring
Interactive services (synchronous)

7. 1. STORE- AND- FORWARD
• Involves acquiring medical data (medical images,
biosignals) and then transmitting this data to the doctor or
medical specialist at a convenient time for assessment
offline.
• It does not require both the parties at the same time.
• Medical specialties like dermatology, pathology etc is
conducive to this kind.
• Most beneficial for population living in isolated communities
and remote regions.

8. 2. REMOTE MONITORING
• Remote monitoring also known as self- monitoring/ testing.
• It enables medical professionals to monitor a patient
remotely using various technological devices.
• It manages chronic diseases or specific conditions, such as
heart disease, diabetes mellitus or asthma.
• It gives greater satisfaction to patients.
• It is cost-effective.

9. INTERACTIVE SERVICES
• Interactive telemedicine services provide real-time
interactions between patient and provider.
• It includes phone conversations, online communication and
home visits.
• Many activities such as history review, physical
examination, psychiatric evaluations and ophthalmology
assessments can be conducted comparably to those done
in traditional face-to-face visits.
• In “clinician-interactive” telemedicine services may be less
costly than in-person clinical visits.

10. USES OF TELEMEDICINE
• Telemedicine is most beneficial for populations living in
isolated communities and remote regions and is currently
being applied in virtually all medical domains. Specialties
that use telemedicine often use a “tele” prefix; for
example, telemedicine as applied by radiologists is called
Teleradiology. Similarly telemedicine as applied by
cardiologists is termed as telecardiology etc.
• Telemedicine is also useful as a communication tool
between a general practitioner and a specialist available
at a remote location.

11. CONT…….
• The first interactive telemedicine system, operating over
standard telephone lines, for remotely diagnosing and treating
patients requiring cardiac resuscitation (defibrillation) was
developed and marketed by Med Phone Corporation in 1989 in
the U.S served as receiving and treatment centers.
• Monitoring a patient at home using known devices like blood
pressure monitors and transferring the information to a
caregiver is a fast growing emerging service. These remote
monitoring solutions have a focus on current high morbidity
chronic diseases and are mainly deployed for the First World,
Glucometer.

13. BENEFITS OF TELEMEDICINE:
• A) Benefits to Patients.
• B) Benefits for Healthcare delivery system.
• C) Benefits to Health care Professionals.

14. BENEFITS TO PATIENTS:
• Reduced physician’s fees.
• Reduced visits to specialty hospital.
• Reduced travel expenses.
• Early detection of disease
• Reduced burden of morbidity

15. BENEFITS FOR HEALTH CARE DELIVERY
SYSTEM:
• Significant reduction in unnecessary visits &
hospitalization for specialized care at tertiary
hospital
• Earlier discharge of patients
• No need to create physical infrastructure in
remote hospitals.
• Improve monitoring facilities at the rural based
centers.
• Increase stuff productivity.

16. BENEFITS TO HEALTH CARE PROFESSIONALS :
• Improved diagnosis & better treatment
management.
• Continuing education & training.
• Quick & timely follow-up of discharged patients.

17. APPLICATION
• Tele-health care: It is the use of information and communication
technology for prevention, promotion and to provide health care
facilities across distance. It can be divided in the following activities
• Tele-consultation
• Tele-follow-up
• Tele-education: Tele-education should be understood as the
development of the process of distance education (regulated or
unregulated), based on the use of information and telecommunication
technologies, that make interactive, flexible and accessible learning
possible for any potential recipient.

18. CONT……
• Disaster Management: Telemedicine can play an
important role to provide health care facilities to the
victims of natural disasters such as earthquake,
tsunami, tornado, etc and man-made disaster such as
war, riots etc. During disaster, most of the terrestrial
communication links either do not work properly or get
damaged so a mobile and portable telemedicine
system with satellite connectivity and customized
telemedicine software is ideal for disaster relief.

19. CONT……
• Tele-home health care: Telemedicine technology can be
applied to provide home health care to elderly or underserved,
homebound patients with chronic illness. It allows home health
care professionals to monitor patients from a central station
rather than travelling to remote areas chronically ill or
recuperating patients for routine check-ups. Remote patient
monitoring is less expensive, more time savings, and efficient
methodology. Tele-home care virtual visits might lead to
improved home health care quality at reduced costs, greater
patient satisfaction with care, increased access to health care
providers and fewer patients needing transfer to higher, more
costly levels of care. A Computer Telephone Integrated (CTI)
system can monitor vital functions of patients twenty four hours
a day and give immediate warnings.

20. BARRIERS
• Physician/ Patient Acceptance
Physicians and patients have unique technological resources
available to improve the patient-physician relationship. It has been
found that patients have no difficulty in accepting telemedicine
program. The survey conducted by SGPGIMS tele-follow up program
for the patients of Orissa state revealed that 99% patients were
satisfied as they don’t have to travel 1500km to show their diagnostic
reports to their doctors. In tele- consultation they were also happy that
they get the specialist consultation and their cases have been seen by
some expert doctors. Doctors in government sector tend to look upon
telemedicine as an additional duty or workload. Therefore, there is
need to weave telemedicine into the routine duties of the doctors. The
private doctors sometime fear that telemedicine is likely to increase
their practice further.

21. CONT…….
• Availability of Technology at a Reasonable Cost
It is myth that to establish a telemedicine
platform is an expensive. The basic system needs
hardware, software and telecommunication link. In
all areas there is a significant reduction in the
prices. Most of these costs are well within the reach
of most of the hospitals, and can be removed by
nominal charge to the patients and students in case
of tele-education which would be much less than
the physically travelling.

22. CONT…….
• Accessibility
Although information technology has reached
in all corner of the country but the accessibility of
people living in remote and rural area to the
nearest health center (PHCs, CHC or district
hospital) may not be easy due to poor
infrastructure of road and transport. It may be
possible that the available telemedicine system in
the health centers may not function because of the
interruption in power supply

23. CONT…….
• Reliability
Some health care professionals has doubt about the quality
of images transmitted for consultation and tele-diagnosis. In
tele-radiology, telepathology, tele-dermatology the quality of
image (colour, resolution, field of view etc) should be
international standards to avoid any wrong interpretation and
mis-diagniosis. The delay in transmission of data may be of
critical importance in tele- mentoring and robotic surgery and
have to be reduced to the minimum.

24. CONT……..
• Lack of Trained Manpower
Telemedicine is a new emerging field, there is lack of training
facilities with regards to application of IT in the field of medicine.
Most of the health care and IT professionals are net familiar with
the terms commonly used in telemedicine such as HIS, EMR,
PACS, etc. telemedicine is also not the part of course curriculum of
medical schools.
• Legal & Ethical
Telemedicine technology has been proved and established
and its advantages and benefits are well known but still many
health care professionals are reluctant to engage in such practices
due to unresolved legal and ethical concerns. In case of a cross-
border tele-consultation which country’s litigation laws will be
applied in case those of the country in which the patient is living or
those of the remote physician.

25. CONT…….
• Privacy and security concerns
There are many issues that should be considered
regarding the security, privacy and confidentiality of patient
data, in telemedicine consultations. How are patient’s rights
of confidentiality of their personal data ensured and
protected? How to ensure security of the data and restrict
its availability to only those for whom it is intended and who
are authorized and entitled to view it? How to prevent
misuse and even abuse of electronic records in the form of
unauthorized interception and /or disclosure?

27. DEFINITION
Tele-nursing refers to the use of
telecommunications and information technology
for providing nursing services in health care
whenever a large physical distance exists between
patient and nurse, or between any numbers of
nurses.

28. NEED FOR TELENURSING IN INDIA:
The health of a nation is the product of many factors and
forces that combine and interact. Economic growth, per
capita income, literacy, education, age at marriage, birth
rates, information on health care and nutrition, access to
safe drinking water, public and private health care
infrastructure, access to preventive health and nursing
care and the health insurance are among the contributing
factors.
The advances in Medical science, biomedical
engineering on one side and Telecommunication and
Information Technology on the other side are offering wide
opportunities for improved health care.

29. NEED FOR TELENURSING IN INDIA:
Despite making huge strides in overall
development, the health coverage to majority of
our population is still a distant dream.
India is a vast country gifted with rich and ancient
historic background and geographically the nature
has provided India with all the varieties like the
mountain regions like Ladakh, deserts, green
planes and far flung areas in the north east and
offshore islands of Andaman’s and Lakshadweep.

30. NEED FOR TELENURSING IN INDIA:
India today has more than 1 billion population and there
is finite limit of elasticity in providing health care in terms
of infrastructure, facility, the manpower and the funds.
Wide disparities persist between different income groups,
between rural and urban communities, and between
different states and even districts within States.
The population is predominantly rural and distributed in
distant geographical locations apart from the high-density
urban areas; to provide the basic minimum health care
has been one of the priorities of the Health administration
all along.

31. NEED FOR TELENURSING IN INDIA:
Further this is compounded by the following factors like:
High cost of health care and lack of investment for health
care in rural areas.
Inadequate medical facilities in rural & inaccessible
areas.
Problem of retaining nurses in rural areas where they are
required to serve & propagate widespread health
awareness.

32. APPLICATIONS
• Tele nursing applications is home care. For example, patients
who are immobilized, or live in remote or difficult to reach
places, citizens who have chronic ailments, such as chronic
obstructive pulmonary disease, diabetes, congestive heart
disease, or disabilitating diseases , such as neural degenerative
diseases (Parkinson’s disease, Alzheimer’s disease, ALS) etc,
may stay at home and be “visited” and assisted regularly by a
nurse via videoconferencing, internet, videophone etc. Still
other applications of home care of patients in immediate post-
surgical situations, the care of wounds, ostomies, handicapped
individuals etc. In normal home health care, one nurse is able to
visit up to 5-7 patients per day. Using tele nursing, one nurse
can visit 12-16 patients in the same amount of time.

33. CONT……
• A common application of tele nursing is also used by call
centers operated by managed care organizations, which
are staffed by registered nurses who act as case
managers or perform patient triage, information and
counseling as a means of regulating patient access and
flow and decrease the use of emergency rooms.
• Tele nursing can also involve other activities such as
patient education, nursing tele consultations, examination
of results of medical tests and exams, and assistance to
physicians in the implementation of medical treatment
protocols.

34. LEGAL, ETHICAL AND REGULATORY ISSUES
• Tele nursing is fraught with legal, ethical and
regulatory issues, as it happens with tele health as a
whole. In many countries, interstate and intercountry
practice of tele nursing is forbidden (the attending
nurse must have a license both in her state/ country of
residence and in the state/ country where the patient
receiving telecare is located). Legal issues such as
accountability and malpractice etc. are also still
largely unsolved and difficult to address. In addition,
there are many considerations related to patient
confidentiality and safety of clinical data.

35. GUIDELINES FOR TELE-NURSING (GIVEN BY
AUSTRALIAN NURSING AND MIDWIFERY COUNCIL)
• Nurses and midwives practicing in tele nursing shall be registered
nurses or midwives. Enrolled nurses involved in tele nursing need to
be under the supervision of a registered nurse or midwife.
• Nurses and midwives practicing tele nursing are personally
responsible for ensuring that their nursing and/or midwifery skills and
expertise remain current for their practice.
• Nurses and midwives who are practicing tele nursing in Australia are
expected to practice within the framework of the ANMC National
Competency Standards for Registered Nurses, National Competency
Standards for the Midwife, the ANMC Code of Professional Conduct
for Nurses in Australia and other relevant professional standards.

36. CONT…….
• The legal issues involved in tele nursing across jurisdictions
are still untested and therefore unsettled. In the absence of a
settled position, it is the ANMC’s view that nurses and midwives
are required to be registered in the jurisdiction where they are
located when providing the tele nursing advice, and also in
each jurisdiction where their tele nursing advice may be
received and acted upon. Nurses and midwives should discuss
the need for multiple registration status with their employer and
the relevant NMRA, and the need for professional indemnity in
all jurisdictions with their employer.
• Nurses and midwives have a duty to inform consumers of their
name, qualification and registration status. Consumers may
wish to confirm registration status with the relevant nursing and
midwifery regulatory authority.

37. CONT…….
• Nurses and midwives should inform consumers of tele health
process including other person/professionals who may be
participating or present in the tele health consultation and obtain
consent before proceeding.
• Nurses and midwives in tele nursing have a duty to provide privacy
and confidentiality in all interactions.
• Nurses and midwives must comply with government and institutional
policies relating to privacy, confidentiality, informed consent,
information security and documentation during the provision of tele
nursing care. Nurses and midwives are required to documentation
during the provision of tele nursing care. Nurses and midwives are
required to document all interactions during the tele nursing
consultation.

38. CONT……..
• Nurses and midwives practicing in tele nursing should be
aware of both the evidence base for the practice and the
areas of practice in need of research.
• Nurses and midwives practicing tele nursing should engage
in evaluation of their practice in relation issues of quality,
safety and patient outcomes.
• Enquiries regarding a nurse or midwife’s registration status
or complaints about practice can be made to the relevant
nursing and midwifery regulatory authority with which the
nurse or midwife registered to practice.

39. NURSING
INFORMATICS

40. NURSING INFORMATICS
• Is the integration of nursing, its information,
and information, management with information
processing and communication technology, to
support the health of people world wide.
-----(International Medical Informatics
Association )

41. • Nursing Informatics is a specialty that integrates
nursing science, computer science, and information
science to manage and communicate data,
information, and knowledge in nursing practice.
---- American Nurses Association.
• Nursing information management and processing: a
framework and definition for systems analysis, design
and evaluation.
-------- William Goossen

42. USE OF COMPUTERS IN NURSING
EDUCATION
• Literature Access and Retrieval
• Computer Assisted Instruction
• Classroom Technology
• Distance Learning
• Testing
• Student and Course Record Management

43. USE OF COMPUTERS IN NURSING PRACTICE
• Bedside Data Entry (medication record etc)
• Computer-Based Patient Records
• Client Monitoring- Local and Distant
• Telenursing
• Practice Management
• (scheduling)

44. USE OF COMPUTERS IN NURSING ADMINISTRATION
• Human Resources
• Medical Records
• Quality Assurance
• Accreditation
• Budget and Finance

45. USE OF COMPUTERS IN NURSING RESEARCH
• Literature Search
• Data Collection
• Data Analysis
• Research Dissemination

46. FUNCTIONS OF NURSING INFORMATICS
• 1. Patient classification for assistance with
staffing and scheduling.
• 2. Care planning and documentation to reduce
the inordinate amount of time nurses spend on
managing, communicating, documenting patient
information.

47. • 3.Quality assurance for evaluating the
quality of nursing services based of number
of facts namely patient records, nursing
care plans, patient care criteria etc.
• 4 Order management, reporting to
enhance communication between nursing
and other departments.

48. FUNCTIONS OF NURSING INFORMATICS
• 5 Inventory, for communications between the
nursing dept. and materials management for
supplies.
• 6 Discharge planning, for standardized
discharge plans.
• 7 Evaluation of nursing services by reports or
query.

49. BARRIERS TO NURSING INFORMATICS:
• 1. Nursing does not have a universally
accepted a defined vocabulary.
• 2. Communication.
• 3. Information security.
• 4. Inadequate support.

50. • 5. Restricted access to training and training
systems for nurses and
• Nursing students.
• 6 Few leaders and educators with NI skills.
• 7. Limited empirical support for the contributions
which realistically
• Make to nursing and patient outcomes.

51. E-NURSING

52. E – NURSING
• Nurses all around the world have risen to the
challenge of new technology. Today, the nurses work in a
variety of E-Health programs such as tele-triage. They
access online libraries and databases of clinical practice
guidelines from computers in their work places. Nurse in
specialized areas of practice now interact with their
peers in discussion groups over the internet. Nurses are
also involved in standards development for the
implementation of electronic health records and many
nursing educational programs are now offered online.

53. GOAL OF E-NURSING
• To enhance nurses to benefit from all
developments in information, communication and
technology, to improve nursing and client
outcomes.

54. TYPES OF E – NURSING
• Smarter Decision Making:
ICT initiatives such as electronic health
records, telehealth, databases, e-mail and internet
resources enhance the decision-making process.
They give nurses access to timely, evidence-
based and expert information, enabling them to
make swifter, better-informed judgments on behalf
of their patients. The result is safer patient care
and better health outcomes.

55. CONT……..
• E – Nursing work outs:
Nurses reap the full benefits of technology into
their daily practice. Health care organizations are
beginning to acknowledge the necessity of
providing nurses with access to information,
communication and technology that supports
nursing care, yet the implementation of such tools
needs to be accelerated.

56. PURPOSE OF E – NURSING
• To guide the development of ICT initiatives in
nursing so that nursing practice and client
outcomes are improved.

57. IMPORTANCE OF E – NURSING
• It has got the tremendous potential to
improve the practice of nursing, if applied in
appropriate and useful ways.

58. METHODS
E-learning methods may include the following
• Computer-based training
• Web-based lectures and presentations
• Virtual classrooms in which learners are logged on
to an online classroom environment at different
times (asynchronous) or at the same time
(synchronous) as the learning activities are
happening.

59. E – NURSING STRATEGY FOR PROFESSION
• Nurses In Clinical Practice
 Participate in ICT initiatives, identify needs and evaluate possible
solutions.
 Increase competence in use of ICT.
 Access multiple source of information for evidence-based practice.
• Employers and Administrators
 Recognize ICT as a tool of professional nursing practice.
 Support involvement of nurses in ICT initiatives.
 Encourage adoption of ICT that supports nursing practice.

60. CONT……
• Educators and Researchers
Incorporate ICT competencies into curriculum.
Develop research programs to optimize nurses’ use
of ICT.
• Nursing Organizations
Provide leadership for nurses’ involvement in ICT.
Recognize ICT competencies as part of entry-level
and continuing competence requirements.

61. BENEFICIARIES OF E – NURSING
• Individual nurses
• Their clients
• Employers
• Nursing professional
• Regulatory organization
• The profession as a whole both nationally and
internationally.

62. ADVANTAGES OF E – NURSING
• Integration of information, communication and technology.
• Improved information and knowledge in the nursing
practice.
• Human resource planning will be facilitated.
• New models of nursing practice and health services
delivery will be supported.
• Nursing group will be well connected.
• Improves the quality of nursing work environments.
• Contribution to the global community of nursing.

63. DISADVANTAGES
• High expense
• Decreases manual contribution
• Increases dependence on ICT
• Misuse of the technology provided