course materials

1. Informatics And Telehealth In Rural Medicines TedEx Video Analysis
Informatics And Telehealth In Rural Medicines TedEx Video AnalysisInformatics And
Telehealth In Rural Medicines TedEx Video AnalysisUse understanding of informatics and
telehealth to post a discussion that answers the following questions: How can telehealth
tools improve outcomes? What populations of patients can benefits from these tools? What
are the consideration for telehealth that need to be address in terms of providers and
patients in order for these programs to be successful.Should be in APA styleI attached some
articles and also a link to a video that my helpORDER NOW FOR CUSTOMIZED,
PLAGIARISM-FREE PAPERSBRIEF REPORT Nurse Practitioners in Telehealth: Bridging the
Gaps in Healthcare Delivery Kristi Henderson, DNP, FNP, Tearsanee Carlisle Davis, DNP,
FNP, Mary Smith, DNP, FNP, and Melissa King, MSN, FNP ABSTRACT There is no denying
that many changes must be made in the health care delivery system in order to meet the
needs of all people and improve the health of our nation. Because of advances in technology
over the past 2 decades, telehealth has greatly improved patient access to health care and
equipped providers with innovative tools to provide quality health care to a larger
population. The health care climate demands an innovative approach to health care delivery
with an attention to scalable and sustainable models. Telehealth, and the use of nurse
practitioners, will be an integral part of these new models. Keywords: connected care, nurse
practitioners, telehealth, telemedicine Ó 2014 Elsevier, Inc. All rights reserved. T here is no
denying that many changes must be made in the health care delivery system in order to
meet the needs of all people and improve the health of our nation. Because of advances in
technology over the past 2 decades, telehealth has greatly improved patient access to health
care and has equipped providers with innovative tools to provide quality health care to a
larger population.1 No longer does geographic location limit the health care services one
can access. The health care climate demands an innovative approach to health care delivery
with an attention to scalable and sustainable models. Telehealth, and the use of nurse
practitioners (NPs), will be an integral part of these new models, which provide a scalable
approach to coordinated and collaborative care. However, the widespread adoption and
integration of telehealth can be dif?cult. Informatics And Telehealth In Rural Medicines
TedEx Video AnalysisTelehealth is a broad term that includes videoconferencing, exchange
of medical information via electronic communications, remote patient monitoring,
population health management, and mobile health technologies.2 Our academic medical
center (AMC) has answered the call to minimize health care disparities related to
geographic barriers to gain access to health care by using technology to bring collaboration

2. among multiple disciplines in a virtual environment. Our AMC operates a system-wide
center for telehealth that began as a pilot project nearly 11 years ago. The ?rst program that
launched www.npjournal.org in 2003 was the telemergency program. This program uses
NPs as the distant site providers and allows for direct connection to board-certi?ed
emergency physicians at our level I trauma center for a higher level of care using
telecommunication equipment.3 In some rural areas, the closest, fully staffed emergency
room was 40 miles away, and some rural emergency rooms were staffed with physicians or
NPs with little or no formal emergency medicine training. As a result, the AMC frequently
received poorly managed critical care patients in transfer to their emergency department,
and some patients did not make it that far. The tele-emergency program trains NPs through
an intense didactic and clinical continuing education program that is in addition to the
education received as a part of the NP’s formal degree-granting education and certi?cation
required for practice. The content is focused on the clinical knowledge and diagnostic
procedure skills necessary to work in an emergency department and incorporates
appropriate use of the telemedicine equipment, which allows them to collaborate with
board-certi?ed emergency medicine physicians. This curriculum focuses on topics such as
the approach to the emergency patient, cardiac emergencies, psychiatric emergencies,
toxicologic emergencies, obstetrical emergencies and delivery, and pediatric and orthopedic
emergencies. This content is taught through a combination of inperson classes, online
modules, simulation laboratory The Journal for Nurse Practitioners – JNP 845 sessions, and
clinical rotations. Once the NP completes this 3- to 6-month training, they may go on to staff
rural emergency departments that are a part of the AMC’s telehealth network. This program
provides a sustainable model for the utilization of NPs to positively impact rural
communities through telemedicine. Informatics And Telehealth In Rural Medicines TedEx
Video AnalysisIn this program, the NP uses bidirectional audioconferencing and
videoconferencing for collaboration with emergency medicine physicians at the academic
medical center (Figure 1). The rural hospital emergency departments are out?tted with
telemedicine equipment that is either mounted in the emergency department’s examination
room or contained on a telemedicine cart that allows for mobility between examination
rooms in the emergency department and the inpatient hospital rooms. In either scenario, a
video monitor, camera, and microphone allow for videoconferencing between 2
geographically distant sites. The NP can easily consult with the AMC’s department of
emergency medicine’s physicians or a stroke neurologist with a push of a button. Any of the
AMC’s resources and specialties can be consulted as the emergency physician deems
necessary. This virtual care team provides a treatment recommendation to the NP at the
rural hospital. Should the patient require a transfer to a facility offering expanded services,
the care that was delivered through telemedicine results in an improved transition of care
from the rural hospital to the academic medical center. A study by Henderson et al4
compared patient outcomes of cardiac arrest patients in 8 rural hospitals using the
telemergency program to that of our AMC. The survival of cardiopulmonary arrest patients
in rural emergency departments has historically been signi?cantly lower than that in the
Figure 1. AMC telemedicine workstation. 846 The Journal for Nurse Practitioners – JNP
urban emergency department setting. In this study, rural emergency departments using

3. resuscitation guided by telemedicine consultation with emergency specialists were found to
have survival rates that were not signi?cantly different from those in our AMC. This ?nding
suggests that telemedicine may improve the quality of emergency care delivery in the rural
setting.4 Although the impact on access to care and quality of care is critical, in order for a
telehealth program to be adopted and integrated, there must be a solid business plan that
shows a positive return on investment. The economic evaluation of a telehealth program to
determine the bene?t-cost analysis should consider the broad range of impact a program
has on the health of individuals; the workforce and populations, and the impact on new jobs,
economic development, and the cost of health care.5 The ?nancial impact of a telehealth
program on a hospital or other clinical entity can be assessed in a number of ways such as
the ability to retain patients admitted in the community hospital (avoiding unnecessary
transfers of patients), a reduction in medical staf?ng costs (shared resources), an added
medical service line, a decrease in the length of hospital admission, and/or the prevention
of a ?nancial penalty from hospital readmissions. Informatics And Telehealth In Rural
Medicines TedEx Video AnalysisThe literature is growing to show the positive ?nancial
impact and the win-win scenario found in a telehealth program.5-10 In some cases,
telemedicine has prevented the unnecessary transfer of a patient to the AMC when the
condition could have been managed at the local hospital with support via telemedicine. This
results in bene?ts for both the patient and the rural hospital. If the patient is stabilized and
can stay at their local hospital, they are closer to home and family and are able to receive
the care they need in a familiar environment. If the rural hospital is able to keep the patient,
it keeps the revenue in the community and expands that hospital’s ability to support the
community. In an analysis of the ?rst 8 tele-emergency hospitals, a comparison was done
between the operational cost and the hospital census pre- and postimplementation of the
telemergency program. The program analysis revealed a decrease in provider staf?ng costs
of 25% in the tele-emergency model and showed an increase in the distant hospital patient
admissions of 20%.11 Although this report has Volume 10, Issue 10, November/December
2014 been submitted for peer review and publication, the ?ndings have already led to
telemedicine program expansion and increased adoption. With avoided transfers, the AMC
is then able to focus on the more critically ill patients who need the level of care only they
can provide. The success of this initial telehealth program and the increase of supporting
literature created the impetus for us to replicate this model in other specialties. Over the
past 10 years, the institution has expanded this initial program to a statewide telehealth
network and achieved the designation as a center for telehealth in July 2013. The center is
led by a chief telehealth and innovation of?cer who is a doctorally prepared nurse. The
mission of the center for telehealth is to ?ll the gaps in health care and to improve the
quality and accessibility of health services in order to decrease health disparities, manage
chronic diseases, and improve the quality of life. Our center for telehealth supports the
institution’s commitment to provide health care statewide and matches the state’s need and
demand for telemedicine services. To date, over 30 different specialties are being offered
via telemedicine to over 100 unique nonaf?liated sites across our state, many of which are
manned by NPs. The center is now receiving requests nationally and internationally to
extend these telehealth services outside the state. Currently, the AMC’s telehealth program

4. does not extend outside of the state. TELEHEALTH TODAY Telehealth is being delivered in a
variety of inpatient and outpatient settings in our state, providing services such as
telestroke, teledermatology, telepediatrics, telepsychiatry, teleneonatology, and
telecardiology care to underserved areas. A primary focus of telehealth programs is to ?ll
the need for health care providers, thereby improving access to care for anyone, regardless
of their location. In October 2013, our AMC hired its ?rst telehealth NP dedicated to the
delivery of health care through telehealth technology for corporations and schools (Figure
2).Informatics And Telehealth In Rural Medicines TedEx Video AnalysisThe program uses e-
clinics to deliver care to students in their school clinics and to employees in their workplace.
Because of this program, employees are able to seek care for minor illnesses without
leaving www.npjournal.org Figure 2. Corporate Telehealth workstation. work. Employers
bene?t from this service because it limits the loss of productivity and reduces health care
costs. The program has seen great success in the pilot phase and has hired 2 additional NPs
to meet the demands of Mississippi corporations. The school telehealth program is similar
in that students are allowed to receive episodic care for minor illnesses via telehealth,
which allows parents to stay at work when they choose to do so. In this program, the school
nurse serves as the facilitator who connects to the telehealth system for an NP teleconsult at
which time the patient is assessed, diagnosed, and treated. If there are needs that require
in-person examination or follow-up, the NP coordinates these appointments with a local
provider in the patient’s community. The bene?t is that students who may not have a
primary care provider have access to care when they need it and receive assistance in
securing a medical home for ongoing needs. NPs working in these 2 programs have a family
medicine and/or urgent care background and are knowledgeable about resources in the
community. COORDINATION OF CARE IN THE COMMUNITY Health care reform is placing a
strong focus on the coordination and continuity of care among all populations but
speci?cally for those populations with multiple chronic illnesses and risk factors, which
leave them the most vulnerable.12 Risk factors such as polypharmacy, poor health literacy,
and lack of supportive resources place a greater need for interprofessional collaboration
and can all be The Journal for Nurse Practitioners – JNP 847 positively affected with the
appropriate use of telehealth. Telehealth will play an instrumental role in the utilization of a
collaborative approach that delivers quality care, enhances patient safety, and generates
cost savings.13Informatics And Telehealth In Rural Medicines TedEx Video
AnalysisTelemedicine is instrumental in preventing excessive health care costs through
remote patient monitoring. Research studies are beginning to reveal the impact of remote
patient monitoring on hospital readmissions, disease management, avoidance of emergency
room visits, and patient satisfaction.10,14,15 A study by Pekmezaris et al10 studied the
impact of remote patient monitoring on heart failure patients. The study indicates that
remote patient monitoring has the potential to provide a cost-effective and convenient
method to manage heart failure.10 Remote patient monitoring aids in containing healthcare
costs by enabling nurses and other health care providers to intervene when there is a
change in health status and eliminates the need for costly home care visits for monitoring
only.16 Cost savings are seen with an ef?cient and coordinated delivery system that
minimizes exacerbations of chronic illnesses, curtails adverse events, reduces

5. hospitalizations, and reserves the use of emergency rooms for truly emergency care. The
National Rural Health Association reports that rural areas have greater shortages of
primary and specialty health care providers, a larger population of individuals who rely on
Medicare and Medicaid, an increased prevalence of chronic disease, and geographic barriers
that force travel over long distances in order to gain access to specialty health care
services.17 Telehealth technology will allow for vulnerable populations in underserved
areas to overcome some of these challenges by reducing geographic disparities and health
care workforce shortages and increasing access to preventive services. An example of how
telemedicine is bringing needed services to the rural community is telepsychiatry. There is
a vast shortage of mental health providers in rural communities. Often, primary care
providers are forced to treat patients suffering from mental illness without the expertise of
mental health professionals. Telepsychiatry allows patients in rural communities to have
access to the same level of care as those in 848 The Journal for Nurse Practitioners – JNP
larger cities by using videoconferencing to conduct mental health evaluations and regular
follow-up.18 The provision of subspecialty care to children with special health care needs
who live in rural communities is also a bene?t of using telehealth. Traditionally, parents
would be taxed with the burden of traveling far distances to receive the care that their
children needed. Marcin et al19 reported that pediatric subspecialty consultations can be
provided to these children with high satisfaction for families and rural
providers.Informatics And Telehealth In Rural Medicines TedEx Video AnalysisThe
utilization of telehealth has the potential to meet the Institute for Healthcare Improvements’
triple aim for better health, better health care, and lower costs.5-10,13,15 Population health
management and chronic disease management programs are also capitalizing on the use of
technology.14 A program recently implemented by our AMC, the Mississippi Diabetes
Telehealth Network, aims to bring a diabetes care team to an existing rural health clinic that
currently does not offer any specialty care. Diabetics whose disease is currently
uncontrolled are eligible for this program. Patients enrolled in the program are provided
with a computer tablet that allows for realtime health sessions and coaching as well as
remote monitoring of vital signs and glucose levels.20 The community physician or NP in
the rural health clinic will have access to endocrinologists, ophthalmologists, specialty NPs,
nurses, diabetes educators, pharmacists, and nutritionists to bring a team approach to their
health care. Until now, this type of approach was only accessible to those in urban areas.
Because so much of diabetes management is related to behavior and life style changes, this
program will also provide daily health sessions delivered through a computer tablet to
include symptom and compliance assessment, education, and remote monitoring of the
patient’s glucose level and vital signs. NPs who staff the rural health clinic will be able to
refer patients to specialists located at the AMC for care that would otherwise not be
accessible. It is expected that patient compliance to treatment will improve because their
primary care provider, the NP, will be able to facilitate additional services via telemedicine.
This is another example of how NPs are pivotal in the improving access to care in rural
communities. Volume 10, Issue 10, November/December 2014 CRITICAL CARE SERVICES
The use of technology can provide a cost-effective and ef?cient way to deliver health care,
provide education, and manage chronic disease. The health care system is demanding more

6. with fewer resources. Workforce shortages, the geographically disproportionate spread of
health care providers, and the lack of access to care, whether caused by a lack of
transportation or a lack of health care services in an area, create barriers that the current
model of health care have been unable to overcome. In the current telee intensive care unit
(ICU) program, critical care patients are monitored remotely 24 hours a day by experienced
critical care nurses. Informatics And Telehealth In Rural Medicines TedEx Video
AnalysisThis is in addition to the bedside critical care nurse. The preliminary data from our
model suggest it to have a positive impact on safety and quality and allows for earlier
intervention for changes in patient status. Initially, there was uncertainty as to whether it
was cost-effective at our AMC, which resulted in the program being “turned off.” The result
was an increase in safety and quality concerns that led to reinvigoration of the program.
The program remains active and is expanding in our AMC. The literature reveals a similar
picture of inconsistent outcomes of an ICU telemedicine program. The data are con?icting
on the cost-bene?t analysis, but numerous studies suggest that when telehealth services are
implemented with well-de?ned patient inclusion criteria and protocols that it can be cost-
effective.21-24 This has been true for our AMC. Plans are currently being drafted that will
include adding acute care NPs to the ICU telemedicine model currently used in the AMC. The
NP would be a part of the intensivist team and will ensure continuity of care in this
population. The NP in the tele-ICU will be able to intervene much sooner and place orders
that will prevent a delay in care and improve patient outcomes. Future studies are needed
to determine the impact of the NP on this model. MOVING FORWARD Rural and community
hospitals have threatened viability and survivability. The tele-ICU program and other
telehealth services allow the smaller hospitals to keep their own patients in their facility
safely and www.npjournal.org prove to be a quality and ?nancial bene?t to the
community.15 Financial challenges have often been the reason that rural agencies have
shied away from nontraditional models of care delivery. The center for telehealth not only
creates and implements the programs, but doctorally prepared NPs work with community
agencies to identify needs and create programs that produce a revenue stream that will
ensure sustainability. Each site has different resources, and with that in mind, no 2
programs are identical. Informatics And Telehealth In Rural Medicines TedEx Video
Analysis