Telehealth and Geriatrics: How telehealth improves medication management and patient safety in the geriatric patient Avrakham Rubinov Adelphi University College of Nursing and Public Health December 3rd, 2018 What is Geriatrics? Geriatrics is a subspecialty of internal medicine and primary care that was named in 1909 by Ignatz Leo Nascher. Geriatrics is that specialty of medicine that addresses the health needs of the elderly. Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J., & Ten Have, T. (2012). 2 Telemedicine is a highly effective and necessary tool in geriatrics. The global population of elderly people is increasing at a remarkable rate, This is expected to continue for some time. Older patients require more care. The current model of care delivery indicated costs are expected to rise. Telemedicine is a great opportunity for medical practice to evolve to cost effective and new levels of engagement with patients Chang, W., Homer, M., & Rossi, M. (2018). 3 Geriatics, HIT and Patient Safety CONCERNS: SOLUTIONS: Patient safety is a concern. Telehealth: Difficult to monitor conditions in a patient’s home. Safety risks such as falls and inability to get in and out of the tub or shower. Fewer In-Person Consultations Doctors worry about technical problems associated with telemedicine. poor broadband connections could lead to “possible patient mismanagement.” Many physicians and patients alike still like a “personal touch,” and not all procedures – even simple checkups – can be performed digitally. Difficult to monitor depression or other emotional issues. Health information technology (HIT) is the future of improving care and outcomes for older adults. There is a growing program of research. HIT are solutions to improving the safety, quality and efficiency of care. Gerontological nurse scientists are at the forefront of advancing this work. Electronic health records (EHRs)and telehealth will blend care of older adults. Multimedia/advanced directives from HIT provided to patients recovering from critical illness have increased the intent to sign an advanced directive by 25 times Liu, L., Stroulia, E., Nikolaidis, I., Miguel-Cruz, A., Rincon, A. R. (2016). 4 The HITECH Act resulted growth in the development and implementation of the EHR. The impact of an integrated EHR in 29 Kaiser Permanente hospitals was significant on process and outcome indicators for patient falls and hospital acquired pressure ulcers and other measures of patient safety. The EHR system was associated with improved documentation of falls/pressure ulcers and significant improvements for pressure ulcer risk assessment documentation. Bowles, K. H., Dykes, P., & Demiris, G. (2015). 5 NICHE (Nurses Improving Care for Healthsystem Elders) NICHE builds decision support within the workflow of nurses caring for old.

1. Telehealth and Geriatrics:
How telehealth improves medication management
and patient safety in the geriatric patient
Avrakham Rubinov
Adelphi University
College of Nursing and Public Health
December 3rd, 2018

2. What is Geriatrics?
Geriatrics is a subspecialty of internal medicine and primary
care that was named in 1909 by Ignatz Leo Nascher.
Geriatrics is that specialty of medicine that addresses the
health needs of the elderly.
Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J.,
& Ten Have, T. (2012).
2
Telemedicine is a highly effective
and necessary tool in geriatrics.
The global population of elderly people is increasing at a
remarkable rate,

3. This is expected to continue for some time.
Older patients require more care.
The current model of care delivery indicated costs are expected
to rise.
Telemedicine is a great opportunity for medical practice to
evolve to cost effective and new levels of engagement with
patients
Chang, W., Homer, M., & Rossi, M. (2018).
3
Geriatics, HIT and Patient Safety
CONCERNS:
SOLUTIONS:
Patient safety is a concern.
Telehealth: Difficult to monitor conditions in a patient’s home.
Safety risks such as falls and inability to get in and out of the
tub or shower.
Fewer In-Person Consultations

4. Doctors worry about technical problems associated with
telemedicine. poor broadband connections could lead to
“possible patient mismanagement.”
Many physicians and patients alike still like a “personal touch,”
and not all procedures – even simple checkups – can be
performed digitally.
Difficult to monitor depression or other emotional issues.
Health information technology (HIT) is the future of improving
care and outcomes for older adults.
There is a growing program of research. HIT are solutions to
improving the safety, quality and efficiency of care.
Gerontological nurse scientists are at the forefront of advancing
this work.
Electronic health records (EHRs)and telehealth will blend care
of older adults.
Multimedia/advanced directives from HIT provided to patients
recovering from critical illness have increased the intent to sign
an advanced directive by 25 times

5. Liu, L., Stroulia, E., Nikolaidis, I., Miguel-Cruz, A., Rincon, A.
R. (2016).
4
The HITECH Act resulted growth in the development and
implementation of the EHR.
The impact of an integrated EHR in 29 Kaiser Permanente
hospitals was significant on process and outcome indicators for
patient falls and hospital acquired pressure ulcers and other
measures of patient safety.
The EHR system was associated with improved documentation
of falls/pressure ulcers and significant improvements for
pressure ulcer risk assessment documentation.

6. Bowles, K. H., Dykes, P., & Demiris, G. (2015).
5
NICHE
(Nurses Improving Care for Healthsystem Elders)
NICHE builds decision support within the workflow of nurses
caring for older adults.
Decision takes the form of alerts, reminders, or algorithms that
guide evidence-based care.
Gerontological nurses partner with nursing leadership to
improve care of older adults.
Data is captured in a structured, coded format and provides
clinical decision support to ensure older adults receive
evidence-based, personalized care.
Decision support interventions employ the EHR as a tool to
achieve a learning health system.
.

7. Greenwald, P., Stern, M. E., Clark, S., & Sharma, R. (2018
6
Telehealth and diseases of the elderly
Two diseases that frequently strike geriatric patients:
Heart disease (CPD) and chronic obstructive pulmonary
disease (COPD).
CPD is a progressive and disabling medical condition estimated
to affect 5.7 million Americans consuming $27 billion dollars
in annual treatment expenditures.
Both CPD and COPD are common among older adults.
Each causes patients to feel debilitated and unable to physically
function at their former high level.
Dementia: Challenge for patients located in a rural location
Can impact on the management of dementia
Telehealth is a viable solution to the problems of transportation
and geography
Dementia treatment must be measured carefully for each
patient.
Constant monitoring of how a patient is doing on medication
can now be tracked electronically.
Provides relief for the patient and family that cannot be with the
patient in person.

8. (Gellis, Kenaley, McGinty, Bardelli, Davitt, Ten, 2012).
Glinkowski, Pawłowska and Kozłowska (2013) Chang, Homer,
Rossi, 2018).
7
Telehealth at home
AT HOME:
Convenience for patients to authorize that they records are sent
to specialists for consultations and it cuts down on the number
of doctors visits.
Better care for less money and less time consuming activities
such as long waiting room hours, transportation costs and
general anxiety about having to visit a health care facility.
Still a gap between actual usage of health monitoring
technology and the readiness of older people’s homes to use
home based health monitoring techniques.
Sending information will require more nurse teaching to
patients and more practice before it can be fully and completely
integrated into the home health care regimen.

9. Liu, Stroulia, Nikolaidis, Miguel-Cruz and Rincon (2016)
8
Telehealth at the nursing homes
AT THE NURSING HOME:
Nursing home telehealth system has been branded as e-
TeleHealth.
Rollabout system houses electronic equipment including a
computer, monitor on a moveable arm, and video-conferencing
system.
Includes electronic stethoscope, otoscope, dermascope,
dentalscope, and EKG
Transmission for the rollabout is a wireless network system and
equipment can be plugged into any electrical outlet.
The rollabout was developed to move around in the nursing
home allowing it to be taken to a resident's bedside.

10. Liu, L., Stroulia, E., Nikolaidis, I., Miguel-Cruz, A., Rincon, A.
R. (2016).
9
References:
Bowles, K. H., Dykes, P., & Demiris, G. (2015). The use of
health information technology to
improve care and outcomes for older adults. Research in
gerontological nursing, 8(1), 5-10.
Chang, W., Homer, M., & Rossi, M. (2018). Use of Clinical
Video Telehealth as a Tool for
Optimizing Medications for Rural Older Veterans with
Dementia. Geriatrics, 3(3), 44.
Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J.,
& Ten Have, T. (2012).
Outcomes of a telehealth intervention for homebound older
adults with heart or chronic
respiratory failure: a randomized controlled trial. The
Gerontologist, 52(4), 541-552.
Glinkowski, W., Pawłowska, K., & Kozłowska, L. (2013).
Telehealth and telenursing perception
and knowledge among university students of nursing in
Poland. Telemedicine journal and e-health : Official journal
of the American Telemedicine Association, 19(7), 523-9.
Greenwald, P., Stern, M. E., Clark, S., & Sharma, R. (2018).
Older adults and technology:
telehealth, they may not be who you think they
are. International journal of emergency
medicine, 11(1), 2.

11. Liu, L., Stroulia, E., Nikolaidis, I., Miguel-Cruz, A., Rincon, A.
R. (2016). Smart homes and home
health monitoring technologies for older adults: A systematic
review. International journal of
medical informatics, 91, 44-59.
Sevean, P., Dampier, S., Spadoni, M., Strickland, S., &
Pilatzke, S. (2008). Bridging the distance:
educating nurses for telehealth practice. The Journal of
Continuing Education in Nursing, 39(9),
413-418.
Telehealth and Safety within the realm of Schizophrenia
Created by
Ryan Chang
Overview

12. What is Telehealth vs. telemedicine?
What are some major benefits of Telehealth to the mental health
population?
What are the implications of Telehealth for the future of the
treatment and management of Schizophrenia?
Definition of Telehealth vs. Telemedicine
Telehealth is the remote provision of direct and indirect health
related services from one location to another utilizing
telecommunications. Telehealth includes not just delivery of
services to a patient by a provider, but may also encompass
administrative or managerial support as well as training of
personnel via a web portal. Typically these provisions are
geared toward improvements in care of underserved or minority
populace.
Telemedicine deals directly with the delivery of medical
services and care from provider to patient through the use of
satellite or telecommunications services. This solution could be
utilized for either local or remote application.
How does Telehealth enhance safety?
Telehealth enhances safety through facilitating services to more
adequately address acute/ chronic mental health concerns.

13. Telehealth benefits and safety with schizophrenia
Provides an opportunity for faster and more efficient delivery of
care.
Increases access to health care thereby reducing risk of
individual producing harm to self or others.
Provides a more cost efficient mode of care delivery, reducing
travel related incidentals.
Provides for more efficient management and monitoring of the
condition to prevent high incidence of relapse associated with
this patient population.
Role of the Psychiatric Mental Health Nurse Practitioner
Facilitation of psychiatric interviews, diagnosis and
management of mental health conditions.
Promotion and utilization of applications for monitoring such as
web cams, teleconferencing, two-way audio conferencing and
remote monitors.
Telehealth role in promoting happier, healthier and more
productive lives
Schizophrenia and post traumatic stress disorder (PTSD)
treatment and management have shown tremendous promise
with integration with smart phone technology. The data from
research suggests individuals enjoy a more productive and

14. happier state of existence given the management and monitoring
advantage afforded by applications within the field.
REFERENCES
Amirsadri, A., Burns, J., Pizzuti, A., & Arfken, C. L. (2017).
Home-based telepsychiatry in US
urban area. Case Reports in Psychiatry, 2017, 6296423-3.
doi:10.1155/2017/6296423
Daker-White, G., & Rogers, A. (2013). What is the potential for
social networks and support to
enhance future telehealth interventions for people with
a diagnosis of schizophrenia: A
critical interpretive synthesis. BMC Psychiatry, 13(1),
279-279. doi:10.1186/1471-244X-
13-279.
Dorsey, E. R., & Topol, E. J. (2016). State of telehealth. The
New England Journal of Medicine,
375(2), 154-161. doi:10.1056/NEJMra1601705

15. QUESTIONS?