TELEMEDICINE & TELENURSING PRESENTED BY :— SRADHANJALI BISWAL TUTOR KALINGA INSTITUTE OF NURSING SCIENCES KIIT DEEMED TO BE UNIVERSITY BHUBANESWAR,INTRODUCTION » The field of medicine during the recent years has made an explosion in the recent years in collaboration with the field of technology. When considering medicine and technology separately they have proved to be strong enough to stand alone as different science helping the economic growth of our country. aCont... » In today’s health care environment, the health care workers have to be flexible, innovative and informative, able to solve complex client problems by utilizing the best available resources. For this, newer technologies are being introduced day by day and it has grown to such an extent that it can be termed and treated as a separate field. aTELE-HEALTH DEFINITION:- » Tele-health is defined as “the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health related education, public health and health administration” (Hutcherson, 2002,) aCont...... » Tele health is such a field where the delivery of health-related services and information via telecommunications technologies. Tele health encompasses Blots rtcclotts BRoteSrieresteey And tele-education [TELE-MEDICINE » The term telemedicine is derived from the Greek word ‘tele’ meaning at a distance and the present word medicine which itself derives from the Latin ‘mederi’ meaning healing.DEFINITION The World Health Organization (WHO) has defined Telemedicine as ‘the delivery of Tet) oo Ake CLC (vie Beret Nme lit imeem yen css (ery for the exchange Cy ee ion for diagnosis, treatment and ROCCO MCC ome M Vy (Mm actosl gay and uation and for continuing education of health care providers, all in the interests of advancing the health or individuals and their Onna (aeHISTORY OF TELEMEDICINE 1906: ECG Transmission 1920: Help for ships 1924: The first exposition of Tele-care 1955: Tele-psychiatry 1967: Massachusetts General Hospital 1970s: Satellite telemedicineOBJECTIVES v To make high quality health care available to traditionally under privileged population. v To save the time wasted by both providers and patients in traveling from one geographic location to another to avail services on time. v To reduce costs of medical care. aTYPES OF TELEMEDICINE 2. Store-and- forward (asynchronous) 1. Real -time (Synchronous)PURPOSE OF TELEMEDICINEBENEFITS OF TELEMEDICINE a Reaching more patients Providing better care Research and trainingTHE ROLE OF TELEMEDICINE » Telemedicine can be used when healthcare professionals and patients are unable to meet face to face due to geographical distances, convenience or practicality. e Providing individualised health information; « Enhancing decision making in clinical management; aCONT.... « Facilitating | communication between healthcare professionals. ° Offering support, e Educating patients, carers and relatives on managing health problems by facilitating remote monitoring and information delivery. aBARRIERS TO USING TELEMEDICINE Poor infrastructure and inadequate regulation of telecommunications. Costs for services. Policies/protocols regulating the use of telemedicine. Licence regulations for practising telemedicine. aCONT.... e Maintaining quality of care. e Professional regulation activities and implementing healthcare policies. ° Confidentiality due to increased (unauthorised) access to patient records. aADVANTAGES OF TELEMEDICINE » FOR THE PATIENT © Advanced medical facilities. © Reduction in travel to distant referral medical centers. © Reduction in cost of medicare. © Better monitoring of chronic cases. © Tele-counseling of selected psychiatric cases . aCONT.... » FORTHE GROUP ¢ For arural group 24 hr advice of specialist is a great support . « Better diagnosis of diseases due to availability of specialist opinions. » FOR THE STATE:- » Improved preventive health care measures reduction in urban migration from villages due to better care. early notification of communicable diseases. reduced cost of care.CONT.... » FOR THE DOCTOR: » Doctors licensed to practice all over India. » Motivation for computer literacy among doctors. » Maximum Utilization of resources.(save time, money &travel aat TELENURSINGINTRODUCTION » Tele-nursing refers to the use of telecommuniéations 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. As a field it is part of tele-health, and has many points of contacts with other medical and non-medical applications, such as tele- diagnosis, tele-consultation, tele-monitoring, tele-care etc.Telenursing : The practice of nursing over a distance using telecommunication technology (National Council of State Boards of Nursing NCSBN, 1997) » Nurse/Patient interaction through a telecommunication device aDEFINITION » Telenursing — is the delivery, management, and coordination of care and services provided via telecommunications technology within the domain of nursing. (| American Association of Ambulatory Care Nursing (AAACN), 2004) » Telenursing -is the use of telemedicine / telehealth technology to deliver nursing care and conduct nursing practice. r Encyclopaedia of Nursing Research, Fitzpatrick J. ed., 1999)Telenursing Examples » Phone - Interactive Video - Phone Triage » Internet Support - Remote Telemonitor aUSES OF TELENURSING 4 Tele-nursing has been used as a tool in home nursing. For example people who are immobilized or far away places, or living in difficult to reach places a Citizens who have chronic aliments such COPD,DM,CHD etc 4 Still other applications in home care is patients after urgeries with wound dressings, ostomies, handicapped isted in care with help of telenurisng.Cont... 4 Telenursing help to extend the nursing service to more patients. In home care delivery, a nurse is able reach and care for 5-7 patients, but telenursing help her to attend more in same amount of time. 4+ Acommon application of tele nursing is also used by call center separated by managed care organizations which are staffed by managed care organizations, which are staffed by nurse managers aCont.... 4 To perform patient triage in emergencies through call centres 4 Expert assessment and intervention by specialist clinical nurses 4 Discharge services 4 To do counselling and guidance servicesTELEMEDICINE-COMPETENCIES Hardware (physical computer body) » Computers (laptops, desktops) » Palm computers - Telephones Q » Graphic’s card » Sound cards » Internal Memory ( RAM) » External Memory ( flash drives) aPortable Computers (Laptops/Palm Computers) <= » Wireless technology increases a computer's portability » May be used in hospitals or other community nursing settings » Allow nurses remote access to medical records - Allows electronic documentation in remote locations » May be used in two way audio/video conference CesSoftware (programs to operate 7a pn a computer) idk, » Monitor, keyboards, mouse, printer » Web cameras, speakers, microphone » Email, database, word-processing, internet, browsing, conference calls Example: Digiscope-program to collect patient info related to diabetes.Wireless Network Dz - Provides wireless networking between hospital computers » Allows for wireless Internet access » Used in Video conferencing between nurse and patient » Used in emails, Instant messaging, andSoftware Evaluation gee » Efficiency strongly depends on server » Software design varies between medical facilities » Usability is dependant on internet access at home aTelemonitoring Ring Sensor » Ring sensor worn by patient 24hrs/day » Transmits wireless data . » Home computer analyzes data SS » Sends warning signals to telenursing center » Signal provides diagnostic informationTelemonitoring Ring Sensor Review of System TS » Used for clinical purposes » Used by medical professionals (doctors, nurses, ect) » Monitoring and diagnostic function » Local Area NetworkNurse Informatics Qes » Collecting data from Patient » Assessing data using knowledge - Document all retrieved data + Utilize critical thinking skills » Provide nursing interventions - Continue to monitor and utilize available technology aIMPLICATIONS OF TELENURSING » FOR THE PATIENT 4 Monitoring vital signs on daily basis at home setting and informing the care specialist provides opportunity for early intervention. Reduces the number of visits to the doctor or emergency department # 4 Avoids unnecessary visits to or by providers 4 Provides patient education 4 Removes geographic barrier - Nursing can be provided to remote locationsCont.... » FOR THE PROVIDER 4 Increases the Competencies and scope of practice « More venue for monitoring Client safety in home care 4 facilitates easy client decision-making 4 Creates Professional practice environment « Able to provide expert and specialized care from experienced staff and care managers & Able to take joint decisions regarding care by consultation with staff even at far of placesCont.... » FOR THE HEALTH CARE SETTING a Initial expense up front but as health improves the system will save money Decreased number of in-hospital days for patients with chronic illness who have access to supportive telehealth Decrease number of in-hospital days reduces the required number of staff (nursing in particular) Remove barriers of time and distance Proper training and administrative support is an vital responsibility for the system aAPPLICATION OF TELE NURSING Home care Case Telephone management triageAdvantages » Increase public access to health care » Provide access in rural areas - Decrease wait times » Decrease unnecessary hospital visits » Decrease Healthcare costs » Increase continuity of care » Increase patient compliance with aftercare aDisadvantages - Decreased face-to-face interaction » Risk of decreasing quality of care » May increase liability » Concerns with security » Concerns with maintaining confidentiality- Legal Issues (# ° f= —- » Maintaining patient privacy - Verifying consent » Compliance with HIPAA regulations - Nursing Licensure across state lines » Maintaining compliance with scope of practice t et Ls t < so aEthical Concerns » Maintaining autonomy (identity, privacy) » Maintaining patient’s integrity » Prevent harm to a patientFuture of Telenursing Ongoing development of new Technologies provides endless Possibilities in the future of Nursing care. aConclusion Advances in Tele communication and technologies are revolutionizing education & health services globally, including the provision of nursing services. Decreasing time and distance, these advances increase access to health and health care, especially underserved populations and those living in rural and remote areas. They help to manage the demand for services, ensure more effective use of human and health resources and facilitate education and research activities.