Telehealth: Advantages, Challenges, and Implications for Healthcare

This discussion paper explores the advantages and challenges of telehealth, its implications for healthcare, and recommendations for its implementation. Topics include background definition and scope, nursing perspectives, benefits and challenges, impact and implications, and human resource management.

Running head: DISCUSSION PAPER
Tele Health
Name of the Student
Name of the University
Author Note

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DISCUSSION PAPER
Introduction
Telehealth is a wide term that encompasses video-conferencing and exchange of
important medical information through electronic communication system. It also helps in
remote monitoring of patients, population health management through the application of
mobile health technologies (Henderson et al., 2014). The following is a discussion paper on
telehealth and the salient points that will be highlighted under this topic include the
background definition and scope of the discussed topic, telehealth from nursing perspectives,
its advantages and disadvantages along with its implication in healthcare. At the end, the
discussion paper will aim to highlight few recommendations that will be beneficial in order to
overcome those disadvantages.
Thesis Statement
Telehealth is a cost-effective option in present day healthcare system which helps to
increase self-management of the disease along with decrease in the instances of hospital
readmission
Background Definition and Scope
Telehealth services enable consumers to access health education along with proper
support for comprehensive self-health management via internet. The telehealth service also
enables patients to get personalized education materials and coaching and also help them to
participate in online discussion forms and join other support groups as an additional way for
managing their health. The use and the popularity of mobile phones have significantly
increased consumer’s access to telehealth services and have popularized the term mHealth.
mHealth means services accessed via mobile wireless technology. Another important factor
that is inherently linked with telehealth is telemedicine. Telemedicine means “healing at a

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distance” (Kvedar, Coye & Everett, 2014). According to the American Tele-medicine
Association (2018), telemedicine is defined as the use of the medical information by the
patients via exchange of the information through electronic communication. There are
numerous applications of telehealth. According to Xiang and Liu (2013), telehealth is highly
effective for the patients who are suffering from congestive heart failure (CHF) as it helps to
reduce the instances of hospital readmissions through effective telemonitoring. Telehealth has
also evolved as a comprehensive option for healthcare programs for the veterans. Chronic
diseases which are common among the older adults like diabetes and depression which
require frequent follow up can be controlled via telehealth (Cimperman et al., 2013). Other
important application of telehealth in the present scenario of the healthcare system includes
assistance for the patients for the adherence of the medication regime, remote intensive care
and reduction in the referral waiting time (Kvedar et al., 2014).
Telehealth has been around for several decades in Canada, furnishing patients residing
in remote areas with easy to access healthcare services via the use of videoconferencing.
With the introduction of the mobile phones in the telecommunication market, telehealth has
undergone huge change along with the increase in the number of potential patient. Infiltration
of telehealth in healthcare system has also helped to reduce distance issues prevalent in
Canada, the second largest country in the world. Thus overall both the healthcare
professionals and patients in Canada are increasingly accepting telehealth to access
healthcare (Gillis, Newsham & Maeder, 2015). Jaglal et al. (2013) are of the opinion that
application of telehealth have improved chronic disease self-management program (CDSM).
This has lead to the overall improvement in the self-efficacy, health behaviours and overall
health status of the older adults residing the rural areas of Canada, Single and multi-site
groups access of the telehealth and proved to be very helpful in promoting equitable access of
healthcare service in remote and rural areas of Canada.

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Van Henderson et al. (2014) are of the opinion that telehealth have helped to improve
the access of healthcare to the large group of patients via introduction of the innovative tools.
Nurse practitioners are regarded as an integral part of these innovative tools, which provide
scalable approach in order to collaborate and co-ordinate healthcare. However, the global
adoption and subsequent integration of telehealth can be difficult because of the lack of
proper training among the nursing professionals and lack of proper exposure to in handling
the technology of telehealth. In order to increase hands on training of the nursing
professionals over telehealth, the education of telehealth has been included under the nursing
curriculum. Ali, Carlton and Ali (2015) are of the opinion that being accustomed with the
concept of telehealth from the initial days of nursing will help the aspiring nurses to adapt to
the telehealth concept more spontaneously. However, introduction of telehealth study in
nursing curriculum can help the new nursing professionals however, this approach will have
no effect over the increase of the acceptance rate of telehealth technology among the
registered nursing professionals. Taylor et al. (2015) stated that the gap in acceptance mainly
arise from high level of faith over the traditional healthcare practice. Taylor et al. (2015) are
of the opinion that proper strategies must be framed in order to encourage the healthcare
professionals to practice telehealth service along side with the traditional approach in
healthcare.
Thus the main scope of the topic is, encouragement of the healthcare professionals in
proper adaptation and implementation of telehealth will help to improve the self-efficacy of
the healthcare system.
Benefits and Challenges
Rural community settings represent dynamic barrier in comprehensive access to the
healthcare services of the patients, their family members and informal care givers. These

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barriers mainly include lack of required healthcare facilities, restricted public transportation,
educational limitations and indigenous issues related to the geographic region (NRHA, 2012).
Approximately 80% of the people residing in rural areas are said to be medically under
privileged as they suffer from the lack of adequate availability of the healthcare provides.
These shortage not only decrease the overall access to healthcare but also increases health
inequality and overload over the healthcare service (Brewer, Goble & Guy, 2011). Telehealth
has been found to assist the healthcare professionals in dodging the barriers while procuring
care to the patients residing in the remote (US Department of Health and Human Services,
2012). From the nursing perspective it can be said that the advent and proper implemtation of
the telehealth service in rural healthcare helped the nursing professionals to access the
physical conditions of the patients without toughing. Live view and audio stream
conferencing facilitated unique opportunity to communicate with the patient directly and this
further helped them to execute the care plan based on the self-reported difficulty by the
patient’s.
However, there are certain barriers associated with telehealth in the domain of
implementation and maintenance of the telehealth program. First barrier is the financial
support in order to purchase the start-up program. High initial investment along with increase
in the installation price in the rural areas increases the overall operation cost of telehealth in
the rural areas and thus creating a huge financial barrier. The next limitation in the domain of
the use and the access of the telehealth is the lack of proper nurse education and training
programs (Rutledge et al., 2014). According to van Houwelingen et al. (2016), telehealth is a
completely new technology which demands through education about the operation of the
information technology and concept underlying the electronic communication. van
Houwelingen et al. (2016) further stated that apart from technological knowledge, the
healthcare professionals especially the nurses who are required to interact with the patients

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through virtual media need to adapt special skill set. This is because interacting face-to-face
and interacting through audio-visual conference or simple audio conference is completely
different. This is because, while on virtual conversation, effective communication skills will
help the nurse to understand what the actual problem is via filtering out the out less important
details which the patient or their family members might have pass on due to apprehensions.
However, it has been found that the majority of the nursing professionals lack this
communication knowledge and skill set and thus making gap in sharing of the information
(van Houwelingen et al., 2016). The nursing professionals are also of the opinion that the
patients suffers from certain insecurity in conversing through virtual media or experiences
discomfort among in using the technology, condition more prevalent among the older adults.
This creates a problem for the nurses in fetching proper information (van Houwelingen et al.,
2016). In context to training of the nursing professionals for equitable application of
telehealth, Brewster et al. (2014) highlighted that many nurses as well as the healthcare
professionals are reluctant or unwilling to take training and this limits the human resource in
comprehensive application of telehealth. There are certain technological gaps in telehealth for
example; there is a lack of adequate access to trained technicians to maintain equipment and
staff turnover. There are also gaps in accommodating patients who are the victim of hearing
and visual impairments, delay in transmission of tele-monitoring data during bad weather
condition and patient resistance of compliance (Rutledge et al., 2014).
Impact and implication
Impact of health in healthcare system
There are several positive impacts of telehealth in the healthcare system. Tele-health.
In the rural health care system, application of telehealth has helped to over the difficulty of
bringing the patients from the rural area to the providers. The technology also proposes to

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alleviate the problem further via enabling the providers to store and subsequently forward the
clinical data and the digital images in order to effectively monitor the patient’s condition
under home settings. This in turn helps to reduce the overall cost of care and wastage of
valuable time during communication. Telehealth has also helped the nursing professionals to
effectively control mental health and substance abuse especially in the rural areas.
Application of telehealth in rural areas helps in proper planning in the domain of
preadmission, discharge, family visit and clinical supervision. Apart from the rural areas,
application of telehealth is also helpful under urban settings (Benavides-Vaello, Strode &
Sheeran, 2013). Telehealth in the form of telepsychiatry is a type of teleconferencing that is
used to treat a variety of disorders related to mental health and substance abuse from distance.
Telehealth is also growing popularity in the child or paediatric care especially in the domain
of anxiety, depression, eating disorders, substance abuse, attention deficient hyperactive
disorder and general promotion of mental health (Benavides-Vaello, Strode & Sheeran,
2013).
Application of telehealth in the healthcare system has helped to increase the self-
management. The systematic review conducted by So and Chung (2018) highlighted that the
application of telehealth help to increase self-management of diabetes care among the older
adults. However, Zairina et al. (2016) proposed for further investigation in order to estimate
the overall cost-effectiveness of telehealth application in diabetes self-management. A
randomised control trail study conducted by Zairina et al. (2016) highlighted that the
telehealth application help in the optimal management and self-management of asthma
among the pregnant women. This is extremely important because poorly controlled asthma
during pregnancy can cause fatal harm to both the mother and the foetus. Gellis, Kenaley and
Have (2014) integrated application of telehealthcare over the older adults who are suffering

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from chronic illness and co-morbid depression help to improve the symptoms post discharge
from emergency department under the hospital settings.
Implications in telehealth
From my perspective it can be said that telehealth employs technology that helps to
connect persons receiving care and nursing professionals procuring healthcare services.
Hence in spite of focusing on telehealth as a financial burden, telehealth must be viewed as a
promising opportunity for the nursing professionals in order to operationalize and transform
the art of care under the guidance of the nursing theory. In relation to this Carroll (2018)
highlighted that one of the important implication of telehealth technology in healthcare
domain is transformation of the art of nursing. Carroll (2018) is of the opinion that the
theoretical framework of telehealth has both opportunity and challenges in the digital world
of nursing and thereby improving the overall interdisciplinary pathway of nursing. Moreover,
application of telehealth technology acts as a medium for successful interaction among the
patients.
Tele health and human resource management
Presence of adequate healthcare human resource is an increasing concern for remote
and rural communities in different parts of the world. During the last few decades numerous
telehealth service experiences in Canada have increased the impact of telehealth technology
over professional practice. The qualitative study conducted by Gagnon et al. (2007)
highlighted that there are potential impacts of telehealth over the factors influencing retention
and recruitment of physicians in remote regions. The potential effects of telehealth over the
choice of the physicians on practice location are mainly focused over the professional,
educational, organizational and person-centered level. For example, telehealth could increase
work satisfaction via enabling regional on-call duty system and there helping in better follow-
up of the patients. Nevertheless, there are certain limits of telehealth. The main drawback is it

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is associated with fear that it would replace all the existing medical education and specialists
working onsite in remote regions. Gagnon et al. (2007) concluded that the expected benefits
of telehealth will be materializing if the technology is properly integrated in the healthcare
organization as a support to professional practice.
Recommendation
In order to help telemedicine to reach its full potential adequate evidence must be
complied in order to ensure that the new model for telehealth application does not sacrifice
the overall quality and harm of patients. Proper health reforms are also required to be
undertaken in order increase the access of telehealth. For reforms must come in the form of
financial incentives to the healthcare professionals. This will encourage the application of
telehealth in order to leverage the skills of the healthcare providers across a broader range of
patient population. Moreover, a definite payment system must be framed where the
healthcare professionals will be paid for executing virtual face-to-face interview (Gillis et al.,
2015). Kvedar et al. (2014) also recommended that more health policy research is required to
be framed in order to evaluate the cost impacts and overall quality of telehealth. In order to
demonstrate its value, providers are require to devote more dedicated leadership, time and
expertise. In think the recommendation proposed in several literatures are in accordance of
the future requirement of telehealth. This is because, providing proper incentive structure will
encourage the use of telehealth by the healthcare professionals and proper training will
further iron out the gaps in proper execution of telehealth technology.
Conclusion
Thus from the above discussion, it can be concluded that telehealth has promising
application in revamping the overall healthcare system. The application of telehealth, remote
telecommunication based healthcare system has helped to increase the self-management of

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several chronic diseases from asthma, chronic heart disease and type 2 diabetes. The analysis
of the research articles have also highlighted that the comprehensive application of telehealth
help in effective management of healthcare requirement in rural areas starting from substance
abuse and mental health. In urban areas also telehealth find its important application like
improvement in aged care facilities along with reduction in the cases of hospital re-
admission. However, there are certain gaps in the adaptation of telehealth among the nursing
professionals and this include gaps in clinical knowledge and lack of proper training in
information technology and communication skills. Proper training, policy planning and
framing of the incentive structure are required to be undertaken in order to increase the
popularity of telehealth among the nursing professionals.

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