Telehealth Challenges and Solutions: A Nursing Informatics Perspective

This report presents a case study examining the implementation of telehealth in nursing, focusing on a patient with CHF and COPD who experienced issues due to a faulty internet connection. The case highlights the importance of reliable technology and efficient communication in telehealth. The report further explores the advantages and disadvantages of telehealth, including improved access to care and reduced costs, alongside risks such as errors in virtual communication and data breaches. The study references several research papers that examine the application of telehealth in various settings, including chronic musculoskeletal conditions and nursing education. It also discusses strategies for improving telehealth services, such as enhancing internet infrastructure, addressing staff training needs, and integrating telehealth into nursing curricula. The report concludes by emphasizing the need for informatics nurses to improve telehealth services through technological improvements and better staff training. This is a solved assignment available on Desklib, a platform offering AI-powered study tools and resources for students.

Running Head: NURSING
Telemedicine
Name of the Student
Name of the University
Author Note

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Answer 1
Telehealth, a form of health information technology, aims to provide efficient health
care in less time with minimal efforts (Burch, Gray & Sharp, 2017). In this case study, a
patient suffering from Congestive Heart Failure (CHF) and Chronic obstructive pulmonary
disease (COPD) arrived at a telehealth center for care. Due to faulty internet connection the
patient did not receive effective care and the following day she was being admitted to
emergency department. Thus efficient care to the patient by telehealth technology was not
achieved.
In this case study, the patient missed previous two appointments as she could not
drive and had to rely on her daughter for transportation. Moreover, she was unable to move
out of her bed and perform her own task due to fatigue. The teleheath nurse was connected to
doctor while he or she was checking the patient. The patient was diagnosed with increased in
respiratory rate and strenuous breath. With the help of camera the patients’ skin was assessed.
Other parameters like height and weight was also recorded. The patient was not given any
medication and she was sent home. For this reason, in the following day she was admitted to
emergency department for a week. This gap in telehealth care was due to faulty internet
connection, where the video set up was disrupted. The audio system also went out of service.
For these reasons the telehealth or Health information technology did not work with
maximum efficiency.
Answer 2
Gathering medical history is the first step for process flow in patient’s treatment.
Sometimes patient feels uncomfortable to share their medical issues in front of doctors.
Telehealth can solve the issue as information or images are kept confidential. Monitoring of
the patient and diagnosis of the symptoms can be made faster in critical cases by consultation
among healthcare professionals. This technology also aids in gathering a second opinion

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during emergency health issues. Verification of prescription or any change in medication can
be implemented in less time especially for home bound patients or older patients. The life of
a patient can be saved during an emergency situation. Telehealth aims to create a bridge
between the patient at remote places and health care center. This also reduces the cost of
healthcare (Goodridge & Marciniuk, 2016).
Although telehealth is in rise in the recent times, it has certain disadvantages (Bull et
al., 2016). There is a high risk of error in clinical service due to virtual communication,
especially if the service is given by an inexperienced professional. Faulty electronic devices
can leak confidential medical information which might decrease the trust of patient towards
telehealth facilities. Service provided by this technology can be delayed during server
problem or low speed internet connections. Immediate treatment like medication cannot be
provided by this technology. Images (Magnetic Resonance imaging) or reports (X- rays,
Electrocardiogram etc.) shared in lower qualities can lead to wrong clinical treatment. Legal
regulations are mandatory in this system to avert unauthorized and illegal service providers.
Training of nurse and doctors, data management apparatus and telecommunication system
increase the overall cost of this health sector (Bull et al., 2016).
Cottrell et al., (2017) performed a survey on telehealth service in patients having
chronic musculoskeletal conditions. The survey was done on patients receiving care with
Neurosurgical, Physiotherapy and multidisciplinary services. Evaluation of the survey was
done on areas including demographics, barriers to the service and satisfaction of the patient to
the service provided by telehealth technology. At the end of the survey 85 patients (71%)
could complete the survey. From this service majority of the patient showed satisfaction.
Although, few patients informed ceasing of the treatment due to poor service. 53%, 57% and
78% of the respondents were willing to take up telehealth due to low cost in treatment, lesser
time in treatment and reduced work absenteeism respectively. Most importantly, 43% of the

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respondents preferred home telehealth over traveling to health care clinics. Thus the survey
by Cottrell et al., (2017) justified the advantages of telehealth services for patients in critical
conditions.
Answer 3
As an informatics nurse, I consider the improvement of internet services would
improve telehealth services. Improving bandwidth speed, involvement of IT departments and
sufficient funding will decrease the internet server related problems. According to Taylor et
al., (2015) technology, equipment and organizational barriers to share patients’ confidential
data works as a barrier for telehealth service. Lower staff consciousness, their involvement in
telemedicine and improper nurse training also affects these facilities. Moreover, fear of
amplified work load, non-involvement of staffs in service design, concern for jobs and patient
care affects implementation of telehealth facilities (Taylor et al., 2015).
Implementation of telemedicine can be done by establishing a telehealth pathway,
review of the patient about the service, improving delivery of the service, improving data
sharing technologies, evaluating telehealth service time to time, educating general people
about the importance of telehealth, proper training or arranging campaign, information
session for the nurse and health care professionals, gathering financial support for telehealth
technologies (Taylor et al., 2015).
List et al., (2019) studied the improvement in the implementation of telehealth
facilities in nursing care. This involves classroom, laboratories and clinical rotation in the
study curriculum. This study used the methodology of including telehealth curriculum in a
nursing school. The nursing students were given lectures on telehealth. The students were
assessed by self-reported confidence in telehealth. Knowledge about telehealth was also
assessed to determine whether the involvement of curriculum was beneficial in implementing

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telehealth facilities. 30 nursing students was taken as a sample size. Out of which 24 students
could complete the test of telehealth knowledge properly. Confidence of the student increased
after the involvement of telehealth in the curriculum. The level of confidence increased from
2.82 (prior to lecture) to 3.97 (after the lecture). This data was statistically significant for all
survey (p<0.001). However, the main limitations of this study were no involvement of a
control group, the survey of knowledge was done soon after the lecture and the sample size
being too small. Also, some students might have received knowledge of telehealth prior to
this study have increased their level of confidence. In conclusion to this study, adequate
knowledge and education of telehealth care increase the level of confidence in the nursing
students. Thus, these methods can be implemented to improve telehealth facilities.

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References
Bull, T. P., Dewar, A. R., Malvey, D. M., & Szalma, J. L. (2016). Considerations for the
telehealth systems of tomorrow: an analysis of student perceptions of telehealth
technologies. JMIR medical education, 2(2), e11.
Burch, S., Gray, D., & Sharp, J. (2017). The power and potential of telehealth what health
systems should know: proposed legislation in Congress offers the promise that the
nation's healthcare policy will support the expansion of telehealth, allowing hospitals
and health systems to fully realize the benefits of this important emerging approach to
care. Healthcare Financial Management, 71(2), 46-50.
Cottrell, M. A., Hill, A. J., O’Leary, S. P., Raymer, M. E., & Russell, T. G. (2018). Patients
are willing to use telehealth for the multidisciplinary management of chronic
musculoskeletal conditions: a cross-sectional survey. Journal of telemedicine and
telecare, 24(7), 445-452.
Goodridge, D., & Marciniuk, D. (2016). Rural and remote care: Overcoming the challenges
of distance. Chronic respiratory disease, 13(2), 192-203.
List, B. A., Saxon, R., Lehman, D., Frank, C., & Toole, K. P. (2019). Improving Telehealth
Knowledge in Nurse Practitioner Training for Rural and Underserved
Populations. Journal of Nursing Education, 58(1), 57-60.
Taylor, J., Coates, E., Brewster, L., Mountain, G., Wessels, B., & Hawley, M. S. (2015).
Examining the use of telehealth in community nursing: identifying the factors
affecting frontline staff acceptance and telehealth adoption. Journal of advanced
nursing, 71(2), 326-337.

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Taylor, J., Coates, E., Wessels, B., Mountain, G., & Hawley, M. S. (2015). Implementing
solutions to improve and expand telehealth adoption: participatory action research in
four community healthcare settings. BMC health services research, 15(1), 529.
Young, K., Gupta, A., & Palacios, R. (2018). Impact of Telemedicine in Pediatric
Postoperative Care. Telemedicine and e-Health.