Introduction

The way telemedicine has revolutionized the healthcare industry is astonishing. Just few decades back, it was an impossible thing to imagine that a patient can be treated without actually visiting a doctor. Times have changed and so have healthcare industry and the treatment options. This paper talks about the numerous ways telemedicine has played a significant role in improving and transforming nursing informatics in particular and healthcare industry in general. It also discusses how the availability and convenient use of telemedicine services have benefitted people throughout the developed and developing world. In the last section, the reasons telemedicine has an illuminating future have been mentioned along with various criticisms of the technology.

Telemedicine

In the contemporary healthcare industry, cost-effectiveness, quality, accessibility, and equity are major issues faced by the clients/patients. In fact, these issues are experienced by people in both developing and developed countries. With the introduction and employment of the modern-day Information and Communication Technologies (ICTs) including smart phones, computers, and the Internet, the researchers and innovators have been successful in alleviating the health problems considering the convenience and inexpensiveness of such technologies. In this regard, the term telemedicine refers to “the use of modern information technology, especially two-way interactive audio/video communications, computers, and telemetry, to deliver health services to remote patients and to facilitate information exchange between primary care physicians and specialists at some distances from each other” (Darkins & Cary, 2000). When it comes to nursing informatics, the development and expansion of telemedicine has considerably changed the ways nurses serve consumers and patients.

Contribution of Telemedicine

Telemedicine has remarkably contributed to nurture a value-based and high-quality environment for the enhancement of patient engagement and satisfaction along with better accessibility and reduced costs. Distance is the basic determinant in the utilization of telemedicine as healthcare professionals use ICTs to remote areas considering the inaccessibility and inconvenience. Thus, ICTs makes it possible for the doctors and patients to share the pertinent details for apt and timely diagnosis, evaluation, research, treatment, and prevention of the disease/medical condition. Nursing informatics has segmented telemedicine into various applications such as cardiological, neurological, dermatological, and respiratory categories to be used in the management of various pathologies, conditions, and diseases.

Alternative of Traditional Method

Furthermore, people in their final stages of AIDS/HIV are benefiting from telemedicine as their human contact is decreased. Yet, the patients are accepted, respected, and treated through telemedicine (Breen & Matusitz, 2009). Similarly, telemedicine has guaranteed patient satisfaction due to a decrease in travelling time, waiting time, and minimization of other issues related to appointments and follow-ups. Telemedicine has turned out to be an incredibly life-saving alternative to traditional methods of healthcare counseling particularly for terminal and debilitated populations living in remote regions.

Telemedicine in Mercy Health System

Mercy Health System (a hospital without a bed) is a virtual care center wherein nurses and doctors keep working around the clock. This one-of-a-kind healthcare facility in the United States offers remote support to 38 smaller hospitals situated in states from Oklahoma to North Carolina (for emergency rooms, intensive-care units, and various other programs). A majority of these hospitals have no on-site physician 24/7. Mercy Virtual President reported a 30% decrease in the number of deaths than anticipated. Also, a 35% decrease in the average length stay of the patients was made possible due to the provision of telemedicine services at the facility. The observations indicate that the lives of 1000+ people were saved with the special assistance provided through telemedicine. According to a trade group, the American Telemedicine Association, remote medical care was provided to more than 15 million Americans in 2015 alone which ultimately grew by 30% the next year (Breen & Matusitz, 2009).

International Impact

On an international level, there has been a considerable interest to bring improvements in the healthcare industry’s safety, quality, cost-effectiveness, and cleanliness through telemedicine. McLean conducted a study to investigate and analyze the impact of telemedicine on the quality and safety of the healthcare. It was revealed that the improvement in the quality of life of patients was apparent. Also, improvements were observed in patients of asthma and chronic heart failure (McLean, Sheikh, Cresswell, Nurmatov, Mukherjee, Hemmi, & Pagliari, 2013).

Telenursing

Information technology usage has actually evolved the nursing roles specifically within home settings. Telehealth nursing or telenursing is focused on patients’ long-term physical wellness and self-management. It can be said that telemedicine has empowered the present-day nurses with a better ability to supervise, gather data, inform, follow-up, and offer multidisciplinary care comprising of pain management, distant involvements, and family support. According to a report, “agencies using telehealth have an average patient-to-nurse ratio of 15:1, as compared with non-telehealth agencies having a ratio of 11:1” (Bashir & Bastola, 2018). Consequently, a remarkable difference could be made if telemedicine is effectively used for the provision of patient care to underserved regions experiencing nursing shortage and inaccessible health care.

Nursing and Telemedicine

The lack of specialists in rural areas results in a majority of patients being devoid of well-timed health care interventions. This gap could be easily filled up if more and more home health agencies with telemedicine facilities train their nurses to care for chronic patients while utilizing ICTs. Such provision of care and sense of security allows the nurses to intervene and manage patient condition under expert physician care (Bashir & Bastola, 2018).

Nurse Informatics Uses

As indicated by the above discussion, there is a rare involvement of hands-on patient care in nursing informatics. As an alternative, nurses make use of technologies and tools to assess the patients’ progress via telemedicine. For instance, blood glucose, blood pressure, and heart rate and other vital signs are recorded and evaluated by using tools. Such equipment is usually set up in the domestic setting wherein the patient is placed. The nurse informaticists educate the patients and their family members about the usage of equipment and how to troubleshoot them if a technical issue arises. Similarly, professionals engaged in nurse informatics also facilitate other health care personnel to use telemedicine and other related equipment in a proper manner.

It needs to be noted here that not every nurse is aware of the recent methods and technologies used in telemedicine. A patient whose treatment involves telemedicine cannot be just evaluated by any nurse. Instead, a nursing trained in nursing informatics and knows how specific technologies are used can help in taking care of the populations treated under the umbrella of ICTs. However, telemedicine nurses are necessitated to possess the same nursing skills that are a prerequisite for all nurses whereby “excellent organization, critical thinking and communication skills are required also, but the most important skill is to understand the technology and its potential and limitations, and have the intuitiveness in how to utilize it to provide the care needed at the time” (Page, 2013). Therefore, nurses interested in using technology to provide high-quality health care must obtain a nursing informatics certification to start with.

Telemedicine Counseling

Telemedicine counseling also helped in reducing the maternal fatigue affecting mothers who had infants with difficult behaviors. Parents who had infants with extremely low birth weight rates were also provided with emotional support and education. Overall, telemedicine resulted in patient satisfaction whereby it reduced cost and travel time along with increased convenience. In a Canadian review of various telemedicine programs, the rural areas had higher patient satisfaction as compared to the urban areas. In comparison to waiting for longer personal counseling, 76% people preferred telemedicine counseling due to its ease and convenience (Breen & Matusitz, 2009).

Telemedicine Knowledge in US

In developed countries, such as the United States of America, the healthcare industry has incorporated telemedicine. Even though several issues have popped up with the implementation in different states including legality problems and reimbursement, it is extremely important for developing countries to learn with USA example and incorporate telemedicine by means of volunteer efforts in the regions where healthcare professionals are unable to reach. Both governments and stakeholders need to ensure that telemedicine must replace the obsolete alternatives to treat populations in far-away regions.

Criticism on Telemedicine

Even though telemedicine is gaining popularity on a large scale, criticism concerned with the quality of care received through telemedicine has also surfaced. According to the opponents of telemedicine, various barriers hinder the growth of telemedicine in some regions including developing countries considering the inadequacy of the infrastructure for proper utilization of the modern Internet technologies. Also, the instability of the electric power supplies, unreliable connectivity of the Internet, computer viruses, and limited availability of bandwidth hinder the adoption of telemedicine (Breen & Matusitz, 2009).

Financial Cost

In addition, the financial cost associated with telemedicine is also a major barrier to the adoption and application of telemedicine services. Training cost, equipment, maintenance, and transportation expenses can be difficult to be managed for developing and underdeveloped countries. The application of telemedicine is also restricted due to lack of knowledge, resources, and local skills. In many countries, the education required to be a competent nursing informatics professional is not available.

Conclusion

Today, the big promises have started to materialize while telemedicine is being implemented to its full potential. The swiftness of deliverance of health care services and increase in the number of nursing informatics professionals, it has become crystal clear that people could not be treated in hospitals alone; the Internet connections, modified insurance standards, availability and cheap usage of smart phones as well as technologically-aware nursing personnel are changing the conventional modes of delivering health care services.

It has been proved that information and communication technologies like cell phones, the Internet, and computers have the propensity to address the health problems on a global level. It can be done through the deliverance of nursing and health services via telemedicine. Telemedicine contributes in improving the as the health care situation and physical wellbeing of deprived populations in remote areas when health care professionals use ICTs for an exchange of the information for diagnosis, treatment, and provision of education to nursing staff and health care providers (though in limited numbers) in such areas. Similarly, the healthcare’s safety, quality, cost-effectiveness, and cleanliness have considerably enhanced worldwide through telemedicine. Though there are various hindrances to the application of telemedicine in developing countries, a focused approach towards its implementation may result in miraculous outcomes for poor nations as the health of the local people is improved.

With certain challenges such as limited coverage by insurers, diagnosing difficulties, and privacy issues, telemedicine is evolving with each passing day. The fact that remote areas have no access to healthcare facilities as well as the increasing aged population signifies that telemedicine will flourish in the future despite the mentioned challenges. One cannot simply ignore the advantages of telemedicine. In this regard, healthcare professionals can play a major role “through the development of strategic, industrywide best practices and regulations” along with the preservation of patient-nurse and patient-physician relationships (“How Will Telemedicine Impact the Future of Health Care”? 2016)

References

Bashir, A., & Bastola, D. R. (2018, May 25). Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care: Pilot Study. Retrieved April 11, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993972/

Breen, G., & Matusitz, J. (2009). An Evolutionary Examination of Telemedicine: A Health and Computer-Mediated Communication Perspective. Social Work in Public Health, 25(1), 59-71. doi:10.1080/19371910902911206

Darkins, A. W., & Cary, M. A. (2000). Telemedicine and Telehealth: Principles, Policies, Performances and Pitfalls. New York: Springer Publishing Company.

How Will Telemedicine Impact the Future of Health Care? (2016, November 03). Nursing@Georgetown. Retrieved April 11, 2019, from https://online.nursing.georgetown.edu/blog/future-of-telemedicine/

McLean, S., Sheikh, A., Cresswell, K., Nurmatov, U., Mukherjee, M., Hemmi, A., & Pagliari, C. (2013). The impact of telehealthcare on the quality and safety of care: a systematic overview. PloS one, 8(8), e71238. doi:10.1371/journal.pone.0071238

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Introduction

The key issues faced currently by healthcare industry are quality, equity, access, and cost-effectiveness. These are the issues that both developed and developing countries are facing. Modern Information and Communication Technologies (ICTs) such as cell phones, the Internet, and computers can address the health problems that are prevalent on a global level as people can communicate with each other exchanging and seeking the relevant information. The use of ICTs for the delivery of the health services is referred to as telemedicine. It provides clinical health care to remote areas through the use of information technology and telecommunication.

In telemedicine, distance is a determinant whereby healthcare professionals can provide healthcare services to remote areas through the utilization of ICTs. This technology allows them to exchange all valid information for treatment, diagnosis, prevention, evaluation, and research. It is also used to educate health care providers. In addition, it aims at improving the health of individuals and communities.

This paper discusses the various ways through which the healthcare industry has been transformed through telemedicine, its impact on safety, quality, and management of health care. Furthermore, it also encompasses numerous methods concerning the continuation of medical education through telemedicine. Also, it also talks about the availability and accessibility of its services in developed and developing countries as well as the barriers to its diffusion.

Telemedicine in Developed and Developing Countries

In the developing countries, one of the major concerns is the access to the basic health care. Telemedicine provides great opportunities in increasing access to the health care. Distant healthcare providers can diagnose, evaluate, treat, and even provide follow-up care to the patients in the developing countries that are not sound economically. The underserved areas can get efficient tertiary care advice through telemedicine. In situations where local healthcare professionals have access to expert help, It enables people to obtain opinions from the specialists; unavailable to them otherwise. This aids in providing reassurance to both patients and doctors.

There has been a decrease, both directly and indirectly, in the number of referrals to facilities located off-site due to its programs. This has also led to the reduction of the need to transfer patients. Telemedicine in developing countries is successfully enabling the remote care and diagnosis beneficial for both health care systems and patients wherein the distance traveled to receive special care as well as the related stress, time, and expenses are reduced. Another benefit offered by the telemedicine programs is that they improve practitioners’ practice in rural areas as they receive the support for professional growth and development through this medium.

Secondary benefits such as connecting remote sites through telecommunication technologies help in overcoming geographical barriers as health care providers around the world can connect to remote and rural sites easily. Thus, it is easy to overcome issues such as flight of human capital or the ‘brain-drain’ problem. The remote training of healthcare professionals fosters their academic growth as they can contact the specialists around the world easily at any time. Thus, the services and skills offered locally are improved significantly. These factors are also proved by the telemedicine program in Mongolia that supports maternal and neonatal health.

As far as Mongolia is concerned, the maternal and infant mortality rate in the country is quite high. In order to overcome this issue, telemedicine support is being provided in the remote provinces of the country for the promotion of maternal and infant health. The services supported by telemedicine in Aimags provinces include fetal monitoring, high-risk pregnancy consultations, use of colposcopy for screening of cervical abnormalities, and prenatal ultrasound diagnostics. Women in remote areas who cannot afford paying for expert opinions can be particularly benefitted through the usage of telemedicine program.

In developed countries, such as the United States of America, it has been incorporated into healthcare services. Although different states face different issues pertaining to the incorporation (like reimbursement and other legality concerns), it is highly recommended to help the underdeveloped countries. In particular, countries that lack adequate healthcare facilities need to incorporate telemedicine through the volunteer efforts of healthcare professionals.

How Telemedicine is Transforming Health Care

There has been a considerable interest internationally in improving the healthcare industry’s safety, quality, cost-effectiveness, and cleanliness. McLean conducted a study to investigate and analyze the impact of telemedicine on the quality and safety of the healthcare. The study found that the quality, standard, and safety of the healthcare were improved. For some of the patients, the improvement in the quality of life was observed. On the other hand, it was not the case for other patients. For example, improvements were observed in patients of asthma and chronic heart failure while no improvements could be seen in diabetic patients. For a total of 15 studies conducted on heart failure patients, 9 reported improvement in the quality of life. Some were so satisfied with the telemedicine services that no considerable difference between normal counseling and tele-counseling could be detected. Furthermore, significant improvement in the quality of life was observed in COPD.

Telemedicine counseling

Telemedicine counseling also helped in reducing the maternal fatigue affecting mothers who had infants with difficult behaviors. Parents that had infants with extremely low birth weight rates were also provided with emotional support and education. All in all,  resulted in patient satisfaction whereby it reduced cost and travel time along with increased convenience. Furthermore, it also helped a majority of patients in follow-up for various diseases. In a Canadian review of various telemedicine programs, the rural areas had higher patient satisfaction as compared to the urban areas. In comparison to waiting for longer personal counseling, 76% of people preferred telemedicine counseling as it was easy and convenient.

Breen and Matusitz Study

Breen and Matusitz conducted a study and described the way through which a telemedicine system can be executed in a variety of medical settings, to strengthen and assist the communication such as the interchange, dialogue, and correspondence between the patient and healthcare provider. It provides training, research, public health, and patient care for diagnosis, receiving, and sending of information about health and administrating care. Analysis of X-rays and educating health professionals may also be done through telemedicine.

Telemedicine Applications

Telemedicine has been segmented into various applications such as cardiological, neurological, dermatological, and respiratory diseases and these are used extensively in the management of various pathologies, conditions, and diseases. It has also been discovered recently that people in their final stages of AIDS/HIV are benefiting from telemedicine as their human contact is decreased and the patients are accepted and treated.

Telemedicine Electronic Devices

The technological forms of the telemedicine are classified into numerous electronic devices such as e-mail services, camera light boxes, telephones, fax machines, remote monitoring systems, interactive television units, video conferencing, and multimedia. In military combat solutions, rapid communication services are provided to medics  who could then treat various casualties in firefights. Serious wounds acquired by the military can easily be managed and treated through telemedicine.

Telemedicine Brings Ease

Breen and Matusitz also report that telemedicine has given patient satisfaction through a decrease in travel time, waiting time, and reduction in hassles to get an appointment from the doctor and follow-up. It has turned out to be an extremely remarkable alternative to traditional methods of counseling especially for remote, terminal, and debilitated populations.

Telemedicine and CME

Wang asserts that telemedicine can provide sustainable improvements to health and help in continuing medical education. Telemedicine systems are also an effective way to online continuing medical education (CME) for physicians. It also offers three principal advantages: the delivery of personal health services to remote areas, patient health education, and continuing medical education. Wang also studied the experiences of telemedicine in Taiwan over the period of 1995-2004. The estimated results of the panel data regression showed that an increase in CME lectures provided online led to an increase in per capita national health expenditure and conventional health services. There is a nonlinear nexus between CME and health indicating an improvement in the health of individuals with greater online CME provision. After reaching an optimum, however, decreasing population health is associated with greater CME lectures.

Telemedicine and Communication

Beck mentions in her report that after years of big promises, it is finally living up to its full potential. The delivery of health care has become more rapid through the Internet connections, changing standards of insurance, the presence of smart phones, and jobs being done by more health providers who use electronic communications. Phones, webcam, and emails are linking the patients to the doctors around the world. The better care of health has been provided by telemedicine at locations where medical expertise cannot reach.

Remote Medical Care

In the new virtual care center, Mercy Health System (a hospital without a bed), nurses and doctors keep working around the clock. This care center provides remote support to 38 smaller hospitals situated in states from Oklahoma to North Carolina (for emergency rooms, intensive-care units and various other programs). Most of these 38 hospitals do not have any on-site physician 24/7. The president of the Mercy Virtual reported a 30% decrease in the number of deaths than anticipated and a 35% decrease in the average length stay of the patients have been observed as monitoring of ICUs took place by Mercy specialists. This indicates that nearly1000 people were saved from dying due to the special assistance provided to the patients. According to a trade group, the American Telemedicine Association, remote medical care has been provided to more than 15 million Americans in 2015. In fact, this number grew by 30% in 2016.

Critics in Telemedicine

Even though telemedicine is spreading widely, there are some critics concerned about the quality of care received . Various barriers hinder the growth of telemedicine in some regions including developing countries as the infrastructure is not sufficient for the proper utilization of the modern Internet technologies. Also, the instability of the electric power supplies, unreliable connectivity of the internet, computer viruses, and limited availability of bandwidth hinder the adoption of telemedicine.

The financial cost is also one of the most important barriers to the adoption and application of telemedicine. Training cost, equipment, maintenance, and transport cost can be difficult to deal with for countries with low income. The application of telemedicine is also limited by knowledge, resources, and local skills.

Conclusion

Based on the studies included in this review, it can be concluded that information and communication technologies like cell phones, the Internet, and computers can address the health problems on a global level. It can be done through the deliverance of healthcare services. The health of the individuals and their communities is significantly improved by telemedicine as the health care services are provided to remote areas by health care professionals using ICTs for an exchange of all valid information for treatment, diagnosis, prevention, evaluation, research and for providing education to health care providers. The healthcare’s safety, quality, cost-effectiveness, and cleanliness have significantly improved internationally . Though there are various hindrances to the spread of telemedicine in developing countries, a focused approach towards its implementation may work wonders for nations as the health of the local people is improved.

References

Beck, Melinda. “How Telemedicine Is Transforming Health Care.” The Wall Street Journal, 2016.

Breen, Gerald-Mark, and Jonathan Matusitz. “An Evolutionary Examination of Telemedicine: A Health and Computer-Mediated Communication Perspective.” Soc Work Public Health, 2010: 59-71.

Mclean, Susannah, Aziz Sheikh, Kathrin Cresswell, Mome Mukherjee, Claudia Pagliari, and Akiko Hemmi. “The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview.” PLoS One, 2013.

Rao, Babar, and Adriana Lomabardi. “Telemedicine: current status in developed and developing countries.” Journal of drugs in dermatology, 2009: 371-375.

Wang, Fuhmei. “Continuing Medical Education via Telemedicine and Sustainable Improvements to Health.” International Journal of Telemedicine and Applications, 2016: 1-6.

WHO. TELEMEDICINE Opportunities and developments in Member States. Global survey on eHealth, Geneva: WHO Press, 2010.

[i] WHO. TELEMEDICINE Opportunities and developments in Member States. Global survey on eHealth, Geneva: WHO Press, 2010, 8.

[ii] WHO. TELEMEDICINE Opportunities and developments in Member States. Global survey on eHealth, Geneva: WHO Press, 2010, 13.

[iii] WHO, 14.

[iv] WHO. TELEMEDICINE Opportunities and developments in Member States. Global survey on eHealth, Geneva: WHO Press, 2010, 15.

[v] WHO, 16.

[vi] Rao, Babar, and Adriana Lomabardi. “Telemedicine: current status in developed and developing countries.” Journal of drugs in dermatology, 2009: 371-375, 372

[vii] Mclean, Susannah, Aziz Sheikh, Kathrin Cresswell, Mome Mukherjee, Claudia Pagliari, and Akiko Hemmi. “The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview.” PLoS One, 2013.

[viii] Mclean, et al. 2013.

[ix] Ibid.

[x] Ibid.

[xi] Breen, Gerald-Mark, and Jonathan Matusitz. “An Evolutionary Examination of Telemedicine: A Health and Computer-Mediated Communication Perspective.” Soc Work Public Health, 2010: 59-71, 63.

[xii] Breen and Matusitz 2010, 64.

[xiii] Ibid.

[xiv] Breen, Gerald-Mark, and Jonathan Matusitz. “An Evolutionary Examination of Telemedicine: A Health and Computer-Mediated Communication Perspective.” Soc Work Public Health, 2010: 59-71, 64.

[xv] Ibid

[xvi] Wang, Fuhmei. “Continuing Medical Education via Telemedicine and Sustainable Improvements to Health.” International Journal of Telemedicine and Applications, 2016: 1-6, 2.

[xvii] Ibid.

[xviii] Beck, Melinda. “How Telemedicine Is Transforming Health Care.” The Wall Street Journal, 2016.

[xix] Ibid.

[xx] Ibid.

[xxi] WHO. TELEMEDICINE Opportunities and developments in Member States. Global survey on eHealth, Geneva: WHO Press, 2010, 19.

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