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Tan AJ, Rusli KD, McKenna L, Tan LL, Liaw SY. Telemedicine experiences and perspectives of healthcare providers in long-term care: A scoping review. J Telemed Telecare 2024; 30:230-249. [PMID: 34666535 DOI: 10.1177/1357633x211049206] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To consolidate existing evidence on experiences and perspectives of healthcare providers involved in telemedicine services in long-term residential care. METHODS A scoping review was conducted. A systematic search for articles published in 2000-2021 was performed in CINAHL, Web of Science, PubMed, EMBASE and Scopus; further, relevant journals and grey literature websites were hand searched. Key search terms included 'telemedicine', 'telehealth' and 'nursing homes'. RESULTS Twenty-six articles were included. A narrative synthesis of evidence was conducted. The review identified four themes: (1) Presence of multidisciplinary care, (2) perceived usefulness of telemedicine, (3) perceived ease of use and (4) expanded role of nursing home staff. The presence of multidisciplinary care providers provided a wide range of telemedicine services to residents and promoted interprofessional collaboration between acute and long-term care. Telemedicine was perceived to increase timely onsite management by remote specialists, which enabled care quality improvement. However, technical problems associated with equipment usage reduced the ease of use of telemedicine. Concerns emerged from the expanded role of nursing home staff, which could negatively affect clinical decision-making and create medico-legal risks. CONCLUSION AND IMPLICATIONS Telemedicine is valuable in distance-based care, especially in the current 2019 coronavirus pandemic, for supporting continuity of care to nursing home residents. This review provided evidence from multiple healthcare providers' perspectives. Further research can elucidate their specific roles and responsibilities in telemedicine and challenges in work processes, which will facilitate developing evidence-based competencies and improving technical infrastructure, thus contributing to personal and organisational readiness for telemedicine integration.
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Affiliation(s)
- Apphia Jq Tan
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Khairul Db Rusli
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Laurence Lc Tan
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- GeriCare@North, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
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Ansarian M, Baharlouei Z. Applications and Challenges of Telemedicine: Privacy-Preservation as a Case Study. ARCHIVES OF IRANIAN MEDICINE 2023; 26:654-661. [PMID: 38310426 PMCID: PMC10864944 DOI: 10.34172/aim.2023.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/02/2023] [Indexed: 02/05/2024]
Abstract
Today, technology has an important impact on the development of medical services, especially during the outbreak of COVID-19. Telemedicine, known by terms such as telehealth and digital health, refers to the utilization of technology to provide health care services at a distance that leads to improved monitoring, detecting and treatment of disease, and provision of individual care. It has been considered in various fields such as radiology, cardiology, pulmonology, psychiatry, emergency care and surgery. The most important advantages of using telemedicine are saving time for the doctor and the patient, reducing the cost of multiple visits to the doctor, reducing the spread of contagious diseases and caring for patients who cannot see a doctor, such as the elderly. In this paper, we review the research in the field of applying telemedicine, as well as its advantages and disadvantages. Next, we discuss the challenges in the field of using telemedicine which are privacy preserving, data security, cost of infrastructures, lack of physical examination and responsibility for patients' compensation. One of the most important challenges is privacy preserving of patients' information during transmission and process. We categorize and compare the various methods that have been proposed to protect peoples' privacy.
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Affiliation(s)
- Maryam Ansarian
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Baharlouei
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Okamoto L, Uechi M, Blanchette P, von Preyss-Friedman S, Masaki K. Rapid Cycle Quality Improvement of Telemedicine Protocols in a Skilled Nursing Facility During the COVID-19 Pandemic. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:256-265. [PMID: 37969237 PMCID: PMC10630537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Prior to the COVID-19 pandemic, telemedicine was not well adopted in US nursing facilities. Many nursing facilities have since acknowledged its value due to the need for stricter infection control and reduction of exposure risk from face-to-face visits. A quality improvement project was conducted to improve telemedicine protocols in a high-volume post-acute care nursing facility, enhance provider and facility capability for visits, improve attitudes and skills toward telemedicine, and expand patient access to medical care during the pandemic. Process improvement was facilitated through identifying core areas of need and implementing interventions to address them. Project impact was measured by a retrospective pre-post survey of 7 questions to evaluate process improvement, attitudes, skills, and perceptions using a 5-point Likert scale (5=strongly agree, 1=strongly disagree) completed by 22 respondents (8 medical providers and 14 staff). Scores from before and after implementation were compared using paired t-tests. Respondents expressed improvement in perceived value (3.2 vs 4.8), personal skill/efficiency (2.3 vs 4.2), comfort level (2.3 vs 4.5), and scheduling process (2.3 vs 3.9) for telemedicine visits (all P≤.001). Respondents expressed increased awareness of barriers/benefits of telemedicine (2.8 vs 4.7, P<.001) and improved leadership commitment (2.6 vs 4.4, P<.001). The weekly average number of telemedicine visits per respondent increased significantly after protocol implementation (6.5 vs 25.6, P=.002). With support of facility leadership, interdisciplinary team members and engagement of key stakeholders, a telemedicine protocol was implemented in a single, high-volume, post-acute care skilled nursing facility during the COVID-19 pandemic, allowing patients to receive needed care.
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Affiliation(s)
- Lauren Okamoto
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (LO, MU, PB, KM)
- Hale Nani Rehabilitation and Nursing Center, Honolulu, HI (LO, PB, SVPF)
| | - Matthew Uechi
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (LO, MU, PB, KM)
| | - Patricia Blanchette
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (LO, MU, PB, KM)
- Hale Nani Rehabilitation and Nursing Center, Honolulu, HI (LO, PB, SVPF)
| | | | - Kamal Masaki
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (LO, MU, PB, KM)
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Ulyte A, Mehrotra A, Wilcock AD, SteelFisher GK, Grabowski DC, Barnett ML. Telemedicine Visits in US Skilled Nursing Facilities. JAMA Netw Open 2023; 6:e2329895. [PMID: 37594760 PMCID: PMC10439478 DOI: 10.1001/jamanetworkopen.2023.29895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/13/2023] [Indexed: 08/19/2023] Open
Abstract
Importance Telemedicine in skilled nursing facilities (SNFs) has the potential to improve access and timeliness of care. During the COVID-19 pandemic in 2020 to 2022, telemedicine coverage expanded, but little is known about patterns of use in SNFs. Objective To describe patterns of telemedicine use in SNFs. Design, Setting, and Participants This cohort study used 2018 to 2022 Medicare fee-for-service claims and Minimum Data Set 3.0 records to identify short- and long-term care SNF residents. Clinician visits were grouped into routine SNF visits (ie, regular primary care within SNF) and other outpatient visits (ie, with non-SNF affiliated primary and specialty care clinicians). Using a difference-in-differences approach, assessments included whether off-hours visits (measured as weekend visits), new specialist visits, psychiatrist visits, or visits for residents with limited mobility changed differentially between 2018 to 2019 and 2020 to 2021 for SNFs with high compared with low telemedicine use in 2020. Exposure Telemedicine adoption at SNF after 2020. Main Outcomes and Measures Number and proportion of telemedicine SNF and outpatient visits. Results Across 15 434 SNFs and 4 463 591 residents from the period January 2019 through June 2022 (mean [SD] age, 79.7 [11.6] years; 61% female in 2020), telemedicine visits increased from 0.15% in January 2019 to February 2020 to 15% SNF visits and 25% outpatient visits in May 2020. By 2022, telemedicine dropped to 2% of SNF visits and 8% of outpatient visits. The proportion of SNFs with any telemedicine visits annually dropped from 91% in 2020 to 61% in 2022. The facilities with high telemedicine use were more likely to be rural (adjusted odds ratio vs urban, 2.06; 95% CI, 1.77 to 2.40). Psychiatry visits differentially increased in high vs low telemedicine-use SNFs (20.2% relative increase; 95% CI, 1.2% to 39.2%). In contrast, there was little change in outpatient visits for residents with limited mobility (7.2%; 95% CI, -0.1% to 14.6%) or new specialist visits (-0.7%; 95% CI, -2.5% to 1.2%). Conclusions and Relevance In this cohort study of SNF residents, telemedicine was rapidly adopted in early 2020 but subsequently stabilized at a low use rate that was nonetheless higher than before 2020. Higher telemedicine use in SNFs was associated with improved access to psychiatry visits in SNFs. A policy to encourage continued telemedicine use may facilitate further access to important services as the technology matures.
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Affiliation(s)
- Agne Ulyte
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Andrew D. Wilcock
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Gillian K. SteelFisher
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David C. Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Michael L. Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Ford JH, Jolles SA, Heller D, Crnich C. Characteristics of telemedicine workflows in nursing homes during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:301. [PMID: 36991421 PMCID: PMC10052227 DOI: 10.1186/s12913-023-09249-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
The use of telemedicine increased dramatically in nursing homes (NHs) during the COVID-19 pandemic. However, little is known about the actual process of conducting a telemedicine encounter in NHs. The objective of this study was to identify and document the work processes associated with different types of telemedicine encounters conducted in NHs during the COVID-19 pandemic.
Methods
A mixed methods convergent study was utilized. The study was conducted in a convenience sample of two NHs that had newly adopted telemedicine during the COVID-19 pandemic. Participants included NH staff and providers involved in telemedicine encounters conducted in the study NHs. The study involved semi-structured interviews and direct observation of telemedicine encounters and post-encounter interviews with staff and providers involved in telemedicine encounters observed by research staff. The semi-structured interviews were structured using the Systems Engineering Initiative for Patient Safety (SEIPS) model to collect information about telemedicine workflows. A structured checklist was utilized to document steps performed during direct observations of telemedicine encounters. Information from interviews and observations informed the creation of a process map of the NH telemedicine encounter.
Results
A total of 17 individuals participated in semi-structured interviews. Fifteen unique telemedicine encounters were observed. A total of 18 post-encounter interviews with 7 unique providers (15 interviews in total) and three NH staff were performed. A 9-step process map of the telemedicine encounter, along with two microprocess maps related to encounter preparation and activities within the telemedicine encounter, were created. Six main processes were identified: encounter planning, family or healthcare authority notification, pre-encounter preparation, pre-encounter huddle, conducting the encounter, and post-encounter follow-up.
Conclusion
The COVID-19 pandemic changed the delivery of care in NHs and increased reliance on telemedicine services in these facilities. Workflow mapping using the SEIPS model revealed that the NH telemedicine encounter is a complex multi-step process and identified weaknesses related to scheduling, electronic health record interoperability, pre-encounter planning, and post-encounter information exchange, which represent opportunities to improve and enhance the telemedicine encounter process in NHs. Given public acceptance of telemedicine as a care delivery model, expanding the use of telemedicine beyond the COVID-19 pandemic, especially for certain NH telemedicine encounters, could improve quality of care.
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Yu J, Yun H, Unruh MA, O'Donnell EM, Katz PR, Ancker JS, Jung HY. Perspectives of Physicians with Experience in Nursing Home Care on Telehealth Use During the COVID-19 Public Health Emergency. J Gen Intern Med 2023; 38:1722-1728. [PMID: 36913142 PMCID: PMC10010241 DOI: 10.1007/s11606-023-08087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/07/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Despite expanded access to telehealth services for Medicare beneficiaries in nursing homes (NHs) during the COVID-19 public health emergency, information on physicians' perspectives on the feasibility and challenges of telehealth provision for NH residents is lacking. OBJECTIVE To examine physicians' perspectives on the appropriateness and challenges of providing telehealth in NHs. PARTICIPANTS Medical directors or attending physicians in NHs. APPROACH We conducted 35 semistructured interviews with members of the American Medical Directors Association from January 18 through January 29, 2021. Outcomes of the thematic analysis reflected perspectives of physicians experienced in NH care on telehealth use. MAIN MEASURES The extent to which participants used telehealth in NHs, the perceived value of telehealth for NH residents, and barriers to telehealth provision. KEY RESULTS Participants included 7 (20.0%) internists, 8 (22.9%) family physicians, and 18 (51.4%) geriatricians. Five common themes emerged: (1) direct care is needed to adequately care for residents in NHs; (2) telehealth may allow physicians to reach NH residents more flexibly during offsite hours and other scenarios when physicians cannot easily reach patients; (3) NH staff and other organizational resources are critical to the success of telehealth, but staff time is a major barrier to telehealth provision; (4) appropriateness of telehealth in NHs may be limited to certain resident populations and/or services; (5) conflicting views about whether telehealth use will be sustained over time in NHs. Subthemes included the role of resident-physician relationships in facilitating telehealth and the appropriateness of telehealth for residents with cognitive impairment. CONCLUSIONS Participants had mixed views on the effectiveness of telehealth in NHs. Staff resources to facilitate telehealth and the limitations of telehealth for NH residents were the most raised issues. These findings suggest that physicians in NHs may not view telehealth as a suitable substitute for most in-person services.
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Affiliation(s)
- Jiani Yu
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA.
| | - Hyunkyung Yun
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
| | - Mark A Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
| | - Eloise M O'Donnell
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
| | - Paul R Katz
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA
| | - Hye-Young Jung
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
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Stephens CE, Allison TA, Flint LA, David D, Wertz V, Halifax E, Barrientos P, Ritchie CS. Assessing Technical Feasibility and Acceptability of Telehealth Palliative Care in Nursing Homes. Palliat Med Rep 2022; 3:181-185. [PMID: 36059909 PMCID: PMC9438441 DOI: 10.1089/pmr.2022.0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Over two-thirds of nursing home (NH) residents are eligible for palliative care (PC), yet few receive it, particularly outside of hospice. Little is known about the technical feasibility and acceptability of using telehealth for PC consultations in NHs. Objective To determine the technical feasibility and acceptability of PC telehealth for NH residents seen by a PC team in the hospital in the previous 30 days. Design Mixed methods study including data collection from field observations, focus groups about the telehealth experience with content analysis, and a web-based survey about technical feasibility and acceptability. Sample and Approach Eighteen participants (six PC-eligible NH residents, one PC physician, five family members, six NH nurses) were recruited in 2016 to participate in one of six PC video visits followed by a video-based focus group and web-based survey. Results All participants were comfortable with the PC video visit format, believed it could improve communication and care coordination, and reported they could see themselves using telehealth in the near future. For technical feasibility, audio quality was rated mostly good/very good (71%) and visual quality was rated fair (50%). Conclusions PC video visits are technically feasible and acceptable to NH residents, families, and staff, representing an innovative and relatively low-cost opportunity to improve access to needed NH-based PC services. Assessing stakeholder perspectives on the use of this technology can help inform the selection of the proper telehealth platform to meet the clinical and infrastructure needs, as well as protocol modifications required before testing in a larger trial.
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Affiliation(s)
- Caroline E. Stephens
- Division of Health Systems and Community Based Care, University of Utah College of Nursing, Salt Lake City, Utah, USA
| | - Theresa A. Allison
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Lynn A. Flint
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Daniel David
- NYU Rory Meyers College of Nursing, New York City, New York, USA
| | - Victoria Wertz
- Infusion Treatment Area, Stanford Health Care, Stanford, California, USA
| | - Elizabeth Halifax
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Pamela Barrientos
- Division of Health Systems and Community Based Care, University of Utah College of Nursing, Salt Lake City, Utah, USA
| | - Christine S. Ritchie
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
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Kalaivanan RC, Rahul P, Manjunatha N, Kumar CN, Sivakumar PT, Math SB. Telemedicine in Geriatric Psychiatry: Relevance in India. Indian J Psychol Med 2021; 43:S121-S127. [PMID: 34732964 PMCID: PMC8543607 DOI: 10.1177/02537176211033007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Telemedicine has evolved as a novel tool in delivering health care in the modern world. With the advancement in video conferencing technology at an affordable price and innovative digital medical instruments, it has grown from guiding paramedics in managing patients to aiding physicians in providing direct consultation. Delivering care for older adults has always been challenging due to comorbidities that may warrant a multidisciplinary approach leading to frequent visits across specialties. As per the preliminary reports of the Longitudinal Aging Study in India, 55% of this population suffers from any chronic illness, of which 40% have some form of disability and 20% deal with mental health issues. Over the years, telepsychiatry care for older adults has received increasing acceptability. Videoconferencing with improved connectivity and transmission rates has aided in evaluating, assessing, and providing mental health interventions at ease. The recent regulation of telemedicine practice in the country by rolling out the Telemedicine Practice Guidelines 2020 and Telepsychiatry Operational Guidelines 2020 has fast-tracked its utility during the COVID-19 pandemic. Concerns of physical examination, psychological satisfaction of consulting physician in person, confidentiality, and security of information shared are points that need better addressing in the future. However, Telemedicine is recommended to be used judiciously, taking the risk and benefit of older adults on a case basis as it can significantly bring down the financial and emotional burden.
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Affiliation(s)
- Rakesh Chander Kalaivanan
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Patley Rahul
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | | | | | - Suresh Bada Math
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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9
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de Peralta SS, Ziaeian B, Chang DS, Goldberg S, Vetrivel R, Fang YM. Leveraging telemedicine for management of veterans with heart failure during COVID-19. J Am Assoc Nurse Pract 2021; 34:182-187. [PMID: 33625164 PMCID: PMC8371074 DOI: 10.1097/jxx.0000000000000573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Telemedicine and telemonitoring have become invaluable tools in managing chronic diseases, such as heart failure (HF). With the recent pandemic, telemedicine has become the preferred method of providing consultative care. LOCAL PROBLEM This rapid paradigm shift from face-to-face (F2F) consultations to telemedicine required a collaborative approach for successful implementation while maintaining quality of care. The processes for conducting a telemedicine visit for HF patient are not well defined or outlined. METHOD Using a collaborative practice model and nurse practitioner led program, technology was leveraged to manage the high-risk HF population using virtual care (consultation via phone or video-to-home) with two aims: first to provide ongoing HF care using available telemedicine technologies or F2F care when necessary and, second, to evaluate and direct those needing urgent/emergent level of care to emergency department (ED). INTERVENTION The process was converted into an intuitive algorithm that describes essential elements and team roles necessary for execution of a successful HF consultation. RESULTS Following the algorithm, nurse practitioners conducted 132 visits, yielding 100% success in the conversion of F2F appointments to telemedicine, with 3 patients referred to ED for care. The information obtained through telemedicine consultation accurately informed decision for ED evaluation with resultant admission. CONCLUSION Collaborative team-based approach delineated in the algorithm facilitated successful virtual consultations for HF patients and accurately informed decisions for higher level of care.
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Affiliation(s)
- Shelly S. de Peralta
- Western University of Health Sciences, School of Graduate Nursing, Pomona, California
- VA Greater Los Angeles Healthcare System, Division of Cardiology, Los Angeles, CA
| | - Boback Ziaeian
- VA Greater Los Angeles Healthcare System, Division of Cardiology, Los Angeles, CA
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Donald S. Chang
- VA Greater Los Angeles Healthcare System, Division of Cardiology, Los Angeles, CA
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Sarah Goldberg
- VA Greater Los Angeles Healthcare System, Division of Cardiology, Los Angeles, CA
- University of California Los Angeles, School of Nursing, Los Angeles, CA
| | - Reeta Vetrivel
- VA Greater Los Angeles Healthcare System, Division of Cardiology, Los Angeles, CA
| | - Yichun M. Fang
- VA Greater Los Angeles Healthcare System, Division of Cardiology, Los Angeles, CA
- University of California Los Angeles, School of Nursing, Los Angeles, CA
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Affiliation(s)
- Meta McGee
- ST4 Old Age Psychiatry, Belfast Health & Social Care Trust, Northern Ireland
| | - Claire Potter
- Academic Clinical Fellow, Centre for Public Health, Queen's University Belfast, Northern Ireland
| | - Joseph Kane
- Academic Clinical Lecturer, Centre for Public Health, Queen's University Belfast, Northern Ireland;
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11
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The Nuts and Bolts of Utilizing Telemedicine in Nursing Homes – The GeriCare@North Experience. J Am Med Dir Assoc 2020; 21:1073-1078. [DOI: 10.1016/j.jamda.2020.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/18/2022]
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12
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Gillespie SM, Handler SM, Bardakh A. Innovation Through Regulation: COVID-19 and the Evolving Utility of Telemedicine. J Am Med Dir Assoc 2020; 21:1007-1009. [PMID: 32736843 PMCID: PMC7386846 DOI: 10.1016/j.jamda.2020.06.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Suzanne M Gillespie
- VA Finger Lakes Healthcare System, Canandaigua, NY; Division of Geriatrics/Aging, Department of Medicine, University of Rochester School of Medicine, Rochester, NY.
| | - Steven M Handler
- VA Pittsburgh Healthcare System, Pittsburgh, PA; Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Alex Bardakh
- AMDA-The Society for Post-Acute and Long-Term Care Medicine, Columbia, MD
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13
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Stephens CE, Halifax E, David D, Bui N, Lee SJ, Shim J, Ritchie CS. "They Don't Trust Us": The Influence of Perceptions of Inadequate Nursing Home Care on Emergency Department Transfers and the Potential Role for Telehealth. Clin Nurs Res 2020; 29:157-168. [PMID: 31007055 PMCID: PMC10242499 DOI: 10.1177/1054773819835015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
In this descriptive, qualitative study, we conducted eight focus groups with diverse informal and formal caregivers to explore their experiences/challenges with nursing home (NH) to emergency department (ED) transfers and whether telehealth might be able to mitigate some of those concerns. Interviews were transcribed and analyzed using a grounded theory approach. Transfers were commonly viewed as being influenced by a perceived lack of trust in NH care/capabilities and driven by four main factors: questioning the quality of NH nurses' assessments, perceptions that physicians were absent from the NH, misunderstandings of the capabilities of NHs and EDs, and perceptions that responses to medical needs were inadequate. Participants believed technology could provide "the power of the visual" permitting virtual assessment for the off-site physician, validation of nursing assessment, "real time" assurance to residents and families, better goals of care discussions with multiple parties in different locations, and family ability to say goodbye.
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Affiliation(s)
- Caroline E. Stephens
- Department of Community Health Systems, University of California, San Francisco, CA, USA
| | - Elizabeth Halifax
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Daniel David
- Department of Community Health Systems, University of California, San Francisco, CA, USA
| | - Nhat Bui
- Asian Health Services, Oakland, CA, USA
| | - Sei J. Lee
- Division of Geriatrics, University of California, San Francisco, CA, USA
- San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Janet Shim
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
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Abstract
PURPOSE OF REVIEW Novel technologies, such as high-definition cameras, encryption software, electronic stethoscopes, microfluidic diagnostic systems, and widely available broadband Internet have expanded the potential for telemedicine. This narrative review presents current and future uses of telemedicine in the prevention, diagnosis, treatment, stewardship, and management of infectious disease. RECENT FINDINGS Beginning in the 1990s, early approaches to telemedicine in infectious disease focused largely on treatment of HIV/AIDS, hepatitis C, and tuberculosis. However, recent innovations allow for targeting of additional diseases and in increasingly remote settings. Telemedicine allows virtual visits between patients in the home and remote providers, permitting outpatient management of complex conditions, such as post-surgical site monitoring, and non-urgent infectious maladies, such as uncomplicated urinary tract infection. Remote provider education by videoconference and integrated clinical decision support tools create avenues to improve inpatient care, including antimicrobial stewardship. Technological strides from miniaturization of diagnostic tests to robotic telepresence physical exams improve access to infectious disease care in isolated and infrastructure-poor environments, from cargo ships to other resource-limited settings. Telemedicine in the field of infectious disease is rapidly expanding in clinical, technological, geographical, and human capacity. Recent innovations narrow gaps in access to care for populations traditionally underserved, stigmatized, isolated by remote geography, or lacking technological infrastructure. Current and future approaches will transform inpatient, outpatient, and remote care.
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Gillespie SM, Moser AL, Gokula M, Edmondson T, Rees J, Nelson D, Handler SM. Standards for the Use of Telemedicine for Evaluation and Management of Resident Change of Condition in the Nursing Home. J Am Med Dir Assoc 2019; 20:115-122. [DOI: 10.1016/j.jamda.2018.11.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
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Hale A, Haverhals LM, Manheim C, Levy C. Vet Connect: A Quality Improvement Program to Provide Telehealth Subspecialty Care for Veterans Residing in VA-Contracted Community Nursing Homes. Geriatrics (Basel) 2018; 3:geriatrics3030057. [PMID: 31011094 PMCID: PMC6319220 DOI: 10.3390/geriatrics3030057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/21/2018] [Accepted: 08/31/2018] [Indexed: 11/16/2022] Open
Abstract
Veterans residing in Veterans Health Administration (VA) contracted Community Nursing Homes (CNHs) receive primary care from the CNH they reside in, but often travel to Veterans Affairs Medical Centers (VAMCs) for specialty care services. The Vet Connect project is a quality improvement project aiming to implement video technology to support access to specialty care. Methods: Eight Denver VAMC specialty care providers and three project nurses underwent telehealth training and obtained appropriate equipment. To identify in-person visits eligible for substitution of video visits, project nurses review charts of CNH Veterans, consult directly with Veterans, and obtain recommendations from staff. Project nurses serve as tele-presenters within the CNHs, while VA specialists provide care from the VAMC. After each visit, team nurses coordinate care with and deliver specialty care recommendations to CNH staff. Results: We assessed clinical, business, and technical domains of the Vet Connect project, and utilized process mapping to identify barriers and facilitators to implementation. Clinically, starting on 26 June 2017 through 1 June 2018, N = 203 video visits have been conducted with 11 different CNHs in three subspecialties: geriatrics, palliative care, and mental health. These visits generated 49 referrals for 37 Veterans. Fiscally, cost analyses indicate that per visit, the health care system saves an estimated $310. Technologically, the success rate was 83%. Process mapping helped identify facilitators and barriers to implementation of the telehealth program, including cultivating buy-in from key stakeholders (i.e., medical and mental health providers, telehealth staff, and CNH staff), communication allowing for ongoing program adaptation, and building relationships. Conclusion: Subspecialty care delivery to nursing homes using video visit technology in the Vet Connect program is feasible using centralized organization to coordinate complex clinical, business and technical processes. Vet Connect has proved sustainable and has potential to expand within and outside of the VA.
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Affiliation(s)
- Anne Hale
- VA Eastern Colorado Healthcare System Center of Innovation for Veteran-Centric and Value-Driven Care, 13611 East Colfax Ave., Aurora, CO 80045, USA.
| | - Leah M Haverhals
- VA Eastern Colorado Healthcare System Center of Innovation for Veteran-Centric and Value-Driven Care, 13611 East Colfax Ave., Aurora, CO 80045, USA.
| | - Chelsea Manheim
- VA Eastern Colorado Healthcare System Center of Innovation for Veteran-Centric and Value-Driven Care, 13611 East Colfax Ave., Aurora, CO 80045, USA.
| | - Cari Levy
- VA Eastern Colorado Healthcare System Center of Innovation for Veteran-Centric and Value-Driven Care, 13611 East Colfax Ave., Aurora, CO 80045, USA.
- School of Medicine, The University of Colorado Denver, Aurora, CO 80045, USA.
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