What is telemedicine?
According to the American Telemedicine Association, telemedicine is “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” At first blush, the word made me think of someone in front of a bank of complicated monitors including video of the patient(s) being monitored. None of that is necessarily the case, although “eICUs” are so complicated that someone really can see remote monitoring and view the patient. Still, that definition also includes things like telephone consultations and e-mail.
How are nurses involved?
I have been investigating hospital-alternative nursing jobs and careers for a month, and I have noticed quite a few telemedicine opportunities in diverse areas of medicine and diverse environments for the nurse. In other words, a nurse could work in NICU telemedicine sitting at home fielding telephone calls and analyzing monitor information, or she could instead travel from site to site educating patients and home health nurses on how to use remote monitoring equipment.
How is it used?
Telephone conferencing is so tried-and-true that we might not think of it as telemedicine, but technically it is. This is probably the easiest and most frequent use of telemedicine, and nowadays I see physicians texting to confer (which makes my head explode with HIPAA issues).
Video conferences up the ante. UC Davis conducted a study involving telemedicine for pediatric cases in rural hospitals. This, to me, is a perfect use case for telemedicine. I worked in a community emergency department that saw a fair number of pediatric cases, but not frequently enough for us to be experts at caring for critically ill children, so I can personally attest to the need for such a service. Sure enough, the UC Davis study found that telephone consults decreased error rates in medication doses (the metric they used for comparison) compared with no outside consultation, whereas “visual interaction” decreased the rate far more: 3.4%, 10.8%, and 12.5% error rates for video, telephone, and no consultation, respectively. The study concluded that “the contrast between the telemedicine [in this study telemedicine referred to video conferencing only] and telephone error rates seems to indicate that visual interaction is a key component to improving care.”
Remote ICUs, also called eICUs, usually involve a remote intensivist monitoring ICU patients both via monitor and laboratory readouts and video feeds of the patients. Enthusiasm over this idea ran high a few years ago when I started work as an ICU nurse, but it is now waning. A 2013 New York Times article suggests that the initial enthusiasm may have been fanned by the companies supplying the equipment and that the practice is not as successful as the theory. Also, an obviously astute physician, Dr. Matthew Fink, points out that “[n]urses are the key to success in a good ICU.” Presumably that would be the case whether the physician is in the room or across the planet, because in this case the nurses have to provide the care. Working with a doctor not physically in the hospital must pose some unprecedented interprofessional challenges for nurses.
Devices read over the phone
Telemedicine, going from the super high-tech eICU idea to a super low-tech idea, can also use good old dialup connections and equipment that is friendlier to older patients. When I was in nursing school, part of our community health assignment included shadowing a visiting nurse. One of the patients I saw had congestive heart failure. Each morning she weighed herself and took her blood pressure, and both the scale and the blood pressure cuff were attached to a gizmo that hooked into her land line phone. She dialed the number to her doctor’s office and pressed 2, and the data somehow floated through while she still had the phone up to her ear. When it was done, a recording told her it was done and she could hang up. While we were still standing there, a nurse called back concerned that the patient had gained more than 2 pounds. The nurse I was shadowing then listened carefully to her lungs, and they sounded coarse. The patient felt fine, but the combination of weight gain and adventitious lung sounds allowed her to visit her primary care physician that afternoon, before she felt sick at all, and I’d be willing to bet it kept her out of the hospital.
Soon it will be commonplace for diabetic patients to attach dongles to their phones that analyze their fingerstick blood glucose values, calculate their insulin dose, log all of it, and transfer the data to their primary care physicians. Similarly, such devices and uses will exist for hypertension, weight, and so on. Already scales with smartphone integration exist. Some will even tweet your weight for you: now that is truly motivating.
Medicine will find ways to use new and not-so-new technology to adapt to changing needs. Nurses can have a huge role in tailoring this technology to patient care. The possibilities are certainly intriguing.