Telemedicine has the ability to enhance home health care in a number of ways. It reduces the need for certain kinds of nurse visits, allows remote monitoring, improves medication compliance and enhances patient education. However, a home health and assisted living nurse can’t be replaced by video conferencing equipment, especially in an elderly population that often suffers from social isolation.
A recent qualitative study published by BioMed Central Health Services Research suggests that many nurses dislike the use of telemedicine in home health environments. They dislike how the technology changes clinical routines, how it marginalizes clinical expertise and how it diminishes interactions with patients. Whether nurses are LPNs, RNs, BSNs or MSNs working as supervisors (click here to research programs), they should accept, even reluctantly, that telemedicine isn’t going anywhere. At the same time, home health organizations need to address nurses’ concerns about telemedicine’s disruptive effect on their workloads and their patients.
Disruption of Clinical Routines
The BioMed Central study highlighted a home telemedicine program in Nottingham, U.K., which originally began as a pilot program in 2007. Thanks to the program’s success at reducing hospital admissions and lowering case manager workload, the city decided to expand the program and put telemedicine equipment into the homes of 250 chronically ill patients. These patients worked with community matrons, chronic heart failure (CHF) nurses, chronic obstructive pulmonary disease (COPD) nurses and community support staff.
Although the nurses thought that telemedicine produced good outcomes for patients, it significantly altered how nurses structured home visits. They spent a great deal of time installing, setting up and troubleshooting equipment. In addition, nurses felt frustrated that adding the telemedicine equipment meant adding duplicate documentation. They entered patient data into their own organization’s data system in addition to documenting patient visits within the telehealth system.
Perception of Lack of Expertise
In Nottingham, poor training for the use of telemedicine equipment made nurses feel that they performed poorly in front of patients. They assumed that patients felt that nurses lacked expertise when they didn’t know how to correctly use telemedicine equipment. Training was conducted with large groups of nurses, and nurses learned to use the equipment on plastic dummies instead of on real patients. Also, because Nottingham experienced hiring delays for its team of clinical support workers, nurses were often left to solve technological problems on their own.
The most threatening consequence of having nurses think patients perceive them as incompetent is that their concerns cause them to dislike the telemedicine equipment and not to use it. Because nurses were expected not only to install and set up equipment but also to train patients to use the equipment, their difficulties also influenced patients to choose not to use the equipment.
Diminished Interaction With Patients
We talked to nurses from Carlton Senior Living, who take a much more personalized approach towards assisted living, and they were unanimously worried that usage of this remote equipment would eliminate face-to-face interactions with patients, and that objective data wouldn’t provide a complete picture of the patient’s condition. They argued that subjective data, such as the appearance of a patient, provided crucial clues to the existence of conditions like infections or depression.
Nurses also expressed concern about substituting telemedicine for home visits. In fact, one CHF nurse reported that her patient felt “stir crazy” about not having company or being able to leave the house. “Just talking about things to someone and not to a box makes a difference,” said the nurse.
Before rolling out a telemedicine program, home health providers need to create procedures for equipment installation and setup. Nurses should be expected to help patients use their equipment, but they shouldn’t be asked to perform highly technical troubleshooting tasks. Organizations should send technicians to patient homes for equipment setup and let nurses focus on the clinical aspects of their jobs. In many cases, they may be able to partner with equipment resellers to ask for installation, setup and technical support.
In addition, home health providers should plan ahead to streamline data inputs so that nurses aren’t putting patient data into multiple portals. Duplicate data entry not only increases nurses’ workloads but also increases the chances for inconsistencies between entries and poor syncing of patient records. Most of all, agencies have to remember that telemedicine can improve efficiencies and provide patients with more contact channels. However, no technology can replace a caring human touch.