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Fundamentals of Nursing Informatics Paper:

Telehealth in Providing Safe and Quality Patient Care

Megan Voit, Madison Wszolek, Gracie Zottnick, Kaylee Kannegiesser, and Sarah Bachmeier

Department of Nursing, University of Mary

NUR 242: Fundamentals of Nursing

Professor Weigum

March 8, 2021
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Introduction 

The world of medicine is constantly changing. Telehealth has assisted the progress of

medicine to where it is today by providing healthcare remotely to patients around the world.

Telehealth is a continually growing virtual communication practice providing healthcare

resources and information. This advancement makes the world of medicine more easily

accessible for patients and allows providers to sufficiently interact with them. In addition,

resources such as telehealth can be advantageous especially considering the current state of the

global pandemic.  Explored in this paper is the scope of telehealth technology, error prevention

and patient safety, confidentiality, the benefits and limitations of the technology, and nurses’

involvement in telehealth. 

The Scope of the Technology

COVID-19 has affected many different aspects of daily life, with healthcare experiencing

significant impact Because of the pandemic’s health and safety protocols, in-person office visits

declined 60% (Demeke et al., 2020). This decline in the opportunity for in-person visits created a

different option for people to seek attention from the healthcare system. Telehealth has been an

option for patients, but was not widely accepted for a few reasons, for example, different

insurance coverage policies, high startup costs, and lack of patient interest didn’t make the use of

telehealth appealing (Demeke et al., 2020). Telehealth followed social distancing protocols and

saved Personal Protective Equipment (Uscher-Pines et al., 2020). Before COVID-19 telehealth

was accessed, but mainly by those in rural areas and when travel to the doctor was difficult.

Now, because of the pandemic, telehealth is more widely known and utilized.  

Telehealth “delivers urgent care, behavioral health, preventive care, and chronic care

services directly to consumers through its affiliations with self-insured employers and health
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plans” (Uscher-Pines et al., 2020). There are many different ways that telehealth products benefit

patients. Many think of telehealth being face to face video chats with a healthcare provider;

however, this is just one part of a wide spectrum of telehealth services. Other examples of

telehealth services include usinglogs, videos, and apps, scheduling appointments, refilling

prescriptions, emailing providers, providing access to specialists, and reviewing test results

(Telehealth: Technology meets healthcare. 2020). Because of all the different possibilities with

telehealth it is technology that is continuing to evolve and grow. 

The overall goal of telehealth is to make healthcare more accessible. Telehealth provides

enhanced healthcare services for those living in a rural or isolated community. Moreover, not

only does telehealth provide access to providers, but it also increases accessibility to specialists.

Another goal of telehealth is to provide opportunities to better self-manage a person’s own health

(Telehealth: Technology meets healthcare. 2020). For example, logs allow the user to track

health information to identify changes and if something may not be right. Cell phone apps can

provide reminders of when to take medications and when to schedule a flu shot. Telehealth has

become much more widespread because of the recent circumstances; however, it has allowed

more people to seek health care in a safe and effective way. 

Error Prevention and Patient Safety

A common concern with electronic health information is the margin of error and the

possibility of miscommunication due to the variety of answers that can be obtained by

overlapping sources of information. For example, a patient who receives a brochure from their

healthcare provider but finds that the information conflicts with that of which they find on the

internet may cause confusion and lead to misuse of care interventions or the neglect of using

them at all. Telehealth solves this issue since it looks to prevent the miscommunication errors by
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providing patients with direct contact to a trained medical professional from the comfort of

home. Multiple studies have concluded that “medication errors can be significantly reduced by

telemedicine” (Agboola et al. 2016). For example, a California study reported that children in

pediatric critical care had three times more medication errors than patients who received their

medication intervention education through telehealth (Dharmar et al., 2013). Moreover, instead

of patients relying on the internet, books, or brochures to receive medical information, access to

medical professionals in a face-to-face interaction removes many of the limitations that internet

self-doctoring or brochures produce.

Telehealth programs are useful for primary consultations, but they can also be used for

secondary and tertiary prevention purposes as shown in the reduced number of hospitalizations

and fatalities in heart failure patients in the ten-year span between 2003 and 2013 (Kitsiou et al.,

2015). Furthermore, with telehealth, care is more coordinated and efficient because of the access

to communication among providers and patients. The advances brought by telehealth “facilitate

the exchange of a patient’s information between two or more sites” (Agboola et al., 2016). When

there is more communication between sites like physicians and practitioners, the care that the

patient receives is more fluent, more efficient, and more accurate to the type of care that they

need. The use of telehealth in the medical field aids in the accessibility to care which overall

reduces the margin of error while managing different diagnoses form multiple practitioners and

physicians. It also aids in the coordination of care by providing health care staff with more

clinical hours to maintain hospitalized or long-term care patients. By incorporating the practice

of telehealth into the patient’s evaluation and diagnosis stages of the care plan, the care can be

better individualized and more accurately directed to the proper treatment, therefore increasing

the probability of providing safe patient care.

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Consideration to Protect Confidentiality

Although telehealth can be a great resource for patients for a variety of reasons, there are

some concerns that arise with this approach to medicine. Such concerns include the privacy and

confidentiality of the patient when meeting electronically rather than face to face in a clinical

setting. Due to this concern, certain considerations need to be put in place in order to protect

confidentiality of health information. These include the patient’s location, “only authorized users

should have access to [the] ePHI [Electronic Protected Health Information]” (HIPPA Guidelines

on Telemedicine, 2020), a secure communication network should be used, and “a system of

monitoring communications containing ePHI should be implemented to prevent accidental or

malicious breaches.” (HIPPA Guidelines on Telemedicine, 2020). It is the patient's responsibility

to ensure that they are in a private room where the telehealth appointment can be conducted.

Engaging in doctor appointments at a workplace or at home can oftentimes be difficult as there is

“the potential for work colleagues [and family members] to overhear conversations.” (Powell et.

al., 2017).  However, the “use of headphones and reserving... space for the visit” (Powell et. al.,

2017) both at home and at a place of work can easily solve this concern. Additionally, popular

communication companies such as Skype, SMS, and email should not be used for telehealth

appointments as they can easily be breached and private information can be stolen. Instead, many

“healthcare organizations have elected to use a secure messaging solution to comply with the

HIPAA guidelines on telemedicine” (HIPPA Guidelines on Telemedicine, 2020) that are privacy

oriented and as effective as other forms of communication. With these considerations

implemented into telehealth programs, many patient concerns regarding privacy and

confidentiality can be eased. 

 
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Benefits and Limitations

Telehealth has its benefits and limitations. In this section of the paper, benefits and

limitations will be outlined along with the impact it has on healthcare safety and quality. Benefits

of telehealth include cost savings, convenience, and the availability of health care to those who

have limited access or transportation to medical facilities.  For example, for those in rural areas

without access to local health care, telehealth can provide needed medical care and assistance

from the individual’s home.  The convenience of telehealth provides greater options for those in

rural areas to reach out and receive treatment for health issues.  This option for those in rural

towns impacts patient safety by making them more willing to reach out and get treatment for

health issues than they were before, because of the convenience and access to health care that

telehealth provides. Along these lines, easy access to medical professionals can increase patient

education and prevention of diseases and injuries, which helps impact patient safety. Another

advantage that is very relevant right now is that telehealth can help prevent the spread of

COVID-19 (Kichloo, A. et. al., 2020).  The fear that comes with spreading and contracting the

virus has led to an increase in the interest and use of telehealth to receive care and limit contact

with people; this can be very beneficial for the older population at risk for contracting the virus. 

It is reported that one in four Americans age 50 and older used the service of a virtual medical

visit during the first three months of the coronavirus pandemic, which is higher than the four

percent in that same age group that participated in a virtual visit in the previous year (Concorde,

2020).  Next, telehealth also offers greater independence and allows patients to take a more

active role in their care.  This active role can lessen frequency of depressive symptoms, limit

emergency room visits, and even decrease the number of medications a person is taking.  In

regard to physicians and health care providers, telehealth has boosted productivity by allowing
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health care providers to work efficiently by quickly transitioning from one appointment to

another.  This allows more patients to get the help they need.  

On the other hand, telehealth also has some downsides and limitations.  A significant

limitation is that not every aspect of a visit can be performed virtually.  For example, imaging

tests, blood work, and other hands-on tests may need to be performed to make a diagnosis, and

this cannot be done over a video call.  Another limitation to telehealth is the need for the

patient’s home and the physician’s office to have reliable and fast broadband connections.  This

may not be possible for some patients, especially those living in rural and remote areas and may

cause issues in giving and receiving the care needed.  Another risk is the electronic transmittal of

personal health information. This impacts patient safety by leaving personal information

vulnerable to interference and hackers to capture and obtain the data, causing it to be stolen or go

missing. It is also unclear whether all virtual telehealth apps follow privacy rules dictated by the

Health Insurance Portability and Accountability Act or if telehealth apps, under the Food and

Drug Administration, qualify as medical devices.  This impacts patient safety by possibly

jeopardizing the security of patient information. Another limitation is the ability to obtain

reliable and clear informed consent from patients regarding advantages and concerns about

medical treatments and the use of telehealth (Harvard Medical School, 2020).  It is difficult to

ensure the patient understands and consents to the treatment received over a virtual platform. 

Physicians also have limitations in regard to telehealth because each state licensure for health

care providers is different. Therefore, telehealth runs into issues with different physicians having

different scopes on a state-by-state basis, in turn, affecting what each practitioner can and cannot

do.  Lastly, there is also inconsistency in insurance coverage for telehealth visits and some

virtual services may not be covered creating out-of-pocket costs for the patient.
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Nurse Involvement in Telehealth

         Upon review of the various technologies produced and used to advance telehealth in the

health-care system, nursing input has not been utilized in the design and evaluation process of

these technologies. However, due to the nurse’s integral role in providing safe and quality care to

the patient through telehealth services, efforts should be made to reverse this trend and include

the nursing perspective when researching and designing telehealth technologies. According to

The Pediatric Clinics of North America, the research and design process of informatics and

communication technology (ICT) is a time consuming and expensive process as “only 61% of

information system projects meet customer requirement specifications, and 63% of projects

exceed their estimated budgets because of inadequate initial user analysis” (Wang et. al., 2020).

The Veterans Health Administration developed a network that was able to meet patient needs by

allowing health care providers to customize the telehealth experience for their patients through

use of user data and feedback. However, this took many years of research and trial, copious

funding, and a large network of health care providers to improve. Nursing professionals were not

involved in the development of this patient experience despite their close contact with patients

and valuable insight into patient needs which may have been able to expedite the process (Wang

et. al., 2020). Additionally, the lack of nurse involvement in the design of telehealth could

impede nursing implementation of ICT. The Scandinavian Journal of Caring Sciences reports

that there is varied implementation and use of telehealth technologies among nurses due to

insufficient knowledge and education of ICT (Koivunen & Saranto, 2018). This in turn has been

found to result in an overall lack of acceptance and decreased use of telehealth technologies and

applications. Incorporating nurses into the telehealth design process could help reduce the

knowledge barrier regarding telehealth applications and usage while simultaneously improving
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nurse implementation. Additionally, the need for the integration of telehealth curriculum into

academic nursing programs has been identified to more adequately prepare nurses for conducting

telehealth visits and advocating for safe and quality patient care (Ferguson, 2006 as cited in Fathi

et al., 2017).

As telehealth services continue to expand and grow, nurse selection of ICT has become

extremely important. Efficiently selecting appropriate ICT that most closely aligns with patient

needs is important in ensuring the quality, cost, and convenience of patient telehealth care

(Sensmeier, 2011 as cited in Fathi et al., 2017). Nurses are able to select from numerous

modalities of telehealth such as synchronous or asynchronous telehealth, mobile health, or

remote telemonitoring to name a few (Fathi et al., 2017). The nurse-patient relationship formed

will help dictate the form of telehealth the nurse finds to be most beneficial to the patient. As a

part of the nursing process, evaluation is constantly occurring during the nurse-patient

interaction. Regardless of physical presence, nurses incorporate evaluation into telehealth care as

well. Concerning evaluation of telehealth technologies, review should be done utilizing input

from experts in “clinical care, quality of care, information technology, and patient

representatives” (Wang et. al., 2020). Considering these guidelines nursing professionals should

be included in this evaluation, as well as the design, selection, and implementation of telehealth.

Conclusion

In conclusion, there are many aspects of telehealth that have influenced and improved

patient safety and quality of care. These include the scope of the technology, error prevention,

confidentiality, benefits and limitations, and the involvement of the nursing profession in

telehealth. Further research is needed to improve the overall software and technology involved in

telehealth. Research must be conducted to ensure telehealth applications strictly follow HIPAA
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guidelines and protect patient confidentiality in regard to their privacy policies. Extensive

research, time, and funding was needed to evolve telehealth to where it is today, and even greater

effort will be needed to further develop the software. The nurse’s role in integrating telehealth

into patient care is vital to ensure technology is appropriately and efficiently used. Further

education of nursing use of technology will continue to grow the scope of telehealth and increase

the positive effects seen in the healthcare system.

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