NCM 119A Nursing Leadership and Management

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CHAPTER IX

TELECONFERENCING

E-health
Everybody talks about e-health these days, but few people have come up with a clear
definition of this comparatively new term. Barely in use before 1999, this term now seems to serve
as a general "buzzword," used to characterize not only "Internet medicine", but also virtually
everything related to computers and medicine.

The term was apparently first used by industry leaders and marketing people rather than
academics. They created and used this term in line with other "e-words" such as e-commerce, e-
business, e-solutions, and so on, in an attempt to convey the promises, principles, excitement (and
hype) around e-commerce (electronic commerce) to the health arena, and to give an account of the
new possibilities the Internet is opening up to the area of health care. Intel, for example, referred to
e-health as "a concerted effort undertaken by leaders in health care and hi-tech industries to fully
harness the benefits available through convergence of the Internet and health care."

Because the Internet created new opportunities and challenges to the traditional health
care information technology industry, the use of a new term to address these issues seemed
appropriate. These "new" challenges for the health care information technology industry were
mainly (1) the capability of consumers to interact with their systems online (B2C = "business to
consumer"); (2) improved possibilities for institution-to-institution transmissions of data (B2B =
"business to business"); (3) new possibilities for peer-to-peer communication of consumers (C2C =
"consumer to consumer").

e-health is an emerging field in the intersection of medical informatics, public health and
business, referring to health services and information delivered or enhanced through the Internet and
related technologies. In a broader sense, the term characterizes not only a technical development, but
also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking,
to improve health care locally, regionally, and worldwide by using information and communication
technology.

The 10 E’s in e-health

1. Efficiency - one of the promises of e-health is to increase efficiency in health care, thereby
decreasing costs. One possible way of decreasing costs would be by avoiding duplicative or
unnecessary diagnostic or therapeutic interventions, through enhanced communication
possibilities between health care establishments, and through patient involvement.
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2. Enhancing quality of care - increasing efficiency involves not only reducing costs, but at
the same time improving quality. E-health may enhance the quality of health care for
example by allowing comparisons between different providers, involving consumers as
additional power for quality assurance, and directing patient streams to the best quality
providers.

3. Evidence based - e-health interventions should be evidence-based in a sense that their

effectiveness and efficiency should not be assumed but proven by rigorous scientific
evaluation. Much work still has to be done in this area.

4. Empowerment of consumers and patients - by making the knowledge bases of medicine

and personal electronic records accessible to consumers over the Internet, e-health opens
new avenues for patient-centered medicine, and enables evidence-based patient choice.

5. Encouragement of a new relationship between the patient and health professional,

towards a true partnership, where decisions are made in a shared manner.

6. Education of physicians through online sources (continuing medical education) and

consumers (health education, tailored preventive information for consumers)

7. Enabling information exchange and communication in a standardized way between health

care establishments.

8. Extending the scope of health care beyond its conventional boundaries. This is meant in
both a geographical sense as well as in a conceptual sense. e-health enables consumers to
easily obtain health services online from global providers. These services can range from
simple advice to more complex interventions or products such as pharmaceuticals.

9. Ethics - e-health involves new forms of patient-physician interaction and poses new
challenges and threats to ethical issues such as online professional practice, informed
consent, privacy and equity issues.

10. Equity - to make health care more equitable is one of the promises of e-health, but at the
same time there is a considerable threat that e-health may deepen the gap between the
"haves" and "have-nots". People, who do not have the money, skills, and access to
computers and networks, cannot use computers effectively. As a result, these patient
populations (which would actually benefit the most from health information) are those who
are the least likely to benefit from advances in information technology, unless political
measures ensure equitable access for all. The digital divide currently runs between rural vs.
urban populations, rich vs. poor, young vs. old, male vs. female people, and between
neglected/rare vs. common diseases.

In addition to these 10 essential e's, e-health should also be

 easy-to-use,

 entertaining (no-one will use something that is boring!) and

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 exciting

TELECONFERENCING: SOCIAL MEDIA

Teleconferencing means meeting through a telecommunications medium. It is a generic term for

linking people between two or more locations by electronics. There are at least six types of
teleconferencing: audio, audiographic, computer, video, business television (BTV), and distance
education. The methods used differ in the technology, but common factors contribute to the shared
definition of teleconferencing:

● Use a telecommunications channel

● Link people at multiple locations
● Interactive to provide two-way communications
● Dynamic to require users' active participation

Types of Teleconferences
Audio Teleconference: Voice-only; sometimes called conference calling. Interactively links people
in remote locations via telephone lines. Audio bridges tie all lines together. Meetings can be
conducted via audio conference. Preplanning is necessary which includes naming a chair, setting an
agenda, and providing printed materials to participants ahead of time so that they can be reviewed.

Audiographics Teleconference: Uses narrowband telecommunications channels to transmit visual

information such as graphics, alpha-numerics, documents, and video pictures as an adjunct to voice
communication. Other terms are desk-top computer conferencing and enhanced audio. Devices
include electronic tablets/boards, freeze-frame video terminals, integrated graphics systems (as
part of personal computers), Fax, remote-access microfiche and slide projectors, optical graphic
scanners, and voice/data terminals.

Computer Teleconference: Uses telephone lines to connect two or more computers and modems.
Anything that can be done on a computer can be sent over the lines. It can be synchronous or
asynchronous. An example of an asychronous mode is electronic mail. Using electronic mail (E-
Mail), memos, reports, updates, newsletters can be sent to anyone on the local area network (LAN)
or wide area network (WAN). Items generated on computer which are normally printed and then
sent by facsimile can be sent by E-Mail.

Video Teleconference: Combines audio and video to provide voice communications and video
images. Can be one-way video/two-way audio, or two-way video/two-way audio. It can display
anything that can be captured by a TV camera. The advantage is the capability to display moving
images. In two-way audio/video systems, a common application is to show people which creates a
social presence that resembles face-to-face meetings and classes and enables participants to see the
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facial expressions and physical demeanor of participants at remote sites. Graphics are used to
enhance understanding. There are three basic systems: freeze frame, compressed, and full-motion
video.

WHY USE A TELECONFERENCE?

Videoconferencing increases efficiency and results in a more profitable use of limited
resources. It is a very personal medium for human issues where face-to-face communications are
necessary. When you can see and hear the person you are talking to on a television monitor, they
respond as though you were in the same room together. It is an effective alternative to travel which
can easily add up to weeks of non-productive time each year. With videoconferencing, you never
have to leave the office. Documents are available, and experts can be on hand. A crisis that might
take on major proportions if you are out of town, can be handled because you're on the job.
Videoconferencing maximizes efficiency because it provides a way to meet with several groups in
different locations, at the same time.

As the limited resource of funding has decreased, limited resources now include instructors,
parking spaces and buildings. Students now include time as a limited resources. Teleconferencing
enables institutions to share facilities and instructors which will increase our ability to serve
students.

SOCIAL MEDIA
The term "social media"' is dificult to define and constantly changing. In general, social media
are computer-based technologies through which users can create and share information, ideas,
similar interests, messages, images, and expressions of opinion. These Web-based technologies can
be accessed through desktop computers, laptop computers, and mobile devices such as
smartphones and tablets, Social media can be in the form of blogs, videos, masic sircaming, photo
sharing, video conferencing, and social networks (Ventala,2014). They can generally be classified by
purpose or function such as:
● - Social networking (Facebook, Twitter, Instagram, Snapchat)
● - Professional networking (LinkedIn, professional organization members-only access)
● - Photo sharing (Flickr, Photobucket, Picas)
● - Video sharing (YouTube, Vimeo)
● Video conferencing/presentation/slide sharing (GoToMeeting, Zoom, Facetime, Slideshare)
● - Social bookmarking and Wiki sites
● - File sharing sites (Dropbox, Google drive, iCloud)
● - Content production (blogs, Pinterest)
● - Knowledge/information aggregation (Wikipedia)
● Virtual reality and gaming environments
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The best use of social media in nursing can promote collegial communication and provide
convenient professional development. For patients, social media can provide public health
education, health guidance, and coaching. At the same time, there are challenges to social media
including the sharing of personal or protected information, false information, and cyber bullying.
The American Nurses Association [ANA] (2011) has developed six essential principles for social
networking and the nurse. The foundation for these principles comes from the following ANA
documents: Code of Ethics for Nurses with Interpretive Statements (2001), Nursing: Scope and
Standards of practice, 2nd Edition (2010) and Nursing's Social Policy Statement: The Essence of the
Profession (2010). The six principles can be summarized as;

1. Protection of patient information.

2. Use of ethical patient-nurse professional boundaries.
3. Evaluation of all postings in relationship to content and behavior as it reflects upon the
nursing profession, and the individual nurse's career.
4. Maintaining separation of personal and professional online activities by using appropriate
privacy settings.
5. Abiding by the ethical obligation to be a patient advocate reporting social media content
which
violates a patient's right to privacy and quality healthcare.
6. Participating in the development of policies for handling reports of online conduct which
may raise legal concerns or unprofessional behavior

The issues surrounding social media are not the media themselves but the use of the
technology. When the nurse uses social media, care must be taken to protect the patient's rights and
privacy and to maintain the professional integrity of the murse. If used in a thoughtful manner,
social media can be a valuable tool to impact public health, patient education, and the nurse-patient
relationship (Henderson & Dahnke,2015).

Social media use has increased because it removes geographic and physical access barriers.
Social media supports, promotes, and increases the spread of data. As a result, personal and
community health access have improved. Social media provides a space to share preventive health
information and track personal health outcomes. This does not come without a price and potential
issues. For example, privacy issues must be considered when data are shared across platforms.The
development of applications for sharing personal health data can be costly and requires ongoing
actions to maintain functionality and the latest options (Dosenmager & Aasi, 2017).

Gee and Litchman (2020) note, however, that if properly harnessed, social media can be a
powerful tool for professional nursing practice and patient support. Nurses need to add an
understanding of these new Web-based platforms to their knowledge base, and nursing education
is duty-bound to deliberately add social media to all levels of curriculum. Gee and Litchma conclude
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that social media comes with pitfalls and opportunities for both nurses and patients but suggests
that now is the opportunity for nursing to embrace this new and exciting plaine and use the social
media tools to improve our profession and the health of our communities.

Social media is well established and is used in a variety of ways today. Along with email,
social media represents a unique opportunity for electronic communication in health care. It is a
powerful adjunct to other communication strategies when used appropriately. Some examples
follow:
Example 1: Nurses can connect with other nurses worldwide to share information. Nurses
should present themselves as professionals and be mindful of HIPAA regulations when
participating.
Example 2: Nurses can follow professional organizations through social media for an
excellent source of continuing education that provides nurses with current and relevant
information pertaining to the profession.
Example 3: Twitter can be a great source of healthcare information by following hashtags
such as #BreastCancer. The Healthcare Hashtag Project (Symplur, 2015) maintains a
catalog of hashtags to help healthcare professionals use Twitter more effectively.

Balancing Technology and the Human Element

However, even the most advanced communication technology cannot replace the human
judgement needed by leaders and managers to use that technology appropriately. Examples of the
type of communication challenges that managers face in such rapidly evolving technological society
include the following:
● Determining which technological advances can and should be used at each level of the
organizational hierarchy to promote efficiency and effectiveness of communication
● Assessing the need for and providing workers with adequate training to appropriately and
fully utilize the technological communication tools that may become available to them
● Balancing cost and benefits
● Aligning communication technologies with the organizational mission
● Finding a balance between the technological communication options and the need for
human touch; caring; and one-on-one, face-to-face interaction (Huston, 2017, 2020)

SOCIAL MEDIA SITES FOR HEALTH CARE PROFESSIONALS

1. Sermo
- is a “physician-only” social networking community that verifies the credentials of new
members during registration.
- Physicians representing 68 specialties in all 50 states gather on this site to network, to
discuss treatment options, and to query peers for expert advice
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- Sermo consists primarily of a large message board on which physicians create topics for
discussion. It also provides a rating system by which doctors rank posts on the site on
the basis of perceived credibility

2. Doximity
- newer “physician-only” social networking community that offers text and images that
are compliant with the Health Insurance Portability and Accountability Act (HIPAA),
which allows point-of-care information crowdsourcing.
- As of 2013, more than 100,000 physicians and students were members. Doximity uses a
national database to create “placeholder” accounts with demographic and contact
information for all U.S. physicians. Therefore, although only 12% of U.S. physicians are
active members of Doximity, nearly 100% can be messaged through the network.
3. The Medical Directors Forum (www.medicaldirectorsforum.skipta.com)
- is a social networking site for medical directors that provides a verified, secure, closed-
loop environment for peer-to-peer interaction. The resources on this site include a
comprehensive library, discussion groups, calendar postings, and alerts. The site also
provides dedicated group pages for medical directors working in a wide range of sectors,
including: hospital, veterans affairs, Medicare, group practice, employer, behavioral
health, managed care, correctional facility, and long-term care
4. Facebook
- HCPs can easily connect with each other via “general purpose” online social networks,
such as Facebook which is the most popular social media site.
o VR – Facebook spent billions of dollars to buy Oculus Rift in 2014. The VR device
(with the catch that it can only be used with a Facebook account) is heading
towards mixed reality with its Oculus Quest 2. Not directly a health tool, but it’s
used best in fitness games. Another step into this world will be Facebook’s smart
glass, some cooperation with Ray-Ban.
o A.I. in medical imaging – The company’s A.I. branch, the Facebook Artificial
Intelligence Research (FAIR) group has a number of projects from computer
vision to COVID forecasting. FAIR has been working with the NYU School of
Medicine’s radiology department to significantly reduce magnetic resonance
imaging (MRI) scan time with artificial intelligence.
o Pop-up vaccine clinics – Now why would an online tech company have
vaccination clinics if it has no further plans in healthcare? It might be towards a
greater goal in building health-related trust, but Facebook is doing good: the
company’s pop-up vaccination clinics help bring COVID-19 vaccines to
underserved communities in the US.
o Smartwatch – Facebook has already been rumoured to build its own wearable,
and it seems the company is reaching the end of that development. This
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summer news broke that Facebook is building an Android smartwatch with

health and wellness features. The main draw would be Facebook’s services for
messaging and other social features, but with the company’s reputation with
data handling, its success is at least questionable.
o Social media – Indeed, social media’s core role has returned! During the
pandemic, Facebook and the other channels provided a much-needed link
between people, from support groups to health tips. Facebook’s WhatsApp
played important role in governmental communication as well, where 20% of
the people have signed up for their local governments’ real-time WhatsApp
messages. The social network also takes part in the ‘Alliance for Advancing
Health Online’, in order to improve messaging about health and addressing
vaccine hesitancy, and ensuring vaccine equity among underserved
communities.
5. Zoom
- Zoom’s secure, scalable platform meets the dynamic needs of today’s healthcare,
pharma-biotech, and medical device organizations
o Connect with patients virtually for treatment, care coordination, and follow-up
visits
o Experience simplified scheduling and documentation with custom workflows
and integrations
- 61% of patients in the U.S. plan to access healthcare in person and virtually moving
forward (Zoom-Qualtrics Research, 2021)

REFERENCES:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761894/?fbclid=IwAR2LcbSWUvjmDcXtLyg90v
wivU55_75LNArUA2tnG5D9SvRGrWUEaHhEPSs

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103576/

https://medicalfuturist.com/facebook-in-healthcare/?fbclid=IwAR0S8WW63N341W-
kGUpURECiNvbovw_3TCdi1IxN50TtminheDlTq9LzTfg

https://explore.zoom.us/docs/doc/Zoom%20for%20Healthcare.pdf?fbclid=IwAR1uop4lg1Jd86Cy
6p2VJfzv1FhqWRPW9KhMd0KJNIKPtE65MqFcGhlnGr0