|Year : 2016 | Volume
| Issue : 1 | Page : 58-63
Synergy: Information technology and health sciences
Dorothy Deena Theodore, Soumya Shree, Anuradha Adinarayana Reddy, Roshini Kuriokose
Department of Mental Health Nursing, Narayana Hrudayalaya College of Nursing, Bangalore, Karnataka, India
|Date of Web Publication||2-Jun-2016|
Department of Mental Health Nursing, Narayana Hrudayalaya College of Nursing, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore - 560 099, Karnataka
Source of Support: None, Conflict of Interest: None
Technology is evolving to meet the demands of the current population in need of health promotion and education, and access to care in rural areas that are attacked with chronic illness. Physicians and nurses in hospitals are using telemedicine, telenursing, and e-nursing as advanced technologies. These technologies are continually expanding to develop new modes of medical care delivery. This article deals with telemedicine, telenursing, and e-nursing in terms of their applications and advantages.
Keywords: E-nursing, nursing information system, telemedicine, telenursing
|How to cite this article:|
Theodore DD, Shree S, Reddy AA, Kuriokose R. Synergy: Information technology and health sciences. Arch Med Health Sci 2016;4:58-63
| Introduction|| |
Globalization and technological change processes have accelerated in tandem over the past years and have created a new global economy strengthened by technology, fueled by information, and driven by knowledge. In the past few years, information and communication technology (ICT) have provided us with new communication capabilities and better management of illness experienced by people who reside in remote areas away from modern health care facilities. For example, we can communicate with others in different countries using technologies such as instant messaging, and videoconferencing as well as treat patients online and through telephones. Modern ICTs have created a “global network,” in which people can communicate with others across the world as if they were living in same home. This article deliberates on telemedicine, telenursing, and e-nursing and its application in modern nursing.
| Telemedicine|| |
The term “telemedicine” is derived from the Greek word “tele” meaning “at a distance” and “medicine,” which is derived from the Latin word mederi meaning healing. Telemedicine may be defined as the use of computers and telecommunication technologies to provide medical information and services from distant locations. Telemedicine has existed from the very beginning as seen among the native Africans who used to smoke to signal illness in the village. In 1870s, the first call was made by the inventor of the telephone, Mr. Graham Bell who made the call requesting for assistance for battery acid burns. In 1906, electrocardiogram (ECG) transmission through telemedia was invented and in 1955, telepsychiatry evolved.
In India, the Apollo Group of Hospitals was a pioneer in starting a pilot project at a secondary level hospital in a village called Aragonda, 16 km from Chittoor (population of 5,000, Aragonda project) in Andhra Pradesh (India), which is credited as being the first state to set up a rural telemedicine center in 1999. The hospital started from simple web cameras and ISDN telephone lines; today, the village hospital has a state-of-the-art videoconferencing system and a very small aperture terminal (VSAT) satellite installed by Indian Space Research Organization (ISRO). At presnt, telemedicine facilities have been extended to private hospitals such as Narayana Hrudayalaya (Narayana Health), Apollo Group of Hospitals, Rabindranath (RN) Tagore Cardiac Hospital, and Calcutta (Asia Heart Foundation). Narayana Health is also a part of the “Karnataka Telemedicine Project,” which was inaugurated on April 8, 2002 and links two rural hospitals in Saragur, Karnataka — The Chamarajnagar District Hospital and the Vivekananda Memorial Hospital.
According to World Health Organization (WHO), telemedicine is the delivery of health care services, where distance is a critical factor, by all health care professionals using ICT for the exchange of valid information for diagnosis, treatment, and prevention of diseases or injuries, research and evaluation, and for continuing the education of health care providers, all in the interest of advancing the health of individuals and their communities.
Telemedicine is defined by the Telemedicine Information Exchange (1997) as the “use of electronic signals to transfer medical data (photographs, x-ray images, audio, patient records, videoconferences, etc.) from one site to another via the Internet, intranets, personal computers (PCs), satellites, or videoconferencing telephone equipment in order to improve access to health care.”
Objectives of Telemedicine
Use of ICT:
- To provide specialized health care consultation to patients in remote locations.
- To facilitate videoconferencing among health care experts for better treatment and care.
- To provide opportunities for continuing education of health care personnel.,
- To enable health care provider to offer his/her medical expertise to patients to facilitate remote or local health care delivery to patients.
- It is most beneficial for people living in isolated communities and remote regions.
- It is useful as a communication tool between a general practitioner and a specialist available at a remote location.
- It is used as a teaching tool by which experienced medical staff can observe, show, and instruct medical staff in another location.
- It reduces the cost of health care and increases efficiency through better management of chronic diseases, shared health professional staffing, reduced travel time, and fewer or shorter hospital stays.
- It enables the transfer or exchange of medical information from one specialist center to another over a long distance.
- It helps the patients in providing early advice at a cost that is far below that of hospital visits, thereby cutting the cost of hospitalization.,,
Telemedicine is relevant to our society as some hospitals with poor infrastructure may connect with those having better technology. In some settings, the nonavailability of experts (disparate distribution) can be overcome through telemedicine consultations. Low doctor-patient ratio (large population) is another factor that may be overcome through the use of telemedicine. Here the doctor may consult from a distance and prescribe the relevant care. Lack of proper medical education due to the dearth of qualified and experienced teachers can be dealt with by the use of telemedicine though which experts in the field may be able to use the technology to impart information and demonstrate techniques and procedures. Telemedicine is an effective method for the delivery of health services when there is an inequitable distribution of services, for example, distribution of health resources in urban and/or rural areas.
The telemedicine service was started in Narayana Hrudayalaya hospital in the year 2002 to cater mainly to the rural population in the country. The telemedicine network of the hospital connects to countries such as Malaysia, Mauritius, and Pakistan. Most of the cases referred are through telemedicine. Most referrals are cardiac cases. ECG reports, audio/visual data, computed tomography (CT) scans, x-rays, magnetic resonance imagings (MRIs), and their analysis are exchanged via the telephone line, broadband connection, or satellite. The telemedicine services provided are free and more than 21,000 cases have been referred using this service. At Narayana Hrudayalaya, telemedicine facility is also used to conduct academic teaching/training sessions. Having established the telemedicine network, the same facility is used to conduct teaching programs. Over 550 continuing medical education (CME) programs have been conducted in the past 5 years.
Currently, the telemedicine unit is connected to all the district head post offices (POs) in Karnataka, India (25 in number) through the Internet and software applications. A patient can consult a physician in his/her resident area; he/she can always walk into any district head PO with his/her medical reports and hand it over to the postal staff for uploading the documents, be it a paper document, ECG, or an angiogram. He/she will receive the analyzed reports from Narayana Hrudayalaya within 24 h, which will be handed over the counter or delivered at the doorstep of the patient by post.
Core principles of telemedicine
Some of the principles that need to be kept in mind are as follows:
- It is only a tool (such as a stethoscope); telemedicine is used as a communication medium with the patient. The final decision regarding the treatment or management has to be made by the physician or the therapist.
- It must be physician-directed — Therefore, it is to be also remembered that telemedicine cannot replace the physician. The physician needs to give clear and explicit directions to the patient during the telehealth encounter as to his/her ongoing responsibility for any required follow-up and ongoing health care.
- It must be integrated into established clinical operations and routines — Telemedicine does not stand apart but it should be integrated into the health care delivery system.
- Physician-patient relationships must be preserved — Use of machines and technology has a tendency to make the experience very technical. But health care deals with humans whose core of existence depends on interactions. Therefore, this should not be ignored.
- The health care organization and physician providing telehealth services should be aware of and ensure compliance with relevant legislations and regulations designed to protect the confidentiality of patient/client information and have its own confidentiality guidelines.,
Infrastructure of telemedicine is same as telenursing, which we will be discussing in “Telenursing” Advantages
- The patients can access specialized health care services to underserved rural, semi-urban, and remote areas and also, they can consult expert medical specialists without having to be physically present.
- Telemedicine reduces visits to specialty hospitals for long-term follow-up care, especially for the aged and terminally ill patients.
- After care or postoperative care, patients need not come to the main hospital for minor consultations.,,
- Hospitals can spread their reach in remote villages and serve people without much investment in the infrastructure, and hospitals get revenue from the references made from remote locations.
- Primary diagnosis can be done with the use of telemedicine and the patient can come to the main hospital for a major surgery.
- Hospitals can have CME programs with other hospitals and medical colleges and hospitals can run training programs from their premises for doctors of other hospitals.
- Doctors can learn new techniques by connecting to foreign hospitals.
- Job interviews can be conducted.
- Live images such as ECG, ultrasonography (USG), CT scan, echocardiography (echo), x-rays, and any video output from medical instruments can be transmitted.,,
The barriers of telemedicine are behavioral barriers (such as resistance to telehealth, lack of public awareness, change management, lack of information technology knowledge). Other barriers are financial access to capital, accessibility, technological problems, reliability, reimbursement, legislative licensure, privacy and security concerns, and lack of trained manpower.
The legal precautions to be taken during telemedicine include the following. Accountability –– since services are provided from a distance, they should be accountable. Malpractice could happen when there are unethical practices in terms of nonqualified people functioning as quacks. Multistate registration — Here since the practitioner belongs to one state and has a registration to practice within that particular state, he/she may have to acquire the registration of the other state(s) where he/she practices though telemedicine. Phone orders and ethical confidentiality and safety — This requires a regulation on how phone orders are to be taken and implemented. In Narayana Hrudayalaya, a well-experienced surgeon is consulted through telemedicine, and the prescribed medicine names are immediately recorded for the safety of the patient and practitioners. These are some of the legal precautions, which have made telemedicine most effective in providing worldwide cardiac care.
| E-Nursing|| |
According to the Royal College of Nursing (RCN), e-health is the term we use to refer to all uses of ICT in health and health care. E-nursing is a part of e-health, which refers to the uses of ICT to provide better nursing care. ICT is the machinery — The hardware (computers, personal digital assistants, mobile phones, and other devices) and the software (the information systems) that enable information to be manipulated and transmitted from one place to another.
Goals of e-nursing
The goals of e-nursing are as follows;
- To enhance benefits to nurses from all developments in ICT.
- To improve nursing and client outcomes.
- To reduce the workload of nurses, thus improving the quality of nursing care and yielding better patient care.
Purpose of e-nursing
The purposes of e-nursing are:
- To guide the development of ICT initiatives in nursing so that nursing practice and client outcomes are improved.
- It promotes evidence based practice.
It has got tremendous potential to improve the practice of nursing, if applied in appropriate and useful ways.,
E-nursing strategy for profession
- Nurses in Clinical Practice: E-nursing encourages nurses to participate in ICT initiatives, helps them to identify patient needs, and evaluate possible solutions; it also increases competence in the use of ICT and helps them to access multiple sources of information.
- Employers and Administrators: They have to recognize ICT as a tool of professional nursing practice, support involvement of nurses in ICT initiatives, encourage adoption of ICT that supports nursing practice, educators and researchers, incorporate ICT competencies into the curriculum, and develop research programs to optimize nurses' use of ICT.
- Nursing Organizations: These have to provide leadership for nurses' involvement in ICT, and recognize ICT competencies as part of entry-level and continuing competence requirements.
Nursing Information System (ICT) Benefits: Using nursing information system, nurse can spend more time with patient and less time at nurse station, it Reduces paperwork/paper loss, Automated tools of nursing documentation, Accurate logging of nurses activities, and Uniform standards of nursing care are programmed (nursing process, Cost reduction (Fewer loss of charges)., Advantages and disadvantages of E-nursing are discussed in [Table 1].
In Narayana Hrudayalaya, I-care (electronic tablets) are implemented on a trial basis where nurses document the details about the patient including vital signs, saturation level of the patient, intake and output, central venous pressure (CVP), and medications in I-care. Nurses find this very useful as they can save time in tracing back previous details just by a single click on the details that they need and this avoids duplicating both the services and patient documentation. I-care also helps nurses to take necessary action when the patient is in an emergency situation by listing out the management options on the system itself.
Prerequisites of implementation of E-Nursing documentation
A management committee has to review the collection of data. Each department, clinical/nonclinical, should decide the type of data it requires. The committee reviews and then advises on the information technology (IT) of the hospital's overall requirements. The IT department will manage the software and hardware necessary to fulfill the requirements. A strategic plan of the hospital has to be developed to implement the system, develop policies and procedures, implement e-nursing documentation, organize education and training for users, and offer day-to-day assistance for hardware and software troubleshooting. The staff has to be granted the right of access to specific databases. A password system has to be used to safeguard confidentiality. A maintenance system has to be developed for equipment failure, contingency plans, and backup of vital data. Regular software/hardware audits should be conducted to develop corrective action.
Nurses can contribute to the electronic health record by establishing good documentation practices, be involved in or start auditing practice, and identifying workflow issues or organizational barriers.
| Telenursing|| |
Telenursing refers to the use of telecommunications technology in nursing to enhance patient care. It involves the use of electromagnetic channels (e.g., wire, radio, and optical) to transmit voice, data, and video communication signals. Telenursing started in 1912, i.e., the Australian Inland Mission established nursing posts for nurses in remote areas. In 1970, the health maintenance organization used nurses to give telephone advice. In India, teleconferencing is used as a means of conducting the Doctor of Philosophy (Ph.D.) classes by the Indian Nursing Council (INC) since 2007. Even Indira Gandhi National Open University (IGNOU) uses teleconference for distance education.
- Telenursing was instituted as an effective mode for providing care to patients geographically distant from health care providers.
- Using telecommunications and information technology, nursing care is provided in remote areas.
- Nurses recognize the value of telecare and telehomecare as essential components of telenursing that give patients easy access to high-quality care and eliminate costs and difficulties associated with travel to health care facilities.
- Telenursing continues to grow as a valuable method for providing nursing care, especially in home health care.
Principles of telenursing
- Augment existing heath care services and expand the hospital services to remote areas.
- Enhance optimum and immediate access, thereby reducing chronic illness and hospitalizations.
- Improve and enhance the quality of care, and maintain nursing standard and practices in a better way.
- Reduce the delivery of unnecessary health services by providing relevant information at real time.
- Protect confidentiality and security, and consider patient right.,
The functions of telenursing include providing the patient with informed consent, informing him/her of the choices, advocating technical innovations and systems that support safe, competent, and ethical care, complying with existing organizational policies and guidelines, providing the patient with the nurse's full name, qualifications, and registration.
Competencies of telenursing include participation in the development, implementation, and evaluation, collaboration with team members, a computer-based approach, and advocating for technological innovation. Mobiles, messaging devices, video and audio conferences, digital assistance, faxes, telerobotics, mobile telemedicine, mobile telemedicine, and computer information system user interfaces are the technologies used in telenursing. Often normal phone lines are used to communicate directly between the patient and the center though some system using the Internet. Advantages and disadvantages of telenursing are discussed in [Table 2]. Web-based health patient services provide direct consumer outreach and services over the Internet.
Infrastructure: Telenursing consultation room is where the nurse, specialist, or consultant converses with the peripheral center and telenursing center/home and from where the patient or health care worker consults with the consultant.
Barriers: Behavioral barriers include resistance to telenursing — “fear that nurses are delegating tasks to machines.” Public barriers include change management — understanding the capabilities and limitations of the technologies and applying them appropriately, lack of knowledge on information technology and usage among health care professionals and clients. Financial barriers include access to capital and responsibility issues such as who was going to pay for it and whether the responsibility to sustain/add programs lay at the national, provincial, or regional level or was a combination of all of these? Other issues include national, provincial, and regional. Legislative barriers include licensure, nursing, legal, ethical responsibilities, cross-jurisdictional issues, provincial/territorial response. Policy barriers include the absence of policies impacting telenursing adoption and lack of uniform standards provincially and nationally. Other barriers are the potential for fraud and abuse, privacy concerns, secure access, and consent management — The type required, who should obtain, the secondary use of data, for example, research., Implications of telenursing for patients, providers and health care system are discssed in [Table 3].
Legal, ethical, and regulatory issues
Accountability for practice, security, privacy, and confidentiality, providing informed consent, and liability protection are some of the legal, ethical, and regulatory issues in telenursing. In India Anna University, Apollo Telemedicine Networking Foundation provides a certificate course, School of Telemedicine and Biomedical Informatics, National Institute of Health and Family Welfare, and Rad Gurukul provide training in telenursing.
Telenursing is very important for our country; it needs to be implemented because by using telenursing, nurses will be able to assess patient conditions, provide the best nursing care, and evaluate the effectiveness of nursing care from distant locations. Telenursing may also be used for the purpose of follow-up of the client. Telenursing also helps the patient to get nursing care at their homes and communities where the facilities are not developed. It also reduces the traveling for both the patient and the nurse. In short, telenursing may be used for the primary, secondary, and tertiary management of clients.
| Conclusion|| |
In every sense, telemedicine, telenursing and e-nursing are essential components for providing high-quality, safe, and effective care. Given the intense focus on these issues by the government, the public, and the professions, it is vital that health professionals see these as an essential part of and not just an addition to their practice. Also, we need to consider engaging with ICT to meet the challenge of contributing to high-quality health care.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]