As more health care is delivered in the community, the home care industry is increasingly turning to communications technologies to meet this demand. Telehealth, the practice of providing health care services to people who are distant from the provider using telecommunications and information technologies, can provide services such as client care, consultations and education. Advocates of telehealth note that this mode of health care delivery offers many potential benefits such as: Meeting the needs of underserved populations Building providers and patients’ knowledge and reducing rural isolation Decreasing trips by providers and patients Decreasing patient transfers Reducing acute healthcare utilization costs for chronically ill patients Improving access to care Positively impacting productivity of home health care.

Nurses are vital members of the telehealth delivery team and many futurists view telenursing as an emerging role in nursing practice. One such futurist is Dr. Loretta Schlachta-Fairchild, who along with partner Jo Ann Klein, has founded a telehealth company called iTelehealth Inc. Partners at iTelehealth describe the company as a multi-industry connector whose mission is to develop processes, services, structures, and resources in telehealth, with a focus on alternative care sites including home care, assisted living, nursing homes, and disease management.

Healthnet spoke with Dr. Fairchild at the Frederick, Maryland-based company to learn more about her views on the future of telehealth and its influence on nursing practice.

Healthnet: Tell our readers about your background in telehealth and how you first became interested in the field.

Dr. Fairchild: Coming from an Intensive Care Background, I tend to suffer from “technolust” – a fascination with monitors, sensors, gizmo’s – in short, devices that facilitate and improve the care of patients. During a career in military nursing, I volunteered to serve as nursing advisor to what was then the first Military Telemedicine Testbed in Georgia. From there, I became the Clinical Director of the program, managing 17 tele-consultation programs and was the Army Principal Investigator of a home telehealth technology development grant called the Electronic Housecall.

The notion of providing technology to patients in their homes was powerful both in thought and in practice. The changes I saw firsthand in patients’ lives were astounding, and keep me motivated to this day. It is astounding to see homebound, chronically ill, sick patients, who cost the healthcare system a lot of money transformed into happy, relatively active seniors with manageable chronic illness. Home-based telehealth (a combination of BOTH technology AND health care delivery) changes people’s lives, and we have the testimonials and the data to show it. This is AN answer to the issues of cost of care, access to care, patient empowerment and many of the challenges of chronic illness.

Because I have a graduate degree in Healthcare Administration, I am attuned to the business models of healthcare delivery. There are fiscal imperatives to promote and disseminate the use of home-telehealth delivered care to offset rising chronic care and acute care costs. Ultimately, the point of care should take place in patients’ living rooms and kitchens, where the decisions are made that impact whether people wind up in the hospital. Our view is that more investment in IT at home will prevent acute care costs.

Healthnet: What prompted you to start your own business in telehealth?

Dr. Fairchild: Our business was formed because of our interest in telenursing practice and our belief that providers need to become aware of and promote the use of home telehealth technology. In order for patients to benefit, providers must understand and be fluent in the use of the technology. I sometimes feel like a “tele-evangelist”, spending my time promoting the vision and benefit of nursing’s role in promotion of this life-changing technology. We must inform our profession in order to provide care in this way. The bottom line is, that WE nurses need to promote the solutions to healthcare decision-makers in leadership roles. That means, from a business AND clinical perspective.

In the “business” world of healthcare, success is measured by dollars. The business of healthcare must be combined with the clinical care part of healthcare. We at iTelehealth Inc. felt that in order to successfully promote the use of home telehealth-delivered care, we needed to form a business entity to show that it could be both financially and clinically viable. The Principals (owners) and Associates of iTelehealth Inc. bring a variety of business, technical, administrative and clinical skills together, with a view toward pushing the use of home telehealth technology into the everyday world. Because no one in telemedicine is yet making a profit (telemedicine is still in the early adoption phase), it is a challenge to both focus on the vision AND pay the day-to-day costs of operating a live company with all its associated expenses. But, we are passionate about what this type of approach can do for patients, thus we are committed to finding the business model that “fits” the emerging arena of home telehealth.

In addition to my business activities, my doctoral dissertation, The 2000 Telenursing Role Study, was a first attempt to describe the practice of telehealth nurse in the United States. Specifically, we now know: (1) how many telehealth nurses exist, (811); (2) where these nurses are practicing (all over the US – telenurses in 40 of 50 states responded to the study); (3) the nature of these telehealth nurses’ practice’ (4) what their day-to-day challenges are and (5) who makes up their patient population. Nursing can now build from this body of knowledge. Our vision is that Telenursing will be practiced by nurses in ALL specialties, and incorporated into schools of nursing. In doing so, the opportunity to transform healthcare delivery AND nursing will be realized.

Healthnet: Your company description states that you are a multi-industry connector, what do you mean by that.

Dr. Fairchild: Organizations must view telehealth as a communications device AND an export tool. It is now possible with telehealth, to export the skills of nurses, doctors, nutritionists, therapists, and other allied health professionals to anyone, anywhere, any time. This is very powerful technology – but it is also disruptive. For an organization to recognize the benefit of telehealth, and then to commit to operationalize telehealth is two entirely different animals.

The operationalization requires lots of reengineering, business process redesign, training, mentoring, technical support and financial/administrative commitment. Telehealth is not a journey to be taken lightly by an organization – sometimes it is simplistically described as “let’s buy some of these boxes and plug them in”…nothing could be farther from the reality, as it is never that easy.

A Multiple Industry Connector recognizes the components that must be present for success in telehealth: telecommunciations, education, telemedicine equipment, licensure/training/credentialing, administration, budget/finance and project management. Each of these components draws from a completely different industry sector of healthcare and technology. We see ourselves as the “glue” that draws the pieces together to make a “fit” for an organization that would like to use telehealth technology to achieve its business and clinical goals. Rather than “build” a telehealth application (which can take 2-6 years when learning from “scratch”), we can facilitate the use of telehealth in an organization and jump-start their ability to be actually USING the technology by years.

Healthnet: What do you see as the future of telehealth in the delivery of service?

Dr. Fairchild: I grew up watching the Jetson’s cartoons, which fascinated me. Jane gets on her video screen and orders up her groceries and talks to her friends. In my vision of the future of healthcare delivery, Jane also downloads her vital signs data to a nurse, and then receives a video call, either routine or based on an abnormal parameter, where the situation is addressed and taken care of BEFORE Jane has to get so bad that she winds up in the Emergency Room or hospital. I think consumers will drive the demand for this type of service and technology. Our Internet and telecommunications infrastructure (i.e. cable, wireless, Internet in every home) in the U.S. is just now starting to make this type of scenario available (but not yet widely affordable, except for those patients who already have documented high healthcare costs). In my vision of the future, everyone has access via home telehealth to the level of care that they need-the “point of care” changes to the living room, NOT the bedside, where it’s too late to do anything about healthcare costs – the cash register is “cha-chinging” already once the patient has entered the acute healthcare system.

Healthnet: How do you see the role of the nurse evolving in telehealth and how should faculty be preparing future nurses to practice in telehealth roles?

Dr. Fairchild: I would like to think and hope that nurses will be fascinated with and wholeheartedly embrace Telenursing. Unfortunately, not all of nurses (just like not all people in general) are comfortable with or supportive of computers/technology. This seems rather ironic, since nurses routinely use a great deal of technology in their clinical practice – monitors, infusion pumps, etc…. I see the practice of Telenursing as being the catalyst that can completely reframe our profession and take nursing into the 21st century as a highly respected, valued profession. It is not until nurses unit and form a common vision that this will occur. We at iTelehealth Inc. are trying to promote that vision.

Faculty must demand a level of fluency with technology for nursing students. Faculty THEMSELVES must be fluent with technology in order to accomplish this. Communicating by email, insisting on Powerpoint presentations, creating assignments that use Internet search tools and other strategies that embed the use of computer technology into the daily schedule of nursing students is imperative. Openness to change in nursing is also required – remember Nesbitt’s “High Tech/High Touch”, all of this” technology “stuff” will only serve to make the “care” part of nursing more valuable and more in demand.

FITNE wishes to thank Dr. Fairchild for her time and provocative insights. To contact Dr. Fairchild, email her at: lschlacta@itelehealthinc.com or visit the iTeleHealth Inc. website at: http://www.itelehealthinc.com/.

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