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Annotated Bibliography of TeleNursing Publications

Click on each link to access the annotated bibliography for each of the following publications.  If you are connected to the Internet while viewing this page, your experience will be enhanced by clicking on the links within each bibliography.


Note:  This collection of abstracts spans the time period 1974 till October 2002.  The 1970’s articles are historical in nature, documenting the role of Telenursing since that time period. 

American Health Consultants. (1996). Cyberspace holds cost-saving solutions for managed care through “telenursing.”   Interview of Loretta Schlachta by Editor, Case Management Advisor, December 1996.

The Electronic House Call Project is a combined effort of Eisenhower Army Medical Center, The Medical College of Georgia in Augusta, Georgia Institute of Technology in Atlanta, and Jones Intercable in Denver, a company that provides local cable television access.  The focus of the program is “frequent flyers” – patients who are were admitted frequently to the hospital or ED.  They are targeted for home visitation by a nurse in the hopes that frequent electronic visits will enable the staff to intervene before health problems escalate. It is anticipated that the savings will come from reduced admissions, fewer medical complications, and fewer in-home visits.  Patients engage in interactive/visual conferencing in real-time with a “telenurse” at the central monitoring station. 

Arnaert, A., & Delesie, L. (2001). Telenursing for the elderly. The case for care via video-telephony. Journal of Telemedicine and Telecare, 7(6), 311-316.

The elderly resist nursing homes due to fear of autonomy loss. The nursing profession must seek out new methods for healthcare delivery, which empower elderly. The authors assert telecommunications technology offers the possible solution. It allows seniors to receive care needed without social disengagement. The authors discussed using telecommunication technologies, such as video-telephony (i.e. any form of face-to-face video-communication). They state video-telephony provides the elderly the access to a nurse without compromising their autonomy. The authors maintain this supports their emotional, relational and social identity. The elderly embraced video-telephony for its ability to establish on-demand access to a nurse. The authors state nurses responded with some skepticism initially. They further explain, nurses reconciled using video-telephony as a tool, though useful, cannot replace nursing altogether.  

Baines, B. (1996).  Tele-home care in a managed care setting. The Remington Report, November/December 1996, 27-29. 

As home health care growth continues, tele-home care will also grow.  Tele-home care is defined as providing an interactive video telephone home care visit by a home health nurse.  The portable home units use regular telephone lines, and are simple to use, requiring pushing one button to activate.  A central telemedicine unit was purchased and instilled in the office of the home health agency.  One nurse conducted most of the video visits on a scheduled basis.  After the program was initiated, the patient contacts increased by 30%.  In spite of increased contacts, there was a 30% reduction in overall per member/per month medical costs.  Half of the savings were the result of a decrease in inpatient costs  Patients were “highly satisfied” with the services.  The home health nursing staff believed that the video visits  resulted in more efficient use of professional nursing time.

Brennan, P. (1999).  Telehealth:   Bringing health care to the point of living.   Medical Care, 37(2), 115-116.

Telehealth innovations, resulting from the integration of information and communications technologies, support the delivery of clinical services directly to the patient in the location in which he or she resides, works, and lives.  Discussing a research study where videophones augmented, and did not supplant the traditional home health encounter, Brennan states the technology affords greater flexibility in the nature of the encounter and provides clinicians and patients with choices in treatment.

Chaffee, M. (1999). A telehealth odyssey. American Journal of Nursing, 99(7), 27-32.

This article gives a brief introduction to telehealth and telenursing, and also provides The ANA’s Core Principles on Telehealth*. This article describes the intriguing history of telehealth and the first nurse managed telehealth project, which dates back to 1969. Trends of telehealth use, past, present and future are explored. The growth of telehealth is not without issues of concern. Security and confidentiality, licensure, development of policies and standards reimbursement will continue to be hot topics for some time to come.

*Can be purchased through iTeleHealth Inc. See  www.itelehealth.com  

Chan, W., Woo, J., Hui, E., & Hjelm, N. (2001). The role of telenursing in the provision of geriatric outreach services to residential homes in Hong Kong. Journal of Telemedicine and Telecare, 7(1), 38-46.

The increase in the number of nursing home residents in Hong Kong has placed a great burden on healthcare services. The accompanying shortage of geriatric healthcare providers is compounding this burden. The research team tested the benefits of providing several nursing services deployed via telemedicine. The following nursing services were provided: inhaler technique, wound assessment, fall assessment, infirmary assessment and swallowing testing. A research nurse kept detailed notes regarding the telemedicine services and those services requiring on site visits. It was found that 89% of the services could be successfully provided by telemedicine and 11% required on site visits. The ability to reach more clients with telemedicine, than with traditional methods resulted in an increase in positive patient outcomes.

Cunningham, N., Marshall, C., & Glazer, E.   (1978). Telemedicine in pediatric primary care.   JAMA, 240(25), 2749-2751.  

Off-site pediatric consultation via bi-directional cable television (TV) was instituted to provide backup for nurse practitioners treating sick and well children in a small primary care clinic.  During a year of study of the system, there were 2,161 clinic visits and 285 TV consultations.  When both TV and telephone consultation were available, TV was used for 10.8% of the visits, and telephone was used for 9.6% of visits.  Staff reactions, through initially skeptical, were ultimately favorable.  The system allowed pediatric nurse practitioners to function without on-site physician coverage 40% of the time.  The main disadvantages were technical

Cyberspace holds cost-saving solutions for managed care through ‘telenursing’. (December 1996) Case Management Advisor, 161-163.

As managed care organizations struggle to provide quality care to its service-intensive patients, case managers scramble to find new resources. The Department of Defense however, may have found a solution-quality health care via cyberspace. The technology is now being used to manage the day-to-day processes involved with patients who suffer from multiple medical problems. The Eisenhower Army Medical Center along with the Center for Total Access at Ft. Gordon in Augusta, Ga. is delivering this care via the Electronic House Call Project. The focus of the program is to target patients who frequently seek medical attention, also the ‘frequent flyer patient’. The ability to provide more quality nursing visits allows for intervention prior to the escalation of the health problem. Interactive audio-visual conferencing in real time, along with peripheral devices such as an electronic stethoscope, an EKG machine and blood pressure cuff are being utilized to reduce admissions to the hospital, reduce complications and result in fewer in-home visits.

Daus, C. (1997, February/March). Long-distance healing. The Journal for Respiratory Care Practitioners, 73-75.

Medical institutions are successfully integrated telemedicine system into every day operations that merge the delivery of medical care and professional education. The Medical College of Georgia (MCG) Telemedicine Center developed a statewide network, the Georgia Statewide Telemedicine Program, which connects 59 health care and correctional facilities with MCG’s home campus. One of its most successful telemedicine projects has been the creation of a remote site for asthma patients, started in 1996, where a nurse practitioner and respiratory care practitioner work together to assess patients and provide interactive education and care regarding asthma management. As a result of this program, patients are better able to control their asthma.

Another successful telemedicine program is found at the University of Kansas Medical Center (UKMC) who have been able to connect 18 hospitals and medical centers throughout Kansas providing 12 different specialty clinics using remote technology. While the advantages of telemedicine include improved patient satisfaction, improved provider satisfaction, and improved patient outcomes, problems still exist regarding reimbursement for such services, because of the Health Care Financing Administration (HCFA) requirement that the patient and physician be physically present in the same room to receive Medicare reimbursement.

DiCianni, N. & Kobza, L. (2002). A chance to heal. Home health agencies can improve patient care and increase profits with telehealth wound consulting. Health Management Technology, 23(4), 22-24.

The authors discuss telehealth use in wound care. They provide 70-80% of all home visit costs involve wound care. They illustrate this telehealth application as the authors describe the interaction between a wound care nurse in teleconsultation with a field nurse. The field nurse captures the wound’s image for the wound nurse’s inspection and advises the field nurse how to dress the wound. The wound nurse records all images for further study. The authors claim with this telehealth system, wounds consequently heal faster with less field nurse visits, yielding improved health outcomes and a cost savings. They maintain agencies realize a $40,000 return on their investment, compared to $17,000 using telehealth for wound care. The authors iterate improved outcomes with telehealth wound management as 100%healing of stage II wounds compared to 41%. The authors conclude information provided by telehealth wound management facilitates cost-effective wound management with improved health outcomes.

Douglas, K. (1997, September). This nurse is wired. Hospitals & Health Networks, 78. 

HANC (home-assisted nursing care), the first home-based computerized “nurse” to get clearance from the US Food and Drug Administration, is a audio-video device which is used to gather human physiologic data and beam it to a remote nursing station. One hundred of these devices, invented by Stephen Kaufman of HealthTech Services in Northbrook, Illinois, are being used within three health organizations at a cost of $30/day (amortized over three years). The device is being marketed to risk or capitated healthplans and is aimed at improving outcomes and providing nursing care to organizations with limited access to nursing care.

Durtschi, A. (2001). Three patients’   telehome care experiences. Home Health Nurse, 19(1), 9-11.

Tele-home care allows hospice and home care nurses to provide supportive, frequent, prompt, nursing care and professional guidance. This author presents three case studies in a Clinician’s Forum format. He provides the following telehomecare positive outcomes: patient and family satisfaction, dying comfortably at home, improved health and compliance, and cost reduction. The nurse used a videophone with stethoscope and blood pressure machine, transmitting data via regular telephone lines. The author asserts the system’s simplicity, as it required only three color-coded buttons for its operation. The home care office also used a personal computer with appropriate software and a small camera. With outpatient and home care increasing in numbers, telehomecare offers promise to a growing patient population

Elfrink, V. (2001). A look to the future: how emerging information technology will impact operations and practice. Home Healthcare Nurse, 19(12), 751-757.

Industry experts predict information technology (IT) influences the business of healthcare greatly by streamlining clinical processes and increasing the amount of patient data shared among clinicians. The author describes the current status, establishes the need for IT intervention and provides recommendations for future direction in four key areas. These areas are automated process management systems (back office); comprehensive databases, telehealth and advancement of the comprehensive electronic healthcare record and point of care technology. The author considers caregiver IT adoption a healthcare revolution. In the future IT solutions will be widely used to overcome the obstacles of physical time, place and form, thus securing the best healthcare access for all.

Ellis, D., Mayrose, J., Jehle, D., Moscati, R., & Pierluisi, G. (2001). A telemedicine model for emergency care in a short-term correctional facility. Telemedicine Journal and e-Health, 7(2), 87-92.

The authors researched the feasibility of a PC-based telemedicine system in a correctional facility. They sought to evaluate its use as a means of providing emergency medical care to remote sites. The authors reviewed 530 medical records spanning the previous year, entailing 126 telemedicine sessions. They focused on the following data: utilization, chief complaints, diagnostic tests, successful tele-nursing care,  telemedicine outcomes and physical examinations. The authors determined eighty one (64%) of the telemedicine recipients did not require emergency department transport. Telemedicine patients returned to the emergency department 7 days after consultation  with similar rates as non-telemedicine patients. The authors reveal patients conveyed high acceptance and satisfaction. Thirty minute telemedicine consult times contrasted with the conventional,  2 hour and 45 minute emergency department evaluations. Their research provides, a PC-based telemedicine system offered a faster and cost-effective solution to treating remotely located, variety of conditions.

Finkelstein, J., O’Connor, G., & Friedmann, RH. Development and implementation of the home asthma telemonitoring (HAT) system to facilitate asthma self-care. Medinfo, 10(part 1), 810-814.

The National Asthma Education and Prevention Program (NAEPP) designs self-management strategies for asthmatics. Studies reveal low compliance to NAEPP strategies and following the prescribed medication regimens. The authors explain the Home Asthma Telemonitoring (HAT) System as their response to keep asthmatics compliant to NAEPP and their medication regimens. The authors focus on HAT and its intended ability to provide individualized assistance with NAEPP-compliance on a daily basis and alert changes in clinical status. They provided patients spirometers for daily peak expiratory flow (PEF) self-testing and a prophylactic medication plan based on the PEF results. NAEPP uses PEF in their self-management asthma strategies.  The authors iterate previous failures due to a lack of medication compliance and incorrectly performed PEF. Clinicians struggled to provide individualized care. The authors state HAT operates as an application and a peripheral added to a patient’s computer or as a stand alone device attached to a television. The majority of HAT devices exist in the lower income residences in Boston as a handheld device. Patients and clinicians find the HAT mutually satisfying. PEFs approximate those obtained in clinic. The  authors state higher NAEPP compliance occurred with HAT and concludes the need for increased home asthma monitoring.

Grundy, B., Jones, P., &  Lovitt, A.  (1982). Telemedicine in critical care:  Problems in design, implementation and assessment.  Critical Care Medicine, 10(7), 471-475.

Telemedicine consultations were introduced to a ICU unit of a 100-bed inner city hospital in Cleveland, OH from a group of university-based critical care physicians in order to alleviate scarcity and maldistribution of critical care services in the inner city.  Telemedicine “visits” (1548) were made to 395 patients, with an ICU nurse positioning the camera on patients needing consultations at 12:00 noon every day. Interactive television extended the availability of specialist expertise, but full exploitation of the technology for delivery of services was not achieved during the 18 months in use. The teleconsultation services met with some success, but the inner city hospital closed its doors in bankruptcy due to several economic, professional relations and personnel problems 6 weeks after the consultations ceased.

Hamit, F. (1995). Telemedicine before medical telepresence: Promise and challenges. Advanced Imaging, 36, 38, 40.

Telemedicine, as defined by the author, is the interactive transmission of medical images and data to provide patients in remote locations. The idea was generated in the 1920s but the first attempts to implement a distance model occurred in the 1950s, and it wasn’t until the 1970s that projects proved that telemedicine was a viable care-delivery vehicle. The early projects died due to long-range planning and lack of financial support.

Other roadblocks include existing telecommunication technology which limits image size and results in slow transmission of data and provider acceptance, particularly rural physicians who fear that urban medical centers would use the technology to expand their patient base. The author describes existing telemedicine systems at East Carolina University College of Medicine and the Medical College of Georgia. The author also attributes the lack of progress in advancing telemedicine to a lack of technical knowledge and vision by the government official and describes roadblocks associated with federal and state regulations.

Hardin, S., & Langford, D. (2001). Telehealth’s impact on nursing and the development of the Interstate compact. Journal; of Professional Nursing: Official Journal of the American Association of the Colleges of Nursing, 17(5), 243-247.

Information technology (IT) transforms many industries. Data streams increasingly on a global scale without regard to geography. IT emergence ushered in a new era for the nursing profession as well. Nurses care for patients in remote sites in the US. The authors discuss how IT consequently requires healthcare regulation reengineering. They suggest the state level nursing licensure and scopes of practice convention too provincial for telehealth’s wide breadth. In response to this challenge, the creation of a new mechanism for licensure and practice, the interstate compact, is developing. The authors delve into the development and regulatory challenges created by telenursing and the interstate compact.

Higgins, C. A., Conrath, D. W., Dunn, E. V.  (1984).  Provider acceptance of telemedicine systems in remote areas of Ontario.  The Journal of Family Practice, 18(2), 285-289.

Telemedicine, the use of telecommunications technology to assist in the delivery of health care, is an increasing popular solution to some of the problems faced by rural residents in obtaining health care.  Since September 1, 1977, the Sioux Lookout zone in northwestern Ontario has been experimenting with slow-scan video equipment as part of its health care delivery system.  The attitudes of the providers who use the system were surveyed.  The nurses were positive about slow-scan video as an aid in the delivery of health care; however, the physicians were less enthusiastic.  This difference can be explained by physicians’ having had more extensive training than the nurses, and therefore not feeling the same need for medical backup and support.  Both nurses and physicians had more positive attitudes toward the system after experience with it. 

Horton, M. (1997). Identifying nursing roles, responsibilities, and practices in telehealth/telemedicine. Healthcare Information Management, 11(2), 5-13.

With an increase in telemedicine health care delivery and the limited amount of research in this area, the author noted a need to identify the roles, responsibilities, and practices of nurses practicing in this arena. A descriptive study was developed to identify the roles, responsibilities, and practices of nurses in ongoing telehealth/telemedicine programs to define a baseline for future research in telenursing. The convenience sample consisted of 130 participants from nurse-run clinics, home health and rehabilitation center, and the military. Seventy-four respondents actually qualified to participate in the study. These nurses demonstrated higher levels of education in nursing (36% BSN, 18% Masters) than workforce nurses (31% BSN, 8.5% Masters/Doctorate) as reported in the Universal Healthcare Almanac.

Roles were defined to include perceived job responsibilities. Formal responsibilities were considered activities or functions normally written or voiced expectations given by a job supervisor. More than 70% of respondents reported practices to include reinforcing physician instructions, scheduling appointments, documenting written and verbal instructions, and staying with a patient throughout an appointment. A major finding of the study demonstrated that nurses are active in telemedicine and 80% of the respondents routinely assist patients during the process of interactive telemedicine making it more appropriate to identify nurses as providers of telehealth and telemedicine care. Additional comments on the roles, responsibilities, and practices of telemedicine nurses centered around satisfaction, specific nursing actions, roles, technology, and nursing. Role frustration was listed as a reason for limited practice of nursing applications in this healthcare setting.

The researcher concludes that nursing consultation via telemedicine may improve the quality and accessibility of care in capitated environments due to its emphasis on prevention and wellness. The research suggests that the professional nursing role be redefined within the context of technology and telemedicine.

Howard, A. (2001). Clinical call centres: does low-bandwidth video have a place? Journal of Telemedicine and Telecare, 7(Suppl 2), 14-16.

The author explores the use of low-bandwidth video in homecare to reduce chronic care management costs while also improving health outcomes. He defines low bandwidth as the 9.6-56 kbit/s range capable in a common device; the telephone. The author describes the prohibitive Integrated Services Digital Network (ISDN) costs and contrasts them with low bandwidth video equipment costs. He iterates low bandwidth video can enhance the clinical assessment and the social aspect and illustrates with examples. The author provides connectivity and user device as the two main areas. He includes a case study describing mutually satisfying results. The author mentions other case studies in progress and concludes with the identified need for research to indicate specifically where in healthcare low bandwidth video yields positive outcomes.

Hughes, E. (2001). Communication skills for telehealth interactions. Home Healthcare Nurse, 19(8), 469-472.

Bi-directional telecommunications present to nurses, a new skill to master.  The nurse must convey compassion and competence during telehealth sessions, since the interaction sets the tone. The American Nurses Association (ANA) drafted a tool to help meet these needs. The author discusses the ANA’s 11 competencies for telehealth nursing. Two competencies focus on nurse-client relationships. The author provides seven communication skills the ANA designed to promote fostering relationships. The author iterates the ANA’s goal is to optimize the healthcare professionals’ ability to interact when conducting a telehealth session.

Hutcherson, C. (2001). Legal considerations for nurses practicing in a telehealth setting. Online Journal of Issues in Nursing, 6(3):4.

The author focuses on realized and potential legal issues, nurses confront in telehealth. She begins with the emergence and increasing dependence on information technology, its ability to transfer information efficiently and therefore, its’ increasing acceptance for healthcare delivery. The author segues into the US government’s healthcare regulatory state-level practice. She provides this context to illustrate the potential conflicts inherent in telehealth nursing and its technological capacity for healthcare delivery regardless of state borders. The author characterizes telehealth as an example of technology outpacing public policy. She defines telehealth, telemedicine and offers the vagueness of multiple terms as another potentially legal telehealth obstacle for nurses. The author provides the questionable acceptance of telehealth nursing as legitimate nursing, as another obstacle. She provides telehealth nursing challenges state-level healthcare regulation, asserting, the US federal government regulates interstate commerce and offers examples of the federal government regulating interstate healthcare. The author presents the licensure question, pondering the nurse’s need to hold a home state license as well as the patient’s state. She suggests the need for telehealth nursing certification to ensure uniform skill competency. The author concludes the article, iterating the importance of observing quality patient care as the focal point in such discussions.

Japsen, B. (1998). House calls:   Kansas hospital’s experiment in home health telemedicine cuts costs, visits.  Modern Healthcare, March 23, 1998, 47.

Although home health telemedicine programs have the potential to save Medicare money, fewer than a dozen are operating in the US and most are tied to universities, the US Department of Commerce estimates.  The Hays, Kansas project has demonstrated marked savings.  It’s average telemedicine home health visits costs $35, while its in-home visits costs $90.  The big cost difference is in travel time. With home health telemedicine the nurses can check on home patients more frequently. This has the potential to keep home health patients out of the emergency room, and save money.

Jenkins, R., & White, P. (2001). Telehealth advancing nursing practice. Nursing Outlook, 49(2), 100-105.

The authors compared telemedicine-based nursing assessments with face-to-face nursing assessments of home-based patients with chronic congestive heart failure (CHF) home care patients (N = 28). The researchers randomly assigned nurses to a method of assessment: on-site (real time) or telemedicine (monitor time). Nurses assessed patients within 10 minutes of each other. Assessment data consisted of lung sound auscultation, heart sound auscultation, rate and rhythm, blood pressure, weight, edema, respiratory effort, and the patients’ face, lip, and nail color. The authors observed eighteen physiological parameters, using either the Wilcoxon signed ranks test or the McNemar test. The study revealed few significant differences between the assessments of the real time and monitor time nurses. The monitor nurse was more likely to claim abnormality than the real nurse was when assessing the color of nails. The real nurse picked up ankle edema, pedal edema, and inspiratory wheeze more frequently than did the monitor nurse. The authors provide the nurses commented favorably, but recommend modifying the interview to allow symptom reporting not easily observed by the monitor nurse such as diaphoresis. The authors state patient exit interviews indicate a favorable reaction to telemedicine monitoring, citing a quick connection to a nurse and response to their concerns and questions. The authors conclude nurses and patients expressed the necessity of the occasional nurses’ presence when using telemedicine.

Jones, J. & Brennan, P. (2002). Telehealth interventions to improve clinical nursing of elders. Annual Review of Nursing Research, 20 293-322.

The authors provide a retrospective view of exploratory or experimental geriatric telehealth research performed from 1966 to 2001. They obtained research reports from such sources as MEDLINE, CINAHL, PsychInfo, ERIC, and ACM. The authors conducted the search within the English language, using the terms Telemedicine or Health Information Networks, Nursing, and Research. The authors targeted research using interactive computer technology designed for assessment and intervention of geriatric nursing problems. The authors refined their search parameters to experimental or exploratory research reports. They included studies exploring the association between one intervention variable and technology. The authors’ efforts yielded 18 reports describing eight research projects. They reveal collective quantitative interpretation of the studies unfeasible due to research methodology variability amongst the studies. The authors iterate Telehealth’s potential for enhancing geriatric nursing because of nurse, patient and caregiver acceptability, and cost efficiency.

Jerant, A., Schlachta, L., Epperly, T., & Barnes-Camp, J. (1998). Back to the future: The telemedicine house call. Family Practice Management, 5(1), 18-28.  Retrieved April 9, 1999 from the World Wide Web:

Thirty five years ago, home visits were a major part of the family physician’s work, but home health care’s significance has declined since then with of developments in communication, transportation and medical technology.  However, now shorter hospital stays, a continuing need for care following discharge, increased longevity and the trend toward receiving end-of-life care at home are all increasing the demand for home care. 

The Electronic Housecall Project was instituted to determine the effect of frequent electronic home visits on the utilization patterns and cost of care for chronically ill patients with multiple medical problems. A video camera and microphone were installed in patients homes, along with stethoscopes, otoscopes, thermometers, pulse oximeters, and other peripherals to transmit data to the nurses station.  Barriers to increased acceptance are listed, as well as proposed solutions to widespread acceptance. 

Johnston, B., Wheeler, L., & Deuser, J.  (1997). Kaiser Permanente Medical Center’s pilot tele-home health project.  Telemedicine Today,  16-19.

As Kaiser Permanente saw its home health care referrals grow from 360/mo to 520/mo in the first quarter of 1997, they felt this was a mandate to explore remote consultation technology because it might allow them to maintain and even improve patient contact while reducing travel costs.  The pilot project implemented had 100 patients in the treatment (intervention) group and 100 patients in the control group.  The system selected for this study was the American Telecare, Inc.  It operates over ordinary telephone lines, takes very little time to install, and even frail and elderly patients find it simple to use.  Education of all staff was critical, due to expressed skepticism at beginning of the study. Preliminary final data shows a high satisfaction rating with patients and nursing staff.

Johnston, B., Wheeler, L., Deuser, J., & Sousa, K. (2001, January). Outcomes of the Kaiser Permanente tele-home health research project. Archives of Family Medicine, 9, 40-44.

The objective of this study was to evaluate the use of remote video technology in the home health care setting as well as the quality, use, patient satisfaction, and cost savings from this technology within a large HMO in Sacramento, CA.  The results showed that remote video technology in home health care setting was shown to be effective, well received by patients, capable of maintaining quality of care and have the potential for cost savings.  Patients seemed most pleased with being able to access a home health care provider 24 hours a day.  Remote technology has the potential to effect cost savings when used to substitute for some in-person visits.

Jones, P., Jones, S., & Halliday, H. (1980). Evaluation of television consultations between a large neonatal care hospital and a community hospital.   Medical Care,18(1), 110-116.

Two-way television consultations between community hospital nurses and neonatologists at a nearby teaching hospital were conducted over a two- and one-half year period of time and were evaluated with respect to a baseline time period in which the television was not available.  Screening for illness and prematurity in neonates occurred in a high risk population residing in a black, economically deprived, innercity area.  Outcomes including transfer of sick babies from the community hospital to the large teaching hospital are analyzed in relation to prenatal maternal risk characteristics, Apgar scores, birth weight and gestational age. The community hospital nurses were responsible for much of the ongoing care and emergency decision making in the newborn nursery since regular physician coverage in this area was limited. Clinical observations showed that the nurses did become more proficient in physical assessment of newborn infants.

Kinsella, A. (2000). Take a reality check on telehealth: The nurse is in the picture! Home Healthcare Nurse, 18(2), 89-92.

With the advent of newer technologies to perform home care services, the role of the home care nurse is changing. Beyond using the new technologies to care for their patients, home care nurses must play a role in the design and development of the tools. Nurses working closely with telehealthcare tools and their patients can form a unique team. Developing and managing the team approach to telehealthcare - one linking the machine, the patient and the nurse, is clearly essential to the program,s success

Kjervik, D. (1997). Telenursing – Licensure and communication challenges.  Journal of Professional Nursing,13(2), 65.

Telenursing is the sharing of nursing information using electronic means, such as a telephone or the Internet to answer consumers’ questions.  The National Council of State Boards of Nursing issued a background paper on regulatory issues facing nursing in 1996.  The Pew Commission, in 1995, pointed out that the current system of regulation is costly and inflexible, limits access to care and equivocates on quality of care.  Fifty states have their own requirements  resulting in lack of uniformity and creates a barrier to integrated delivery of care and telemedicine.  However, because the locality rule used to determine the standard of care in malpractice cases has eroded considerably, the national standard holds the promise of uniformity.  Proactive models are being proposed by nursing to guide legislators faced with questions on how to remove barriers to practice.

Loane, M., & Wooton, R. (2002). A review of guidelines and standards for telemedicine. Journal of Telemedicine and Telecare, 8(2), 63-71.

The authors explore telemedicine guidelines, as available through electronic sources such as Medline, Telemedicine Information Exchange (TIE), and the Internet. The authors discovered the following three recurring themes: clinical, operational and technical. Clinical guidelines derive from their specific setting such as home telenursing and telepsychiatry, and evolve from their clinical points of origin. The authors provide examples of clinical guidelines in use. Operational guidelines reveal the organization’s data connectivity requirements within and with other entities. They discuss examples of operational guidelines. Technical guidelines listed reference standards such as the Digital Imaging and Communications in Medicine (DICOM) standard and few others. The authors state telemedicine guideline benefits. They iterate the lack of telemedicine standards suggests its lack of wide acceptance by clinicians, but its apparent need for standardization, a sign of maturity as an emerged technology. The authors speculate an international singular source of standardization as a telemedicine mainstreaming catalyst.

McManamen, L., & Hendricks, L.  (1996). Telemedicine:  Tuning in critical care’s future.   Critical Care Nurse,16(3), 102-107.

Two nurses from Montana and Wyoming discuss a core principle of telemedicine: “Move the information rather than the people.”  McManamen and Hendrickx describe several uses for telemedicine in their collaborative project:  care for critically ill patients in the home, support for family members, ACLS training and recertification, teaching  Trauma Nurse Core Courses, orientation for new staff in 10 satellite centers, and relieving isolation of professionals in rural health centers. Both the clinical applications and the distance learning aspects of telemedicine allow patients and health professionals to remain in smaller communities without loss of opportunity for teleconsultation from peers, medical specialists, and advanced education for all health professionals. 

Nakamura, K., Takano, T., & Akao, C. (1999). The effectiveness of videophones in home healthcare for the elderly. Medical Care, 37(2), 117-125.

An intervention study design was applied to evaluate the add-on benefits to home healthcare from a videophone system using Integrated Services Digital Network (ISDN) installed in individual homes of clients and service providers.  An intervention group were provided with videophones (VHHC group), and it was compared to a reference group of regular healthcare cases (HHC group).  The functional independence of individuals in the 2 groups was assessed before and 3 months after home healthcare was started, with and without videophones.  The results showed improvements in functional independence of 5 pairs of males and 11 pairs of females.  Improvements in ADL, communication, and social cognition independence of the VHHC group over the 3-month period measured by the Functional Independence Measure were 1.5 points, 0.7 points, and 1.9 points, respectively; statistically, these were significantly greater than those of the HHC group (individually P < 0.05).  The effectiveness of the videophones in home healthcare service was found to be significant.  This evidence supports the use of videophones in home healthcare to improve the quality of service. 

National Council of State Boards of Nursing. (1997). The National Council of State Boards of Nursing position paper on telenursing:  A challenge to regulation.  NCSBN: Chicago, IL.

Telenursing is defined as the practice of nursing over distance using telecommunications technology.  Often, the client is located in one state and the nurse in another jurisdiction.  What are the regulatory concerns for this practice across state lines?  Does the nurse need to be licensed in both states?  Telecommunications and information technology have brought forward new situations and challenges to nursing regulators.  For updates on the actions of the NCSBN, check their website:  http://www.ncsbn.org.

Nelson, R., & Schlachta, L. (1995). Nursing and telemedicine:   Merging the expertise into ‘telenursing.’ The Journal of Healthcare Information and Management Systems Society, 9(3), 17-22.

Current roles of nurses in telemedicine include program managers, clinical coordinators, and head nurses of telemedicine centers or programs.  The entire telemedicine experience includes patient preparation, explanation for telemedicine procedure, scheduling, and coordination of actual appointment, in addition to troubleshooting and integrating needed equipment and instrumentation.  Nurses with knowledge of computers/informatics, who are comfortable in independent decision-making roles, and in positions where the future is uncertain, are especially suited for telemedicine. Collaborative experiences of advanced practice nurses and medical specialists is helpful. Several enabling characteristics listed for nurses entering the telemedicine arena are:  strong clinical experience, leadership ability to work and collaborate with other health professionals, knowledge of informatics and ability to be instrumental in moving the field forward with new technology. Finally, making electronic housecalls on home patients is another future role for nurses.  

Nelson, R., Stewart, P., & Schlachta, L. (1997). Outcomes of telemedicine services…patient and medicolegal issues. Journal of Healthcare Information and Management Systems Society, 11(2), 14-16.

The medical liability, licensing and credentialing, reimbursement, and patient privacy/security issues described in this 1997 article, are still of concern in 2001.  The authors interviewed directors and staff of 25 telemedicine sites in August 1995 to see what their main concerns were then.  In spite of start-up problems, the interviewees exhibited a high level of enthusiasm and were willing to share successes and opinions.  Finally, the authors stated that moving telemedicine into primary care will be a significant enhancement to patient care.

News Uplink. (1997).  Kansas Blue Cross payment policy yields home-healthcare savings.  Telemedicine and Telehealth Networks, August 1997.

Blue Cross/Blue Shield of Kansas is reimbursing clients for telemedicine-mediated home-healthcare visits, and is yielding savings. The insurer is proceeding cautiously, approving coverage on a case-by-case basis for high-risk, frequent users of outpatient and emergency service.  Slow acceptance by physicians and group contracts that mandate co-payments present obstacles, however.  The telemedicine unit used for home visits is distributed by American Telecare in Eden Prairie, MN, and costs about $4000.  It operates over ordinary telephone lines and features a small video screen.  Despite these challenges the CEO of Kansas Care, foresee steady growth for home telemedicine over the next two years.

Niesl, S., Alemagno, S., & Stricklin, M. (1997, July). Healthy talk: A telecommunication model for health promotion. Caring Magazine,  46-50.

Healthy Talk is a joint venture with the Visiting Nurse Association of Cleveland (VNA) and TelePractice, Inc. It is a pilot telephone screening program to gather and evaluate information about a client's health status using health promotion and disease prevention (HP/DP) objectives defined in 1991 by the US Dept of Health and Human Services, as a framework for managed care environments. Incorporating Healthy Talk tools, a grant-funded demonstration project, Healthy Town, provided HP/DP services to low-income families with children and underserved elders.

The project addressed local barriers to health access utilizing a nurse case management system model to provide the framework for the program. Healthy Talk screening tools allowed clients to call from any touch-tone phone to complete the screening with callers answering a series of yes and no questions with nurse assistance as needed. After the call, a computer sent a fax to the VNA nurse who could identify the client based upon a confidential identification number, and together, they developed mutual goals and a health prevention plan. The program demonstrated that clients will engage in their own self care and health promotion. In addition, Healthy Town significantly increased service to clients with a greater focus on education and access to health care resources at a lower cost than traditional health care.

Ohler, L., & Daine, V. (2001). Potential telecommunication risks: cautions and suggestions for the team. Progress in Cardiovascular Nursing, 16(4), 172-175.

The authors discuss confidentiality challenges posed by telenursing and its use of electronic media such as e-mail. They caution managers to refer to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) when setting up e-mail in the workplace for federal compliance and provide sources for HIPAA guidelines. The authors iterate e-mail informed consent. They continue with acceptable and unacceptable telephone practices for telenursing and provide communication standardization necessary in each practice. The authors emphasize adopting a standard documentation list. They mention the interstate licensure issue and the potential risk of providing telenursing without adequate state licensure. The authors conclude suggesting, nurse practice acts lag with technology’s advancements, meriting addressing potential risks. 

Orlov, O.I., Drozdov, D.V., Doarn, C.R. & Merrell, R.C. (2002) Wireless ECG monitoring by telephone. Telemedicine and E-Health: The Official Journal of the American Telemedicine Association,7(1), 33-38.

The authors researched the feasibility of using a home-based, wireless, telephonic 3-lead electrocardiogram (ECG) system. The subjects consisted of 70 males and 4 females, ages 21-56. The authors divided the 74 subjects into two groups. One group received ECG screenings at Moscow construction site first-aid stations in Russia. The other group, admitted patients, received ECG screenings in a Tblisi hospital in Georgia.  Upon discharge, the patients continued ECG monitoring at home. Doctors received and interpreted the ECG signals at one location. The authors state only 15 out of the 165 readings as abnormal ECG tracings. They assert home-based ECG tests acceptability. The authors iterate remote telephonic, wireless ECG feasibility for its ability to transmit readings from remote locations and its ease of use.

Quinn, E. E. (1974). Teleconsultation:   Exciting new dimension for nursing.  RN, 37(2), 36-42.

A teleconsultation nurse facilitated consults between the Veterans Administration Hospital in Bedford, MA and medical specialists at Massachusetts General Hospital in Boston, MA.  Linked by two-way television, each hospital had a TV studio, conference room, lecture area, examination table, cameras, lights, monitors and control panels.  Consultations in medicine, psychiatry and neurology were carried out successfully.  A teleconsultation nurse is a multifaceted role with responsibilities for technical aspects, programming, patient preparation, and staff orientation. Flexibility and leadership are skills needed by the teleconsultation nurse as this new role develops and expands. 

Robbins, K. (1998).  Telenursing:  Using technology to deliver health care.   ANNA Journal, 25(2), 134.  

Listing both advantages and disadvantages of telenursing, Robbins states telenursing is not a specialty.  It is the use of technology to deliver health care.  The American Academy of Ambulatory Care Nursing (AAACN) has produced Standards for Telephone Nursing Practice.  Also, the American Nurses Association (ANA) has produced guidelines for practice.

Roberge, F., Page, G., Sylvestre, J., & Chahlaoui, J. (1982, October 15). Telemedicine in northern Quebec. Canadian Medical Association Journal, 127, 707-709.

Television transmission of diagnostic and educational information can help to improve specialized medical care in remote and underserved areas. This describes a pilot study in which the Canadian satellite Anik-B was used to link the James Bay area in northern Quebec with two large Montreal teaching hospitals.  Broad-band real-time television was well suited for tele-education and teleconsultation activities. A much less costly method, using narrow-band slow-scan television, was also examined but it requires improvements.  The technology of telemedicine is in place, but its future use is impeded by the prohibitive costs of operating an efficient two-way broad-band television system for several remote health care sites.  A solution to his problem may be an intermediate-band system combining some of the low-cost features of narrowband slow-scan television with the interactive high-resolution advantages of broad-band real-time television.

Rooney, E., Studenski, S., & Roman, L.  (1997). A model for nurse case-managed home care using televideo.  Journal of American Geriatric Society, 45(12), 1523-1528.

 Registered nurses, using a proprietary telehome care system provided home care services to 46 patients in congregate senior apartments and individual patient homes. All enrolled patients received an individualized, computer integrated, nursing care plan that utilized outcome-based clinical pathways and scheduled televideo nursing interventions. All enrolled patients received a comprehensive initial in-home assessment as well as comprehensive follow-up in-home assessments every 60 days.  Patients received an average of four telehome care visits per week for an average of 12.25 minutes per visits.  Nurses were estimated to perform 24 telehome care visits per day using the system. The comprehensive home care program provided nursing services in the home effectively.  Telehome care may be a cost-effective complement to traditional in-home care. 

Russo, H. (2001). Window of opportunity for homecare nurses: telehealth technologies. Online Journal of Issues in Nursing, 6(3):5.

The author discusses telemedicine as the solution for the growing nursing shortage, She states people over 65 will double in population in 30 years, exacerbating the nursing shortage. The author iterates the advantages information technology holds for nursing, from education, documentation to decision support. She lists telehealth-nursing examples such as bi-directional communication in homecare settings, remote physical assessment capabilities, and medication supervision in home care and expanded healthcare for the prison population. The author speculates telehealth as a means for nurses to reshape healthcare and foresees unlimited opportunities for nurses as they assume new roles.

Savenstedt, S., Bucht, G., Norberg, L., & Sandman, P. (2002). Nurse-doctor interaction in teleconsultations between a hospital and a geriatric nursing home. Journal of Telemedicine and Telecare, 8(1), 11-18.

The authors studied the interactions between a doctor and nurses, and the problems encountered, using  teleconsultation technology. The doctor, a geriatrician managing elderly patients in two geriatric wards of a nursing home, provided teleconsulations from a university hospital 12 kilometers away. The authors obtained data by videotaping nurse-doctor teleconsulatations, written questionnaires characterizing teleconsultation content, and, interviewed the nurses and doctors. The teleconsultations covered 101 problems, of which 13 required a physician provide a physical exam in one ward. The authors state the other ward managed 69% (81 out of 118) of their problems with teleconsultation. They provide, physicians learned to trust the nurses findings and suggestions. Physicians became more dependent on the nurses’ ability to organize and present information. The authors maintain nurses required extra effort in organizing their information in preparation for the teleconsulation. Some nurses felt intimidated by this demand and relied on more confident nurses. The authors suggests, consequently teleconsultation shifts the power balance between nurses and doctors more towards neutrality. Both conveyed approval over using teleconsultation but added it required further improvement. The authors conclude teleconsultation, a potentially useful tool in healthcare, provided mutual trust exists between physicians and nurses.

Schlachta, L. (1998).  Disease management via telehealth:  Technology tools for the year 2005.  Proceedings, Pacific Medical Technology Symposium, August 17-20, 1998; Honolulu, HI, Los Alamitos, CA: IDDD Computer Society.

Telehealth is a broader concept than telemedicine.  Telehealth includes the use of interactive video for healthcare practice, the use of the Internet, both for providers’ and patients’ access to clinical information, and expanded use of peripheral monitoring devices.  Home based telemedicine technology will be the fundamental delivery model for health care in the future.  Opportunities for telenursing exist in preventive medicine, community health home health, acute and primary care, school health, psych/community mental health, and disease management. 

Disease management fits in the continuum of care after diagnosis. A nurse team leader works in partnership with the patients’ treating physicians, and other health care professionals. A disease manager nurse uses a computer to access protocols and information over the Internet, then stores patient outcomes into a database for analysis later.  The challenge is to leverage the opportunity of home telemedicine technology to shift from provider-focused care to patient-centric and patient-focused health care. 

Schlachta-Fairchild, L. (2001). An Examination of Telenursing in the United States.  in E-Health.  Chicago:  Healthcare Information and Management Systems Society: pp 25-31.

This chapter reports the findings of the U.S. 2000 Telenursing Role Study, a national, web-based survey of practicing nurses using telehealth technologies (defined as transmission of data and/or video communications, and excluding the group of telephone triage nurses).  Nurses from 40 of the 50 States responded to the 154 question survey. Telenurses worked in 29 different practice settings, to include vendors, web portals, consultants, policy organizations and others.  Telenurses are more highly educated than the general population of US RN’s. The mean experience of telenurses is 21 years in nursing.  Telenurses salaries are on average approximately $3500 higher than the average RN salary.  Findings of the Index of Work Satisfaction yielded a score of 14.77, in keeping with other studies of nurses in various settings, whose satisfaction score ranged from 12-15.  Findings suggest that telenurses experience no difference in job satisfaction than other RN’s in other settings/specialty areas.

Schlachta-Fairchild, L. (2001). Telehealth: a new venue for health care delivery. Seminars in Oncology Nursing, 17(1), 34-40.

Telehealth provides a departure from conventional healthcare models. Its recent introduction already radically changed healthcare services, though arguably telehealth is yet to achieve maturity. The author explains healthcare’s transformation from telehealth’s impact in order to enlighten oncology nurses. The author referenced articles, research studies, and reviewed relevant articles. The author briefly defines telemedicine, telehealth and telenursing and discusses their relationships with each other. She covers telemedicine’s evolution to its current state. The author describes current controversies surrounding telemedicine. She explains requirements for implementing a hospital-based telemedicine site. The author explains telehealth’s capabilities and limitations in oncology nursing. She concludes oncology nurses have the opportunity to influence telehealth’s development and wonders whether they will or will they allow others dictate those changes. 

Serafini, M. (1996). High-tech house calls.   National Journal, February 3, 1996.

In Kansas, home care nurses have stopped ringing doorbells of some elderly patients.  With the help of a local cable company, the nurses have arranged to conduct two-way video visits by television, so that frail patients don’t have to leave their homes. Instead of costing $91 for a home visit, the fee for a video visit is about $35-40, at Home Based Electronic Link to Professionals (HELP).  Supporters of home telemedicine have to rely on anecdotal evidence to spread the word on cost-effectiveness, since hard evidence on effectiveness is not wide-spread. Cost and reimbursement, state licensing restrictions, malpractice questions, and Federal Communications Commission regulations all are barriers to full implementation of telemedicine. 

Sharp, N. (1996). NPs, telemedicine & Federal Communications Commission.  Nurse Practitioner Journal, 21(7), 16-18.    

With the passage of the Telecommunications Act of 1996, a high-stakes bid to spur competition in all communications services was signed into law by President Clinton.  Description given of how monitoring activities moved from the legislative arena to the regulatory arena, following the Federal Communications Commission meetings as well as those of the Joint Working Group on Telemedicine.  Nurse Practitioner involvement in these activities is elaborated.

Sharp, N. (1997). Nurse in a jeep.  Nurse Practitioner Journal, 22(12), 82-89.

The image of a nurse in a electronically-connected Jeep is not far-fetched anymore.  The Jeep will be equipped as a satellite center as the nurse moves between patient homes on her daily rounds as a home health nurse.  The Comprehensive Telehealth Act of 1997 was incorporated into the Balanced Budget Act of 1997, and provided for some limited telemedicine/ telehealth services for rural Medicare patients in health professional shortage areas (HPSAs).  When the nurse in a Jeep returns home, she tunes into her digital television and receives continuing education programs on her home TV. 

Sharp, N. (1998). Teleconsultation: Death of distance.  Nurse Practitioner Journal, 23(10), 84-89.

The Health Care Financing Administration (HCFA) issued a “Notice of Proposed Rule Making” (NPRM), on June 28, 1998.  These are the rules and regulations to accompany the Comprehensive Telehealth Act passed in 1997.  The rules have several restrictions that make it difficult to provide telehealth services to Medicare beneficiaries.  Nurse practitioners are urged to stay tuned and follow the activities of HCFA in this arena.  There will be opportunities opening up for NPs to provide telehealth services.

Simpson, R. (1998).  Long-distance nursing kindles multistate licensure debate.  Nursing Management, 29(12), 8-9.

Telehealth enables nurses to practice across state lines, but it also raises the critical issue of multistate licensure.  This brief review explores the key issues, developments, players, and models of telehealth and multistate licensure being considered by states. 

Simpson, R., (2002). Issues in telemedicine: why is policy still light-years behind technology. Nursing Administration Quarterly, 26(4), 81-84.

Telemedicine enables the clinician to provide care with no regard to geography.  If all the technological requirements exist, healthcare reaches beyond any border. Lacking in its emergence and development: policies allowing clinicians to deliver care outside of their license boundaries. The author discusses the controversy telemedicine raises with licensure policy and its lag behind technology. He offers labor union, state-level and federal perspectives on telehealth licensure. The author suggests cooperation between governmental entities in order to achieve universal licensure acceptance. He concludes telehealth’s fate depends on synchronizing policy with technology.

Siwicki, B. (1997).  Measuring the benefits of telemedicine.  Health Data Management, Faulkner and Grey. 

After almost three decades of effort, health care technologists have proven that telemedicine technology works.  Now what is needed is a vast number of legitimate, in-depth studies that spell out that telemedicine delivers quality health care that is cost-effective.  Hard data from pioneering health care organizations is given:  (1) Telemedicial Emergency Neurosurgical Network, teleneurology in hospital E.Ds in East Bay & North Bay of San Francisco;  (2) The UT Telemedicine Network, teledermatology in hospital E.Ds, Knoxville, Tennessee;  (3) Memorial University of Newfoundland, tele-echocardiograms and telepsychiatry in Newfoundland, Canada;  (4) South Cameron Memorial Hospital, various clinical specialties, plus dietary services and psychiatry.

Siwicki, B. (1999). Providing proof to payers.  Telemedicine, Faulkner & Grey.

Reimbursement for home health care switched to a prospective payment system, starting in 1999, and it is predicted that some home health agencies will flounder and fold due to inadequate reimbursement.  The Cambrian Homecare agency in California decided to invest in home telemedicine to contain costs as well as increase access to patients who need it most.  They are collecting hard data to prove telemedicine’s efficiencies will cut costs to the HMOs and PPOs. The home care system has been dubbed PATSY, for personal audio-visual telemedicine system.  It weighs 16 pounds and features a flip-up video screen and telephone handset and three large buttons used to initiate video link-ups and blood pressure tests.  The nurse’s base unit is similar although it features controls for clinical test operations and picture clarity. 

Siwicki, B. (1997). Saving children’s lives.  Health Data Management, Faulkner & Grey.

Describing the challenging terrain in the state of Utah, brought to light the difficulties of reaching people in small, remote towns and Indian reservations.  Primary Children’s Medical Center in Salt Lake City uses telemedicine software and transmits medical images over standard telephone lines from one computer to another.  To create photographs necessary for a child abuse or neglect teleconsultation, the caregivers at Primary use a colposcope to take magnified pictures of areas of a child’s body.  This technology eliminates the transportation costs associated with getting a child from a remote site to an expert physician and aids in reducing complications from misdiagnoses, thus reducing overall costs. 

Smith, C., Cha, J., Kleinbeck, S., Clements, F., Cook, D. & Koehler, J. (2002). Feasibility of in-home telehealth for conducting nursing research. Clinical Nursing Research, 11(2), 220-233.

The purpose of this study was to determine the feasibility of using home audio/ video telehealth equipment for administering nursing interventions to families, observing the patient response, and collecting research data over specific intervals of time. The study design was a descriptive comparison with observational data collection. The subjects were adult patients (n = 5) using nighttime mechanical ventilators for obstructive sleep apnea and their home caregivers (n = 7). Skin color vital signs, spirometry, and pulse oximetry data collected simultaneously through telehealth equipment and through nurse observation in the home were the same. The authors observed care and the caregiver's use of the patient equipment. When provided nursing interventions, equipment demonstrations, visual illustrations, and audio taped educational directions to facilitate patient care, their data transmitted across telehealth venues with a few exceptions. Costs of telehealth visits were less than traditional home visits, and patients evaluated telehealth with positive responses.

Snyder, K. (1997, August 5). Telemedicine: The new frontier. Drug Topics, 3-6.

Broadly speaking, telemedicine refers to the electronic transmission of medical information or expertise to a patient at remote locations. The Department of Defense (DOD) has been developing both battlefield and peacetime telemedicine applications.  Various types of telemedicine equipment are listed in the article.  It is recommended that these devices be assigned to high utilizers of care – the people suffering from chronic diseases and advanced medical problems, such as heart disease, lung problems, diabetes, cancer or AIDS. The equipment could be easily modified to be useful to pharmacists, doing drug utilizations reviews, for remote dispensing, and as a compliance aid.  The objective is to keep people out of the hospital and avoid expensive intervention, while promoting patient participation in their own health care.

Straker, N., Mostyn, P., & Marshall, C. (1976). The use of two-way TV in bringing mental services to the inner city. American Journal of Psychiatry, 133(10), 1202-1205.

The authors describe a telemedicine mental health program conducted between 1973 and 1975 which was aimed at improving the efficiency of mental health service delivery to high-risk populations where manpower shortages are most acute. The cable TV link program between the Mount Sinai School of Medicine and Wagner Child Health Station in East Harlem, New York City provided mental health care to a pediatric population. 

Through this program, nurses and community health workers, who have the primary responsibility for patient care at the clinic, were trained via weekly lunch-hour television conferences with a child psychiatrist. Patients and their mothers awere evaluated by the child psychiatrist via TV consultations attended by which nurse associates, health workers, medical students, and child psychiatric fellows.  Patients and mothers respond positively to the system, and a high percentage of the psychiatrist's treatment recommendations were accepted. Other positive outcomes of the program include reduced travel time, decreased safety risks, and improved relationships between the clinic and the community it served. Based on the results of this program, the authors suggested that such TV links can increase mental health services to underserved inner-city children.

Sussman, D. (2001). Long Distance relationships: Telehealth lets healthcare professionals see more, do more. [On-line]. Available: http://www.nurseweek.com/features/99-8/telecoac.html

With the aid of specially designed telephones, computers and television screens, nurses can check assess their patients in inner-city apartments, suburban hospices, and rural clinics. The technology allows health care providers to monitor blood pressure, adjust pain medications and supervise wound care. The field of telehealth has grown significantly over the past few years due to the increasing elderly population, the rising number of home health referrals, the national nursing shortage, early hospital discharge, and the high cost of home care. Some of the barriers to implementing telehealth have been the cost of equipment, reimbursement and acceptance from nurses.

Tachakra, S., El Habashy, A., & Dawood, M. (2001). Changes in the workplace with telemedicine. Journal of Telemedicine and Telecare, 7(5), 277-278.

Telemedicine’s presence and acceptance increases because the state of telecommunications technology continues to improve and gain ubiquity. In addition, telemedicine provides the flexibility and timeliness healthcare consumers increasingly expect. Nurses appreciate the improved respect present in their interactions with physicians. The authors explored workplace changes caused by telemedicine as opined by nurse practitioners. They surveyed 110 emergency nurse practitioners (ENPs) using telemedicine. The authors provide 90 respondents (82%) returned completed surveys. The respondents state since exposed to telemedicine, they became more receptive to change (96%) and explore new possibilities (93%). The authors claim the ENPs felt inclined to learn new concepts (99%) and encouraged to teaching others (90%). Their study reveals improved interactions between ENPs and physicians. The authors conclude although workplace changes continue, they are not as pronounced as a previous study predicted.

Visco, D., Shalley, T., Wren, S., Pieri Flynn, J., Brem, H., Kerstein, M., & Fitzpatrick, J. (2001). Use of telehealth for  chronic wound care: a case study. Journal of Wound, Ostomy and Continence Nursing, 28(2), 89-95.

Wound care represents a considerable share of the healthcare required by home-based patients. Nurses manage wounds with greater efficiency through use of telehealth. As the state of telehealth progresses, its use gains familiarity. The authors focus on a telehealth program adopted by the Mount Sinai Hospital Home Health Agency. The authors reveal wound care outcomes on a patient. The authors compared face-to-face wound evaluations with transmitted wound images. They assert wound care management possible with transmitted images. Telehealth increased collaboration between different clinicians and improved documentation. The authors conclude telehealth offers promise as a tool for wound care.

Wakefield, B., Flannagan, J., & Specht, J. (2001). Telehealth: an opportunity for gerontological nursing practice. Journal of Gerontological Nursing, 27(1), 10-14.

Telehealth technological innovations continue. Capabilities improve with progress in telecommunications development. While the emphasis on performance metrics continue, telehealth implementation often lacks fit metrics observance. The authors discuss the importance of end-user feedback with telehealth implementation in order to achieve organizational fit. They argue a carefully paced introduction period eases the transition to telehealth use.  The authors provide a list of questions an organization answers in order to ensure a successful implementation. They conclude telehealth holds great promise as a means of providing care to remote patients, whom otherwise lack access to healthcare. The authors caution telehealth lacks health effectiveness and cost-effectiveness studies.  

Wheeler, M. (1994, March). Soft wall technologies coming closer to home. Health Management Technology, 22-24.

Through the use of bio-computer technology, the author illustrates how a nurse can remotely triage a pediatric patient utilizing monitoring devices plugged into a voice-activated PC (personal computer). The voice-activated system provides a full-health history of the patient, augmenting the physical data, in order to finalize an assessment and treatment plan which is remotely relayed to the family doctor for approval. The voice-activated system automatically updates the child’s electronic record and completes the plan of care by validating physician approval.

The author justifies the importance of this technology based upon the economics and the expanded multimedia features of computer technology. He emphasizes the role of the PC as the source of the future delivery healthcare system into the home environment through the support of the global network resources that will marry large centralized clinical repositories. Through this process, the PC will have the capability to provide educational, triage, and advice services which will increase the amount of healthcare delivery while decreasing redundant utilization.

Williams, T., May, C. & Esmail, A. (2001). Limitations of patient satisfaction studies in telehealthcare: a systematic review of the literature. Telemedicine Journal and e-Health: The Official Journal of the American Telemedicine Association, 7(4), 293-316.

Telemedicine lacks adequate patient satisfaction studies. The authors endeavored to illustrate from previous empirical studies, patient satisfaction with telemedicine. Their efforts involved matching at least one of 11 'telemedicine' terms with one of five 'satisfaction' terms. The authors searched the following sources: Telemedicine Information Exchange (TIE), MEDLINE, Science Citation Index (SCI), Social Science Citation Index (SSCI), Psycinfo, and Citation Index of Nursing and Allied Health (CINAHL). They referenced 93 studies, spanning different healthcare specialties. The authors observed professional-patient interaction, the patient feedback, and technical aspects of the consultation. Only 33% of the studies included a measure of preference between telemedicine and face-to-face consultation. The authors provide almost half the studies measured only one or two dimensions of satisfaction. They reveal telemedicine satisfaction rated at greater than 80% and frequently reported at 100%. The authors iterate telemedicine mainstreaming from research to routine care with studies suggesting patient satisfaction. 

Wright, L., Bennet, G., & Gramling, L. (1998). Telecommunication interventions for caregivers with dementia. Advances in Nursing Science, 20(3), 76-88.

Caregiver interventions via Telecommunications (CIT) is designed for family caregivers of elders with dementia.  Building on Riegel’s dialectical theory of human development, the authors argue that psychotherapeutic interventions, made highly accessible by telecommunication technology, assist caregivers to achieve positive development outcomes.  Specific components of CIT are described, and an outline for a structured protocol is provided.  Advantages, disadvantages, and future directions of telecommunications therapy are discussed. 

Yensen, J. (1996). Telenursing, virtual nursing, and beyond. Computers in Nursing, 14(4), 213-214.  

Telenursing is any nursing at a distance, mediated in whole or part through electronic means, such as telephones, radio, television and electronic networks such as intranets and Internet.  Nursing has been quick to seize the implications of teleconferencing, telephone triage, telecollaboration, voice-activated retrieval of records or information from databases, and cellular and pager telephone mobility in rural and community health.  The actual and potential complementary role of telenursing to clinical practice appears to be limitless.  In the US, the American College of Nurse Practitioners used telenursing as it’s theme at their 1996 National NP Summit.  In Europe, a group of nursing and university groups are collaborating to define a minimum data set for eventual European and international standardization.