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
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.
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),
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
Baines, B. (1996). Tele-home care in a managed care setting. The
Remington Report, November/December 1996, 27-29.
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),
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
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.
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),
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
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.
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
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
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.
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,
(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
Durtschi, A. (2001).
Three patients’ telehome care experiences. Home
Health Nurse, 19(1), 9-11.
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
(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.
Mayrose, J., Jehle, D., Moscati, R., & Pierluisi, G. (2001).
telemedicine model for emergency care in
a short-term correctional facility. Telemedicine
Journal and e-Health, 7(2), 87-92.
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
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.
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,
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.
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.
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),
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),
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.
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.
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.
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.
(2001). Clinical call centres: does
low-bandwidth video have a place? Journal of
Telemedicine and Telecare, 7(Suppl 2), 14-16.
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
(2001). Communication skills for
telehealth interactions. Home Healthcare Nurse, 19(8),
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.
(2001). Legal considerations for
nurses practicing in a telehealth setting. Online
Journal of Issues in Nursing, 6(3):4.
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),
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.
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.
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
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.
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),
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.
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
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.
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,
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:
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),
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
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.
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
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),
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.
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.
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
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.
(2001). Window of opportunity for
homecare nurses: telehealth technologies. Online
Journal of Issues in Nursing, 6(3):5.
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.
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.
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
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
L. (2001). An Examination of
Telenursing in the United States.
Chicago: Healthcare Information and Management Systems Society: pp
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.
L. (2001). Telehealth: a new venue
for health care delivery. Seminars in Oncology
Nursing, 17(1), 34-40.
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.
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.
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),
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
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.
(2002). Issues in telemedicine: why
is policy still light-years behind technology. Nursing
Administration Quarterly, 26(4), 81-84.
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
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.
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
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),
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
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
Sussman, D. (2001).
Long Distance relationships: Telehealth lets healthcare
professionals see more, do more. [On-line]. Available:
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.
El Habashy, A., & Dawood, M. (2001).
Changes in the workplace with telemedicine. Journal of
Telemedicine and Telecare, 7(5), 277-278.
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.
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.
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.
Flannagan, J., & Specht, J. (2001).
Telehealth: an opportunity for gerontological nursing practice.
Journal of Gerontological Nursing, 27(1), 10-14.
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.
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.
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
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.
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
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
Yensen, J. (1996).
Telenursing, virtual nursing, and beyond. Computers in
Nursing, 14(4), 213-214.
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