Integrating Telehealth into Agency Clinical Culture: Two Models

In our lead story this week, we heard from experienced telehealth nurses who attested to the value of incorporating home telehealth systems into agency practice. A closer look at the stories of two agencies reveals that positive experiences surface whether an agency deploys one or the other of two quite different basic models.

The first model is one in which the agency develops the role of the dedicated telehealth nurse, a specialist who supplements in-home care provided by primary home care nurses.  In the other model, nurses in the field provide both in-home care and telehealth services for the patients assigned to them.

“We understand telehealth as an enhancement to skilled nursing services, not as a replacement for the primary visiting nurse,” said Rae Szymanski, Executive Vice President and Chief Operating Officer, VNA of Hudson Valley in New York. “We decided to establish the role of the telehealth nurse to be an adjunct to the visiting nurse.”

Thus, at VNA of Hudson Valley, a telehealth nurse specialist conducts remote monitoring and video visits for all patients selected for telehealth support. She provides just-in-time care when necessary, such as when a physician order requires a quick change to a patient’s medication dosage, but her primary role is to watch over patients’ conditions.

The telehealth specialist keeps field nurses informed about patients’ health status and any abnormal findings found via remote monitoring. She also shares insights that may help the primary nurses better assess their patients.

“This model has advantages,” explains ATI’s Vice President for Partner Development, Jan Wuorenma, RN, BSN, MBA. “It is the least disruptive way to incorporate telehealth in home care and it opens a new career option for nurses who are interested in specializing in telehealth.”

The Visiting Nurse Association (VNA) of Greater Philadelphia utilizes telehealth to meet the challenge of caring for high-risk patients with COPD and heart failure. Their choice of telehealth structures illustrates the second basic model. Patient care staff is organized into three telehealth teams. Each team consists of one nurse practitioner paired with a licensed practical nurse (LPN).

The three teams are dedicated to caring for targeted, high-risk patients diagnosed with COPD or CHF. The nurse practitioners are responsible for both in-home care and telehealth services for the carefully selected patients assigned to them. In this model, telehealth is used directly by the nurse practitioners who care for targeted, high-risk patients in the field.

“Our approach to telehealth establishes a new level of home care for selected high-risk patients,” said Karen Alston, R.N., M.S.N., M.B.A., Senior Vice President and Chief Nursing Officer, VNA of Greater Philadelphia. “The nurse practitioners are our home health case managers. With their advanced training in diagnosis and management of medical conditions, including the chronic illnesses that are the focus of our program, they are well suited for this role.”

“VNA of Greater Philadelphia is noteworthy because, instead of separating the roles of telehealth nurse and field nurse, their model incorporates telehealth as part of every nurse’s tool set,” said Wuorenma. “In addition, they use telehealth to initiate and sustain team care for selected sets of home care patients with the most complex conditions. These are patients with the highest risk of disease exacerbation and subsequent repeat hospitalizations. With the challenges we face as the Baby Boom generation ages into its chronic disease years, it is a model for the future direction for home care.”