I have long been a fan of telemedicine. The first time I wrote about telemedicine was in 2007. The following quote is how I explained it to D Magazine in 2013:
“This is a daily occurrence in consumer markets, but is absent in healthcare markets because health plans [including Medicare and Medicaid] pay 89 percent of medical bills,” Herrick says. “You can talk to your attorney over the phone; he or she will bill you for his or her time. You can talk to your accountant over the phone. But most people don’t routinely consult with their physician over the phone because insurers are reluctant to pay for telephone consultations. Many health plans will only reimburse for physician visits if they are in-person—even though more than half of all contacts with primary care physicians could be done by email or over the phone.”
I’ve even written about veterinary telemedicine and remote mental health counseling here and here. Yet, it was a surprise when I first heard about telenursing. Yes, virtual nursing.
If you think back to physician visits or when you were in a hospital, many of your interactions were with a nurse. Doctors prescribe medication, diagnose illnesses, and create physician orders. Nurses are the foot soldiers who carry out doctors’ orders. Using a military term you could almost say nurses are “boots on the ground,” except they usually wear tennis shoes from my experience. There are numerous tasks that nurses must deal with that take up their time but do not necessarily require them to physically be present in the hospital. According to Health Tech Magazine:
Virtual nursing is moving from concept to real-world implementation as health systems look for new solutions to address workforce challenges and better support patient care.
Virtual nurses can support many tasks that don’t require hands-on patient care, including virtual admissions and discharges, remote documentation, telerounding, blood and medication verification, virtual observation, patient education, and on-demand coaching and support.
Every hospital I’ve been in has what’s known as a nurses station. That’s the place nurses congregate when doing certain tasks. They don’t generally have time to relax, however. It’s a hub of activity. The nurse call button signals there. Patient charts are pulled up there and charting (entering information used in billing and to show an order was carried out) is generally input there. Many of the remote tasks mentioned above already take place from the nurses station. With remote nursing nurses employed by a call center (for lack of a better term) could potentially cover more hospital floors or even multiple hospitals at once. More from Health Tech Magazine:
Virtual clinical workflows can have a tremendous positive impact on patient and clinician experiences.
Patients benefit from improved nurse-to-patient ratios, faster clinical intervention and a second layer of care team support.
Virtual roles extend the careers of seasoned nurses who might otherwise leave or retire. New nurses gain access to virtual nurse mentors during onboarding and when they need help. And floor nurses can enjoy more focused work with fewer interruptions.
Operationally, virtual nursing can improve efficiency and patient satisfaction. It also offers health systems a more permanent solution for workforce reinforcement, reducing reliance on travel nurses by introducing new recruitment and retention tactics. Telenursing also lays some groundwork for next-generation hospital rooms and home-based acute care models.
Temporary and so-called agency nurses have long filled the gap when hospitals are short-staffed and need nurses for shifts they cannot fill internally. There are even agencies that specialize in travel nurses willing to relocate for high-paying, temporary nursing assignments. Somewhere within the various nursing needs of hospitals are virtual nurses, who (presumably) sit in cubicles in an office building far away from the hospital performing nursing tasks that can be done remotely.
Telehealth and virtual care solutions are redefining care, and the healthcare industry is just scratching the surface of what’s possible with virtual nursing. By taking a strategic approach to implementation, health systems can build telenursing programs that support patient and clinician well-being and add a secondary line of defense to patient care.
My first thought is that virtual nursing, from an office cubicle, sounds like the worst of both [nursing] worlds rather than the best of nursing without the drudgery. The Health Tech Magazine article goes into greater detail about the information technology needed for various scenarios. Perhaps virtual nursing supervisors could follow certified nursing assistants, who do the legwork. Yet, I have a suspicion that at some point the remote nursing tasks will be off-shored to lower-cost countries far away.
I see telemedicine as a means to increase physician or nurse’s productivity and capture more complete and reliable patient encounter data – not necessarily better care for any particular patient. House calls disappeared with no apparent adverse effects. I would argue that ending house calls was not about improving any particular patients care, but about freeing up the physician’s time spent going to patients’ residences. That permits the physician to see more patients, and that was a good thing in general.
But it seems to me that doctoring, and nursing too, still require a trained eye to evaluate a patient. Eliminating in-person visits is not the same as changing the location of the visits. Telemedicine, even via Zoom or similar technology, takes away from what the practitioner can observe directly. Such direct observations can prompt questions the practitioner might not ask about, sight unseen. And the patient might not volunteer information if unasked. Some conditions, perhaps serious conditions, may not be diagnosed until symptoms emerge. Those are my patient care reservations.
And now comes home visits by nurses as part of a medical insurance plan. I don’t know much about this except that I’m enrolled in a Medicare Advantage plan that offers nurse visits in the home. I get a call from the plan at least once a year offering this service. This is an obvious benefit to people who have difficulty getting to a physician’s office for medical reasons or even social reasons (e.g., transportation). Virtual office visits might also seem meet the needs of such patients although I would still have the same misgivings as above. Anyway, isn’t it interesting that another form of home visits is beginning to appear alongside the appearance of virtual visits via telemedicine?
I wonder how much of virtual nursing is inpatient observation from afar, how much is clinical office support for tasks that take floor nurses’ time or how much is virtual hand-holding for certified nursing assistants.