Telehealth Policy and Procedure: Developing Guidelines for Nurses

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A nurse provides telehealth via a laptop.The COVID-19 pandemic prompted many changes in health care, some temporary and some permanent. Among the changes that appear to be here to stay is a significant shift toward the use of telehealth. According to a 2021 report in JAMA Network Open:

  • Prior to the COVID-19 pandemic, telehealth represented 0.3% of all ambulatory contacts in health care from March 2019 to June 2019.
  • After the COVID-19 pandemic began, telehealth represented 23.6% of all ambulatory contacts in health care from March 2020 to June 2020.

The use of telehealth continued in 2021. Almost 25% of the adults whom the U.S. Department of Health and Human Services surveyed between April 2021 and October 2021 reported having used some form of telehealth.

Several key factors, including the pandemic, solidified telehealth as an essential health care delivery tool. As such, it has become critical for nurses and other health care professionals to develop an understanding of telehealth policy and procedure.

Nurses who may be considering enrolling in an advanced nursing program and pursuing a leadership role can benefit from learning more about policies and procedures related to telehealth.

The Benefits of Telehealth

The many benefits of telehealth help explain its popularity. A 2022 report in Healthcare IT News, for example, noted that telehealth can:

  • Increase patients’ access to health care
  • Give patients greater flexibility in scheduling appointments
  • Make it easier for patients to participate in follow-up appointments
  • Enable health care providers to expand their patient base
  • Increase interdisciplinary collaboration among health care professionals who can join together in telehealth sessions
  • Reduce costs for both patients and health care providers (for example, by reducing patient expenses associated with travel and child care, and providers’ costs associated with maintaining large offices)

A number of telehealth benefits also are specifically related to advanced practice registered nurses (APRNs), such as nurse practitioners. For example:

  • A 2021 report in ONS Voice noted that APRNs are particularly well suited to provide telehealth because of their adaptability, expertise in advocating for their patients, and passion for educating their patients using tools such as visual aids.
  • APRNs are particularly helpful in providing health care to vulnerable and remote populations via telehealth, according to a 2021 article in The Journal for Nurse Practitioners.
  • According to a 2022 report in mHealth Intelligence, nurse practitioners can help address the growing demand for mental health care by using telehealth.

Telehealth Challenges

While telehealth offers many benefits, it can also present challenges. These challenges underscore a need to develop strong policies and procedures regarding telehealth.

When offering telehealth services, health care providers must ensure they comply with federal and state requirements. Specifically:

  • HIPAA Compliance. A 2020 report in Fierce Healthcare noted that providers need to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This involves protecting confidential patient information as well as all of the technology providers use in telehealth.
  • State regulations. As the Health Resources and Services Administration has pointed out, because telehealth can enable providers to treat patients across state lines, providers must be knowledgeable about the regulations and licensing requirements of the states in which their patients reside. They also need to be aware of interstate compacts that might affect the regulation of telehealth.

A 2020 report by KFF, a nonprofit that focuses on national health issues, highlighted other challenges associated with telehealth.

  • Patients may not have the necessary technology or internet access to participate in telehealth.
  • Patients may be reluctant or feel uncomfortable participating in telehealth.
  • Smaller providers may not have the resources to invest in telehealth technology and infrastructure.
  • Providers may need to update their liability and malpractice insurance to ensure it covers telehealth.
  • It can be difficult to assess vital signs via telehealth if patients don’t have the necessary equipment in their homes.

Telehealth Challenges That Nurses Face

For nurses in particular, telehealth can present unique challenges. In 2021, for example, The Online Journal of Issues in Nursing reported the following.

  • Most nurses have not received formal training and related support in providing telehealth.
  • Nurses have reported feeling uneasy about discussing sensitive and private issues during a telehealth session.

In addition, a 2021 article in ONS Voice noted that:

  • Nurses have struggled with a lack of physical access to their patients in assessing factors such as patient dexterity and reflexes.
  • Nurses have found it challenging to provide emotional support to patients through telehealth.

Telehealth Guidelines for Nurses

As the use of telehealth continues to grow, nurses in leadership roles have a unique opportunity to establish telehealth policies and procedures to guide high-quality care that complies with all requirements. Nurses who have earned a doctor of nursing practice degree (DNP) are well-positioned to use their expertise to ensure that telehealth practices are geared toward improving patient outcomes.

A 2021 article in The Journal for Nurse Practitioners offered guidelines for nurses using telehealth. It suggested:

  • Considering an array of factors in selecting a telehealth service model. Those factors included:
    • Ensuring compliance with state and federal regulations regarding telehealth
    • Focusing on the primary purpose of telehealth (for example, direct service delivery, referral to specialists, or management of chronic illnesses)
    • Becoming familiar with the technical requirements of the chosen service model
  • Establishing a specific process for patients’ telehealth visits. For example:
    • Using a checklist of important tasks to perform before, during, and after a telehealth visit
    • Employing a specific process for obtaining patients’ consent for a telehealth visit
    • Creating specific telehealth etiquette guidelines
    • Establishing and following specific guidelines for engaging patients during telehealth visits
  • Using a specialized electronic health record for telehealth visits. This type of record could document:
    • Subjective information, such as patients’ concerns or health history
    • Objective findings, such as lab results
    • Assessment of findings, such as a diagnosis
    • A plan of care for treating the patient

It’s also important to note that policies and procedures for telehealth in nursing can be built around the standards and best practices for telehealth that certain organizations have already established. Examples include:

  • The American Academy of Ambulatory Care Nursing’s Scope and Standards of Practice for Professional Telehealth Nursing
  • The Health Resources and Services Administration’s best practice guides for telehealth
  • The American Telemedicine Association’s practice guidelines

Build a Path to Leadership

With the use of telehealth growing, it’s imperative that health care providers offer remote services in the most effective manner while they continue to safeguard patients’ privacy. Establishing sound telehealth policies and procedures will be a cornerstone of that effort.

Nurses who have an interest in moving into leadership and advancing the use of telehealth and other models of care delivery can explore the Regis College online BSN to Doctor of Nursing Practice degree program to learn how it can help them achieve their goals. Preparing nurses for advanced nursing practice, the program can serve as a springboard into nursing leadership.

Take the first step toward advanced nursing today.

Recommended Readings

How Technological Advancements in Nursing Apply to Nursing Specializations

Nursing Leadership Roles for DNP Graduates

What Is a DNP?

Sources:

American Academy of Ambulatory Care Nursing, Scope and Standards of Practice for Professional Telehealth Nursing

American Telemedicine Association, Practice Guidelines

Fierce Healthcare, “Industry Voices—Telemedicine and Long-Term Implications for HIPAA Compliance”

Health Resources and Services Administration, Best Practice Guides

Health Resources and Services Administration, Telehealth Licensing Requirements and Interstate Compacts

Healthcare IT News, “8 Benefits of Telehealth”

JAMA Network Open, “In-Person and Telehealth Ambulatory Contacts and Costs in a Large US Insured Cohort Before and During the COVID-19 Pandemic”

The Journal for Nurse Practitioners, “Considerations When Using Telemedicine as the Advanced Practice Registered Nurse”

The Journal for Nurse Practitioners, “Transitioning to Telehealth: Today’s Guidelines for Future Sustainability”

KFF, “Opportunities and Barriers for Telemedicine in the U.S. During the COVID-19 Emergency and Beyond”

mHealth Intelligence, “Why Telehealth Has Become an Integral Part of the Mental Healthcare Landscape”

The Online Journal of Issues in Nursing, “Preparing Nurses for Roles in Telehealth: Now Is the Time!”

ONS Voice, “Here’s Why Advanced Practice Nurses Are Ideally Suited to Manage Telehealth Programs”

ONS Voice, “Oncology Nurses Share Successes and Challenges Adapting to Telehealth During COVID-19”

U.S. Department of Health and Human Services, National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services