Technology Care Coordination and Community Resources Considerations
The advances made by healthcare systems around the world can be attributed to a variety of factors, one of which is technology. Technological advancements in healthcare may have resulted from diligent individual or group participation in innovations, but some are the result of accidental occurrences or, more accurately, desperate needs to solve emergencies, as seen in the unanticipated Covid19 pandemic (Clipper, 2020).
While the latter scenario is unlikely, nurses must be adequately prepared to handle technologies in their curriculum, particularly at the baccalaureate level. The use of technology in healthcare has been linked to improved patient outcomes and organizational effectiveness. To be successful, however, the technology must be accompanied by effective coordination of patient care across the entire healthcare continuum and the utilization of community resource services.
The purpose of this paper is to analyze the impact of healthcare technology on a population health problem, explain how care coordination and the utilization of community resources address the problem, and finally, provide insight into state board nursing practice standards and/or organizational and governmental policies and their impact on the population health problem.
The Impact of the Healthcare Technology on the Population Problem
Description of the Healthcare Technology
The healthcare sector has come a long way, from the medieval era of indistinct practices with no scientific basis to the current epoch of well-defined rational practice that leverages technology. There are a few definitions that must be construed when it comes to the use of technology in healthcare.
E-health encompasses a broad range of multidirectional activities that make use of Information Communication Technology (ICT) to store, retrieve, share, exchange, and automate responses to health-related information for disease prevention, diagnosis, treatment, and monitoring, as well as educational and administrative purposes (Omboni et al., 2020). Telemedicine (or telehealth) enables the automatic exchange of medical information between providers and patients for disease management purposes (Omboni et al., 2020).
Telemonitoring, a specific application of telemedicine covered extensively in the subsequent discussion, is defined by Omboni et al. (2020) as the remote monitoring of various vital and nonvital parameters and the management of people with long-term chronic illnesses. Its growing popularity was evident during the Covid19 pandemic when there was a greater need to continue care without physical interactions between providers and patients.
Telemonitoring makes use of a variety of technologies and devices. Data collection devices gather vital and nonvital data from patients, such as blood pressure, temperature, pulse rate, weight, and physical activity. Data can be collected using embedded tools or external sensors like cameras, microphones, and medical devices such as blood pressure machines and glucometers (Omboni et al., 2020).
Furthermore, wired or wireless technologies (Bluetooth, WI-FI) may be used to facilitate the data transmission to caregivers. Interaction between users is required, which can be facilitated through websites and web portals; however, the most basic interactions can occur through telephone calls, text messaging (SMS), and emails, and there is also an increasing use of telephone applications (Omboni et al., 2020). When the information reaches the care providers, they conceptualize it, determine whether the data are within normal ranges or are out of range, and then decide which interventions to pursue.
Advantages and Disadvantages of the Technologies
Regarding the management of adult hypertensive patients, the most successful telemedicine approach appears to be the one based on telemonitoring of BP and tracking of additional vital and nonvital signs with data exchange between the care provider and the patient through the web, emails, text messaging, or video consultation, integrated with education on lifestyle, risk factors, and proper use of antihypertensive medications.
Telemedicine aids in the development and maintenance of long-term relationships between patients and care providers, resulting in improved blood pressure control. Telemedicine also empowers hypertensive patients by influencing their attitudes, behaviors, and self-management practices, resulting in improved medication adherence and compliance with healthy lifestyle practices and, ultimately, medical condition improvement (Omboni et al., 2020; Watson et al., 2020).
Furthermore, telemedicine promotes interprofessional collaboration, information sharing, decision support, and flexibility, improving an organization’s effectiveness. In the Covid19 era, telemedicine has created a non-physical approach to care, limiting the spread of the dreadful infectious disease.
Is the Evidence Consistent with Technology Use in my Nursing Practice
My facility is a primary care hospital that provides a wide range of services to patients with a variety of conditions. During the first wave of the Covid19 pandemic, the emergency department was clogged with critically ill patients, particularly the elderly with Covid19 and multiple other comorbidities. However, as the phases progressed and the use of telemedical interventions increased in providing care to elderly patients with multiple comorbidities in the comfort of their homes, the emergency department reported fewer visits, indicating the effectiveness of this type of approach to care.
Potential Barriers and Costs Associated with the Use of the Healthcare Technology
Despite its proven efficacy, the telemedical approach to care faces challenges that could stymie its progress. It may be costly in terms of purchasing and maintaining computer hardware and software (Carayon et al., 2019). Implementers may also encounter technological barriers, such as the availability of several services on the market, none of which appear to be a benchmark solution to be used as a reference to standardize a telemedicine-based healthcare model (Omboni et al., 2020).
Furthermore, there may be a lack of informatics skills among the personnel, which may jeopardize the success of the interventions. Moreover, leadership issues such as a lack of motivation, inadequate training on the technologies to be implemented, employee resistance, and a lack of administrative support severely impede the implementation and success of telemedical interventions.
The Impact of Care Coordination and the Utilization of Community Resources on the Population Problem
Patient care must be deliberately organized and shared among all members of the assigned care team to meet care objectives. Interdisciplinary collaboration, in which departments or healthcare professionals work together to achieve patients’ care objectives, is advocated for the success of telemedical interventions.
Physicians, nurses, pharmacists, an informatics group, patients, their family members, various financiers, and the community as a whole are part of the team responsible for the success of the telemedical approach to adult hypertensive patients. The data collection devices, in this case, a blood pressure machine, weighing scale, and a wristwatch capable of detecting the level of activity, are given to the patients.
This information will then be entered into a smartphone app and transmitted to primary care providers, who will decide which intervention to pursue. Care providers (physicians, nurses, and pharmacists) may decide to schedule a physical appointment, change, refill, or discontinue a medication regimen, advise on lifestyle changes, or refer the patient as appropriate.
Since the devices and technologies are expensive, collaboration with sponsor stakeholders is a critical determinant of the intervention’s success. Furthermore, a supportive family who reminds patients when to monitor their vital and nonvital parameters, assists them with uploading and sending, and provides them with support in a variety of other ways is extremely important.
The patients’ immediate surroundings and support play an important role in their journey to a healthy life. Numerous community resources are available to patients to assist them with blood pressure control. The American Heart Association (2018) recommends at least 150 minutes of moderate-intensity aerobic activity per week for exercises aimed at lowering the risk of cardiovascular events such as hypertension.
As a result, physicians can recommend organized activities such as recreational sports (football games, swimming, running competitions, or cycling) available in the community. While not everyone has access to these resources, walking can be a simple way to start and maintain a healthy and active lifestyle. Additionally, because diet is a risk factor for cardiovascular disease, a healthy eating pattern must be ingrained in society. Community groups that promote healthy eating (DASH diet) and encourage effective meal preparation practices are extremely beneficial to the health of hypertensive patients.
Furthermore, community health workers may organize a mass screening for hypertension, which results in early detection and treatment of patients. In my community, there is a monthly walking and running race to raise funds to help manage patients with chronic illnesses. While the primary goal is to raise funds, the activities also help reduce the risk of cardiovascular events.
Even though care providers are determined to work in collaboration to improve patient outcomes and organizational effectiveness, there are significant barriers that make it difficult for them to achieve their objectives. Inadequate community resources, such as recreational sports infrastructure, nursing/medical care homes, and a lack of health organization bodies championing a healthy lifestyle, may derail the entire process of health promotion and illness prevention (Carayon et al., 2019; Toscos et al., 2018).
Furthermore, as the number of chronic illnesses rises and the government shifts services to the community level, care providers face a heavy workload that may reduce their productivity in providing care. The relationship between the care team’s circle can also have an impact on the progress of care coordination and the effective utilization of community resources. For example, one may encounter resistance from colleagues or even patients (Carayon et al., 2019; Toscos et al., 2018). This can lead to a breakdown in communication among members of the care team, as well as confusion about each member’s role, resulting in poor care coordination and patient outcomes.
State Board Nursing Practice Standards and/or Organizational or Governmental Policies and their Impact on the Healthcare Technology, Care Coordination, and the Utilization of Community Resources
Each state has its own set of rules that nurses must follow to provide quality, safe, and cost-effective patient care. One common standard of practice is the obligation to protect patient’s privacy and confidentiality. The privacy of patients’ protected health information, as well as their confidentiality, requires that patients’ information does not fall into unauthorized hands and that the information is shared only within the HIPAA stipulated conditions, which include treatment, payment, and improving care operations (Omboni et al., 2020).
Besides the mandate on nurses, local, state, and federal policies ensure that telemedicine equipment is developed, validated, and certified in accordance with regulatory bodies’ recommendations and indications. In Europe, for example, software used for medical purposes (diagnosis, prevention, monitoring, prediction, prognosis, treatment, or alleviation of disease) is defined as a medical device under the new EU Regulation 2017/745.
As such, it must be validated in accordance with current best practices, taking into account development life cycle principles, risk management, validation and verification, and post-marketing surveillance (Omboni et al., 2020). In the United States, the Food and Drug Administration regulation states that telemedicine software (or m-apps) meets the regulatory definition of a device if it is intended for use in the diagnosis and treatment of a disease or condition in humans or animals (Omboni et al., 2020).
Furthermore, 12 states envision a special license allowing a physician to practice across state lines for telemedicine only, while 6 states require the physician to register if they wish to practice across state lines (Omboni et al., 2020). Such regulations and policies ensure that telemedical approaches to care are not abused and are used appropriately to benefit humans.
Nursing ethics play a great role in informing the approach to patient care. Nurses take care to practice in accordance with ethical standards, minimizing ethical violations while providing care. Some of the most popular provisions of the code of ethics for nurses include practicing with compassion and respect for the inherent dignity of all people, focusing on the patient first, advocating for patient’s rights, and having full authority, responsibility, and accountability for nursing practice (Copeland, 2020). The code of ethics, which nurses strive to follow in their daily actions and behaviors, results in the provision of care that is rational and free of many errors.
Conclusion
The rise in chronic conditions has prompted the development of interventions to combat illnesses. Furthermore, the Covid19 pandemic accelerated the development of technological interventions as strategies to ensure continuity of care without requiring a physical patient-provider interaction. This has increased the use of telemedical interventions, which has aided in the long-term management of diseases such as hypertension.
The interventions have been linked to various benefits, which can be categorized broadly into two themes: better patient outcomes and improved organizational effectiveness. However, while it is effective, it faces obstacles such as high costs of technology infrastructure, poor informatics skills, and employee resistance, all of which derail or cause a bumpy implementation process. Scholars advocate for effective care coordination and proper utilization of community resources to streamline the process and eliminate obstacles.
References
American Heart Association. (2018). American heart association recommendations for physical activity in adults and kids. Www.heart.org. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
Carayon, P., Hundt, A. S., & Hoonakker, P. (2019). Technology barriers and strategies in coordinating care for chronically ill patients. Applied Ergonomics, 78, 240–247. https://doi.org/10.1016/j.apergo.2019.03.009
Clipper, B. (2020). The influence of the COVID-19 pandemic on technology: Adoption in health care. Nurse Leader, 18(5), 500–503. https://doi.org/10.1016/j.mnl.2020.06.008
Copeland, D. (2020). Paying for nursing student clinical placements, ethical considerations. Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing, 36(5), 330–333. https://doi.org/10.1016/j.profnurs.2020.01.008
Omboni, S., McManus, R. J., Bosworth, H. B., Chappell, L. C., Green, B. B., Kario, K., Logan, A. G., Magid, D. J., Mckinstry, B., Margolis, K. L., Parati, G., & Wakefield, B. J. (2020). Evidence and recommendations on the use of telemedicine for the management of arterial hypertension: An international expert position paper: An international expert position paper. Hypertension, 76(5), 1368–1383. https://doi.org/10.1161/HYPERTENSIONAHA.120.15873
Toscos, T., Carpenter, M., Flanagan, M., Kunjan, K., & Doebbeling, B. N. (2018). Identifying successful practices to overcome access to care challenges in community health centers: A “positive deviance” approach: A “positive deviance” approach. Health Services Research and Managerial Epidemiology, 5, 2333392817743406. https://doi.org/10.1177/2333392817743406
Watson, A. R., Wah, R., & Thamman, R. (2020). The value of remote monitoring for the COVID-19 pandemic. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association, 26(9), 1110–1112. https://doi.org/10.1089/tmj.2020.0134