MSN-FP6214 Improving Telehealth Technology Essay
Abstract for MSN-FP6214 Improving Telehealth Technology Essay
Remote desktop software, also known as remote access tools, provide a way for computer and mobile device users, support staff, and vendors to share screens, access work computer systems from remote locations, and vice versa. While these tools can save significant time and money by eliminating travel and enabling collaboration, they also provide risks that can lead to data theft, unauthorized access, or destruction of assets. An IT infrastructure that enables secure, reliable access to mission-critical applications and valuable information, such as patient records, helps address these requirements and challenges, so that healthcare organizations can meet with success today and are also fully poised to address the industry landscape of tomorrow.
Implementation Plan and Schedule
This Implementation Plan examines the challenges in today’s healthcare industry, the implications for organizations, and the benefits delivered by a strategic approach to effective delivery of desktops and applications. It provides guidance about how to create a cost-effective IT infrastructure that can enhance patient safety and quality of care by giving clinicians secure, easy and flexible access to electronic health record (EHR) systems and other applications needed for informed decision-making, while safe-guarding the privacy and confidentiality of patient data (Rhoads 2017).
Many electronic health record (EHR) vendors have functionality that provides practices with the ability to facilitate telehealth visits. This is a great way to build existing relationships and ensure seamless integration (American Medical Association, 2020).
Pre-delivery of services for telehealth physician and nurse include training at least 4 months prior to the go-live date. This will ensure staff has time to rotate through learning modules (Martich, 2017). There will also be TEAMs live stream education services offered at various times so staff can interact with the trainer, project managers, and IT. American Medical Association (2020) expresses that roles and responsibilities will vary, depending on the size of your organization, but it is important to include perspectives from all departments that will be impacted by telehealth, including clinical, financial, administrative, IT, and legal champions.
Consider organizing your key stakeholders. Telehealth programs can take months to launch, so the kickoff meeting should gain stakeholder alignment on objectives, concerns, important dates, and approval protocols for the entire implementation process (RHIhub Toolkit, 2019 MSN-FP6214 Improving Telehealth Technology Essay).
Delivery of services to affected population within 1 week will be those patients with the absolute most need. Patients suffering from COVID+ that need to be seen by a specialist is an example of a priority group. Continuity of care for high risk populations will finish the onboarding of patients for the new technology services. Care coordination, home and remote monitoring, nutritionists and speech language services are examples of what can be seen in months 1-3 (RHIhub Toolkit, 2019).
Ensuring privacy and confidentiality of patient information
Complying with government regulations in on the top of mind for healthcare providers. For example, with the HIPAA Security Rule in the U.S. and similar regulations in other countries, providers are continuing efforts such as maintenance, auditing, and process improvements to ensure ongoing compliance. Centralization of patient data, encryption of communications and reduction of data on client devices are ways that IT departments can reduce the security exposure of their organizations and meet compliance regulations.
Collaborating with Patients and Health Care Providers
Healthcare organizations have realized authentication methods must be more specific, authentication measures stronger, and audit trails established and used for evidentiary purposes (RHIhub Toolkit, 2019). Associated with these controls must be support for managing access authorization for users who may serve multiple roles and have multiple relationships with patients. For example, a nurse normally working a shift in an intensive care unit may also occasionally be called for duty in the emergency department on a second shift.
Physicians who do not have a treatment relationship with a given patient may need access to that patient’s health information for quality assurance purposes, research, or in an emergency situation. Some healthcare professionals may need access to the records of virtually all patients currently treated in the provider setting, but should not be provided access where a patient may have invoked a restriction or where a conflict of interest exists (for example, a relative as a patient).
Such access requirements are highly complex and require very sophisticated internal control mechanisms that can only be effectively managed through the use of sophisticated security technology. Consistent access interfaces with data control mechanisms that can be efficiently managed, along with password security and single sign-on access (RHIhub Toolkit, 2019 MSN-FP6214 Improving Telehealth Technology Essay).
Adequacy of Existing Telehealth Technology Infrastructure
In addition to security controls for data at rest in databases or device memory within a provider setting, the healthcare industry needs security for data that is being used by an increasingly mobile workforce. Providers need the convenience of accessing patient information from home, the office, or in transit. Such remote access contributes to patient safety by allowing providers to verify lab values or findings on radiological studies as rapidly as possible. In return, the ability to digitally transmit information back to a care setting from a remote location ensures that the communication is legible and timely (RHIhub Toolkit, 2019).
Finally, as more healthcare services are rendered outside of the traditional provider setting, such as in a home, ambulance, school, job site, etc., the ability to securely communicate health information to and from a base station and often across multiple platforms and venues is essential. New technologies that bundle security services, making them transparent to the user and permitting easy administration, are keys to building appropriately secured information systems and assuring compliance with government mandates (American Medical Association, 2020 MSN-FP6214 Improving Telehealth Technology Essay).
Collaborating with Patients and Other Health Care Providers
An EHR strategy based upon IT modernization can still fail if doctors and nurses do not feel comfortable using online applications and information. Ease of use, simplicity, and a consistent, reliable experience, whether in the office or while roaming, can help win over staff members to a new IT system. Physicians are the lifeblood of healthcare organizations, and it is critical to ensure overall ease and satisfaction with IT systems, because that directly translates into productivity (American Medical Association, 2020).
Potentially the greatest barrier to clinician adoption according to the American Medical Association (2020) is that IT systems are the human-computer interface. Today more than ever, clinicians focus on productivity and the ability to see a greater number of patients in a day.
Introducing new technology can slow this process down and result in pushback. Successful adoption of technology by clinical staff depends upon providing the best access experience, including such desirable capabilities as: support for wireless and mobile technology; simplified access to desktops and applications with single sign-on; support for roaming access; ability to quickly switch users on shared workstations; consistent performance regardless of location, device or network type; and the ability to use the computing device that best fits the patient care scenario (American Medical Association, 2020).
Expand the Community Outreach program by providing tablets to specialty services.
Technology allows patients and providers to communicate more quickly and clearly. Patients would receive reminders from their physicians about checking blood pressure, completing rehabilitation exercises, taking prescribed medications, scheduling follow-up appointments or other similar activities (American Medical Association, 2020. MSN-FP6214 Improving Telehealth Technology Essay).
There are many beneficial outcomes from providing telemedicine to patients. Telemedicine provides physicians a full patient history and means to communicate with the accepting physician during patient transport to other facilities. Digital upgrades like electronic prescribing, medical alerts and clinical flags can further reduce medication errors and measurably improve patient safety (Martich, 2017 MSN-FP6214 Improving Telehealth Technology Essay).
Hawkins (2017) explains that he transformational leadership style is focused on the big picture how to get there. This leadership style focus on improved patient care, better systems and processes. This style works best and thrive in a workplace is in need of big changes and improvements (Hawkins, 2017). This will certainly come useful when implementing the telehealth upgrades to staff and patients.
End-user adoption is perhaps the most critical technology barrier. If providers and patients are not comfortable with telemedicine, then they will not use it. Some providers and patients lack computer skills. In rural areas, at least, this often can be attributed to a lack of equipment rather than a lack of experience with, or interest, in using the technology. With the introduction of user-friendly consumer electronics, the barrier that physicians are not comfortable with computers, digital cameras and video equipment has largely gone away however. Patient adoption of self-management “apps” on Internet-enabled devices in the home and mobile devices are becoming extremely popular, with thousands of apps available at little or no cost (Campling et al., 2017).
Collaborative Technology Integration Strategy
Clinicians are generally mobile professionals; they must go to their patients at the bedside, on the gurney, or in the examining room. They are taught to address the patient face-to- face. Data entry devices that do not permit clinicians to direct their attention to the patient, or consume more time than the clinician spends speaking with, examining, or administering to the patient, or else are heavy and cumbersome to use, will not be used.
With larger screens, tablet PCs are also becoming popular both in wireless and docking mode. As doctors and nurses move from one computer to another, they expect to see the same interface regardless of whether it is displayed on a terminal, an office PC, a wireless tablet or a laptop. These busy professionals do not have time to learn and adjust to a different view or access method for each device according to the American Medical Association (2017).
American Medical Association (2017) also stresses the importance of high performance being another critical factor, especially for remote and mobile workers. Healthcare demands speed, and clinicians need quick response from their applications so that they can complete reports and documentation in a timely manner. To ensure user satisfaction, organizations must find a desktop and application delivery solution that can provide high performance of powerful data or graphics-intensive applications, even over low-bandwidth connections.
Tasks and Responsibilities for Deploying an Upgraded Telehealth Technology
To implement new telehealth technology, certain components need to be considered. This consists of the population of the organization, the types, location and the number of facilities (Rhoads, 2017). It is important that implementing the technology is organizing a team who will make critical decisions. Offer productive support during product integration, make sure to have a comprehensive support system for alleviating any difficulties in the transition. Have everyone properly trained and secure with newly introduced technology before your launch date (Martich, 2017). Short term goal is to have all staff trained prior to initiating the new telehealth technology.
Long term is to have one assigned employee per department as a super user to answer questions and assist staff in the long haul. Also offer SharePoint guides for staff to reflect back on when in question and IT Support (RHIhub Toolkit, 2019).
Build value by communicating openly with employees, speak to the organizational benefits of the new process, and explain what motivated the change. It’s important to address what could be at stake if the implementation fails, giving ownership to everyone collectively.
Highlight the direct value of new technology for employees and trust them to become invested in its success. Value their opinions by taking the time to collect and address feedback (RHIhub Toolkit, 2019). Most evidence for cost savings is implied through indirect reductions in resource utilization. Cost savings in these situations are achieved through the avoidance of patient-generated costs, such as those associated with travel, lost time from work, or caregiver reimbursement. These costs, although not insignificant, are variable and are correlated with travel distance.
Other studies reported goals such as a decreased frequency or avoidance of patient transfers. American Medical Association (2017) states this was most notable in the triage of surgical cases in orthopedics and neurosurgery. In these situations, it could be possible to avoid the mobilization of health professionals such as physicians and nurses.
Many providers are now looking to modernize their clinical information systems to support patient safety initiatives, but this process involves several potential roadblocks: the cost and complexity of implementing, managing and deploying powerful new EHR applications; persuading clinicians to use the new systems on a consistent basis; and making sure that electronic patient information is secure and compliant with government mandates.
To bolster effectiveness of information technology, some healthcare CIOs are consolidating IT for greater management efficiency and cost savings. Some are standardizing on fewer technologies. Others are outsourcing the management of their systems. However, this trend represents only half the cycle of information use. No matter how efficiently information is managed, it is useless and valueless if clinicians cannot access exactly what they need, precisely when they need it, from any location. For this reason, CIOs need to make virtualized access a priority in their strategy to improve patient safety and quality of care (RHIhub Toolkit, 2019).
Staff Training Requirements
Staff Learning Modules will consist of Virtual self-paced learning modules as well as Live TEAMS virtual meetings and educational events. On site visitation will occur on a scheduled visit during the Go-Live event. During that time in which the project managers are on site, the designated super-users/champions and leadership will have an additional learning session. Work flow should also have an effective date and should take effect on that date in the system the administrative user should be able to see the current state of a workflow and any error messages (Nakagawa et al., 2018).
Whoever oversees this function, whether it is a physician or a nurse, what is consistent is that IT, digital along with business and clinical operations teams are working collaboratively to implement effectively in a timely manner and on a secure platform. As a leader in this project it is important to highlight the direct value of new technology for employees and trust them to become invested in its success. It’s essential to address what could be at stake if the implementation fails, giving ownership to everyone collectively. Another key area of importance is providing training to create a seamless and convenient experience for clinicians and their patients. Build value by communicating openly with employees, speak to the organizational benefits of the new process, and explain what motivated the change. Value their opinions by taking the time to collect and address feedback (RHIhub Toolkit, 2019 MSN-FP6214 Improving Telehealth Technology Essay).
Cost-effectively deploy desktops and applications across all users and locations, while leveraging existing IT infrastructure. Martich (2017) suggests to provide secure, flexible, real- time access to clinical information for physicians and other clinicians at the point of care.
Improve clinician satisfaction by delivering convenient access to systems using single sign-on and role-based access to authorized desktops, applications, and information. Enhance the security of patient records by providing access safeguards that include industry-standard encryption and support for strong authentication. Support the mobile work style of clinicians with roaming access support.
A comprehensive desktop virtualization solution can address these challenges. This solution enables delivery of EHR as a service, making information resources securely available in real time, regardless of the clinician’s work scenario. It provides: Easy and fast access over virtually any trusted or non-trusted network and device to any desktop, application or resource whether centralized on the server, distributed on the desktop, or both. Information security that authenticates users and allows access appropriate to their clinical role and access scenario. A consistent high definition user experience when roaming from one device to another. Flexible access from offsite physician offices, home offices, remote locations and mobile devices, as well as across the healthcare campus (Martich, 2017).
American Medical Association (2017) recommends that basic patient history, documentation capabilities, image capture and physical information is required for the consults. Consulting physicians have basic patient history, documentation capabilities, image review and physical information. The telehealth configuration integrates directly into office workflows. The image upload capability allows referring physicians to load all required images from digital cameras.
Standard digital cameras with a macro-mode are all that is required to adequately capture images required to support specialty consults. Images are typically 5 mp with 300px or better resolution. A separate telemedicine encounter type is used to support reporting and contracting/billing. This encounter type will also be utilized for future telemedicine configurations. A training program and online training materials are available for clinicians involved with the project (Martich, 2017).
Post-Deployment Telehealth Technology Evaluation and Maintenance Strategy
Ensuring evaluation measures and efforts are tailored for each component of the plan will allow programs to obtain an accurate, holistic picture of their program strengths and opportunities for improvement (Martich, 2017). Programs should consider the data needed, methods for collecting the data, ways to present the data, and the frequency at which these data analytics reports will be generated. As telehealth programs implement their activities, continuous program monitoring is important to help identify potential points of improvement. Regular evaluation of the program allows the implementation team to identify areas of high and low performance and therefore make changes as needed. This information may be provided in data reports and patient satisfaction surveys (RHIhub Toolkit, 2019).
Conclusion
Improving patient safety requires flexible, on-demand access to confidential information about current medical histories, medications, allergies and test results, from any location, where care is given or decisions are made. In addition to patient records, clinicians need access to applications such as computerized physician order entry (CPOE) that not only streamline orders, but also include reference databases and alerting mechanisms (Martich, 2017).
The evolving healthcare industry is shaped by a variety of factors and challenges, including government mandates for staff efficiency in order to save lives; a need for more stringent security measures to comply with the increasing regulations governing privacy and security of patient information; a high demand for improved customer service due to increased public scrutiny of quality of care and patient safety; and a growing need to solve the fiscal dilemma of meeting the significant care demands of an aging population (American Medical Association, 2020).
References for MSN-FP6214 Improving Telehealth Technology Essay
American Medical Association. (2020). Digital Health Research: Physicians’ motivations and requirements for adopting digital health – Adoption and attitudinal shifts.
Retrieved from https://www.ama-assn.org/ system/files/2020-02/ama-digital-health-study.pdf
American Medical Association (2017). 50-state survey: Establishment of a patient-physician
relationship via telemedicine. Retrieved from: https://www.amaassn.org/sites/default/files/media-browser/specialty%20group/arc/ama-chart- telemedicine-patient-physician-relationship.pdf
Campling, N. C., Pitts, D. G., Knight, P. V., & Aspinall, R. (2017). A qualitative analysis of the effectiveness of telehealthcare devices barriers to uptake of telehealthcare devices. BMC Health Services Research, 17 doi:http://dx.doi.org.library.capella.edu/10.1186/s12913-017-2270-8
Evaluation Strategies and Considerations for Telehealth Programs (2019 )RHIhub Toolkit. Retrieved from https://www.ruralhealthinfo.org/toolkits/telehealth/5/strategiesandconsiderations
Hawkins, P. (2017). Leadership team coaching: Developing collective transformational leadership (Third ed.). London;New York;: Kogan Page.
Nakagawa, K., Kvedar, J., & Yellowlees, P. (2018). Retail outlets using telehealth pose significant policy questions for health care. Health Affairs, 37(12), 2069-2075. doi:http://dx.doi.org.library.capella.edu/10.1377/hlthaff.2018.05098
Martich, D. (2017). Telehealth nursing: Tools and strategies for optimal patient care (1st;1; ed.). New York: Springer Publishing Company, LLC.
Rhoads, C. (2017). Telehealth in rural hospitals: Lessons learned from Pennsylvania. Boca Raton: CRC Press, Taylor & Francis Group. doi:10.1201/b19049
MSN-FP6214 Assessment 1 Executive Summary: Technology Needs Assessment and Telehealth Example Answer
Telemedicine, or telehealth as it is more commonly referred to, is an emerging technology through which healthcare services can be delivered to patients remotely. Telehealth is how telecommunication technologies enhance healthcare, as well as health education delivery and support. It aids long-distance healthcare and facilitates patient self-management (Center for Connected Health Policy [CCHP], 2020).
The implementation of telehealth within a healthcare organization has vast implications for the improvement of patient outcomes. This executive summary presents a recommendation for implementing a specific telehealth technology at Denver Fertility (DF) aimed at improving patient outcomes and quality of care – supported by evidence from a technology needs assessment – whilst concurrently discussing policy considerations and its potential impact on stakeholders.
Relevance and Importance of a Needs Assessment
With the ever-changing healthcare market, there are many new technologies a healthcare organization may choose to implement within their practice. A needs assessment must be performed to determine which telehealth technology is best suited to their individual practice and will ultimately improve patient outcomes.
A needs assessment serves to define the specific needs of populations and telehealth programs whilst identifying possible assumptions about the value, purpose, and intent of instituting new technology amenities (DeGaetano & Shore, 2015). Identifying population needs and creating services to fill these needs is fundamental to telehealth implementation. With the ever-increasing healthcare costs, identifying a specific solution to fill an explicit need is essential to a successful telehealth establishment (DeGaetano & Shore, 2015).
Furthermore, a needs assessment is an evidence-based planning for healthcare organizations that ensures appropriate allocation of resources and allows for tailored health services (Aldossary et al., 2017). This assumes that a given organization is limited by cost and amount of resources. In this instance, conducting a needs assessment at DF to determine a specific technology to implement is critical.
Telehealth Technology and Patient Outcomes
Evaluation of a performance gap analysis and technology needs assessment performed at DF indicated that the application of mobile health, or mHealth, is the most fitting option for the implementation of a new telehealth technology. CCHP (2020) defines mHealth as health care, practice, and education that is supported by any mobile communication device. mHealth supports healthcare through the provision of services and personal data via numerous applications (apps), such as targeted text messages, diabetes monitoring, and fitness tracking, to name a few (CCHP, 2020).
There are several critical issues in nursing care occurring at DF that need to be addressed: (a) patients’ lack of access to services, (b) deficiency in communication between providers and patients, and (c) patient knowledge deficit. MHealth assists nursing care in several ways and ultimately affords improvements to multiple areas and patient outcomes. Ford et al. (2020) report that patients experienced increased knowledge and awareness of their health and diagnoses after using mHealth.
In addition, a literature review of 19 studies regarding mHealth found that along with increased access to services, patients experienced improved self-efficacy and self-awareness, and enhanced communication between patients and providers occurred (Radbron et al., 2019). Application of mHealth at DF would assist in all aspects of gaps in performance.
Safety Requirements and Regulatory Considerations
When implementing new telehealth technology, it is important to consider safety requirements and regulatory considerations. These exist not only on a national level but state-to-state as well. Healthcare providers must be aware of and adhere to these requirements and regulations to avoid penalties. In 2012, the Federal Communications Commission (FCC), the Food and Drug Administration (FDA), and the Office of the National Coordinator for Health Information Technology (ONC) were tasked with the regulation of current technology as well as developing advances in mHealth. These organizations cooperate to protect patient safety and promote innovation. However, additionally, the Federal Trade Commission (FTC) defends patients and consumers of mHealth from misleading claims and data breaches (Marcoux & Vogenberg, 2016).
One such regulation is that telehealth providers must be licensed in the state where they practice and the state where the patient resides. This can be a logistical nightmare for some providers, but it is important to consider nonetheless when implementing telehealth technology (Marcoux & Vogenberg, 2016). Another aspect to contemplate is reimbursement regulations for private insurance and federal programs, such as Medicare and Medicaid, alike. It often comes down to specific wording in laws that determine whether or not an organization may be reimbursed for services rendered via mHealth (Adler-Milstein et al., 2014).
Additionally, to uphold patient safety, some states have specific requirements for online prescribing, such as in-person consultations or physical examinations before writing prescriptions (CCHP, 2020). In order to maintain federal and individual state regulations, there is much research and education for healthcare organizations to do before establishing a new telehealth technology. The time, effort, and resources required for this endeavor are something to consider.
Patient Confidentiality and Privacy Protections
In addition to safety requirements and regulatory considerations, patient confidentiality and privacy protections must be considered. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects personal health information (PHI). With the addition of telehealth to a covered healthcare organization, obligations to patient confidentiality and privacy do not change (CCHP, 2020). Healthcare organizations must uphold standards, even with new potential risks for a breach in patient data.
For example, telehealth upkeep may require consultation with an information technology (IT) team, which involves members not part of the patient care team. This exposure to patient data can be remedied by entering into a business associate agreement that requires the IT organization to uphold the same standards of HIPAA as the healthcare organization (AAAAI, 2018; CCHP, 2020). Encryption and password protection are additional ways to assist with HIPAA compliance but are not infallible (CCHP, 2020).
Interestingly enough, the current COVID-19 pandemic has caused regulatory bodies to waive imposed penalties for HIPAA noncompliance for healthcare providers utilizing telehealth during this national emergency (Relias Media, 2020). It is uncertain how long this allowance will last for telehealth healthcare providers. This could allow a smoother transition period until the healthcare organization ascertains complete compliance.
Potential Impact on Stakeholders
Acquisition of new telehealth technology has vast implications for stakeholders and end users. First and foremost, there is potential for a profusely positive impact on quality of care and patient outcomes if DF were to implement mHealth within their organization. Increased access to services, enhanced knowledge and self-efficacy, and improved communication are all potential positive impacts for patients and family members (Ford et al., 2020; Radbron et al., 2019).
For healthcare providers, mHealth eases the workload and improves efficiency. As Ford et al. (2020) found, mHealth aids in patient education. This alleviates time spent in this area for nurses and providers, allowing them to focus their efforts on additional areas of patient care. Additionally, information stored in an app instead of on paper reduces the time spent collecting and collating data (Radbron et al., 2019). As stated previously, mHealth also improves communication between patients and members of the healthcare team.
A final consideration is the cost, time, effort, and resources stakeholders will have to put into implementation in order to reap these rewards. While these aspects are essential to consider, the benefits of new telehealth technology seem to outweigh these.
Conclusion
With the ever-changing face of healthcare and the push for improved patient outcomes, telehealth is a valuable asset for organizations to consider implementing. While the challenges of numerous regulations and the time and resources spent are of note, the potential benefits of increased patient knowledge, access to care, self-efficacy, and provider-patient communication are difficult to ignore. Advancements are continually being made in healthcare, and telehealth is likely here to stay.
References
Adler-Milstein, J., Kvedar, J., W. Bates., D. (2014). Telehealth among US hospitals: Several factors, including state reimbursement and licensure policies, influence adoption. Health Affairs, 33(2), 2-7-215 https://doi.org/10.1377/hlthaff.2013.1054
Aldossary, S., Martin-Khan, M., Bradford, N. K., Armfield, N. R., & Smith, A. C. (2017). The development of a telemedicine planning framework based on needs assessment. Journal of Medical Systems, 41(5), 1–9. doi:http://dx.doi.org.library.capella.edu/10.1007/s10916-017-0709-4
American Academy of Allergy Asthma and Immunology [AAAAI]. (2018). Security and HIPAA. Retrieved from https://www.aaaai.org/practice-resources/running-your-practice/practice- management-resources/Telemedicine/HIPAA
Center for Connected Health Policy [CCHP]. (2020). About telehealth. https://www.cchpca.org/about/about-telehealth
DeGaetano, N., Shore, J. (2015). Conducting a Telehealth Needs Assessment. In: Tuerk P., Shore P. (eds) Clinical Videoconferencing in Telehealth. Behavioral Telehealth. Springer, Cham. https://doi.org/10.1007/978-3-319-08765-8_2
Ford, E. A., Roman, S. D., McLaughlin, E. A., Beckett, E. L., & Sutherland, J. M. (2020). The association between reproductive health smartphone applications and fertility knowledge of Australian women. BMC Women’s Health, 20(1), 1–10. https://doi-org.library.capella.edu/10.1186/s12905-020-00912-y
Marcoux, R. M., & Vogenberg, F. R. (2016). Telehealth: Applications from a legal and regulatory perspective. P & T: A Peer-Reviewed Journal for Formulary Management, 41(9), 567– 570.
Radbron, E., Wilson, V., McCance, T., & Middleton, R. (2019). The use of data collected from mHealth apps to inform evidence‐based quality improvement: An integrative Review. Worldviews on Evidence-Based Nursing, 16(1), 70–77. https://doi-org.library.capella.edu/10.1111/wvn.12343
Relias Media. (2020). Shift to telehealth could remain trend after COVID-19: Reproductive health remains priority. Contraceptive Technology Update, 41(6), 1–4.
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