Setting up a programme

Telehealth programmes are often established by health care organisations, such as the NHS or general practice. Telecare programmes on the other hand are often led by social care organisations, such as local authorities. In all cases nursing staff involved in using the technology should be fully involved in planning and preparation, and must ensure that they receive adequate and appropriate training and ongoing support. Close partnership working with the commercial companies which provide the equipment is also important.

Objectives

There may be a number of reasons for establishing a telehealth or telecare programme. The over-riding objective should always be to improve the level of service and quality of life for patients and carers. Specific objectives of particular programmes may include:

The specific health needs of a population may also be a driver.

Before establishing any programme it is important to find out as much as possible in advance. For telehealth and telecare programmes this may be through training, site visits, or by talking with telehealth consultants and those involved in existing programmes.

The reasons for setting up a telehealth or telecare programme will determine how success is measured. For example, it may be measured in terms of number of consultations, number of referrals, improvements in health status, cost reductions, etc. The reasons will also to some extent determine the scope of the programme for example the specialties involved, the physical environment, the equipment required, telecommunication needs, technical infrastructure, the number of people needed, fit with routine practice, etc. 

Skill mix and training needs

As telehealth and telecare services involve the application of information and communications technology in delivering health services or monitoring health status, it is likely that a range of different skills will be needed: managerial, clinical, technical and operational. The precise mix of skills will depend on the nature of the programme. It may be useful to specify the roles and responsibilities of people involved in any programme.

The use of telehealth and telecare means that nursing staff will have to learn new skills and ways of working. Nursing staff need to understand the technology and be confident and able to support patients and carers in its use. A significant challenge is in making and sustaining relationships with people without their physical presence - this represents a very different way of working for most nursing staff.

Informatics courses tend to focus on general principles rather than on specific telehealth and telecare skills; many telehealth and telecare programmes address this gap by delivering bespoke training for those involved.

Tools

A number of different tools may be used to support telehealth and telecare. These include relatively simple, everyday technologies such as telephones, email, discussion boards and video conferencing through to purpose-specific electronic tools such as ECG, stethoscope, ultrasound, cameras for general examination and specially designed for dermatology, colposcopy, dentistry, ophthalmoscope/otoscope, spirometer, microscope, etc. It is likely that any telehealth and telecare programme will require you to draw on external expertise for guidance. A common configuration, used in chronic disease management, involves the use of monitoring devices in a patient's home. Data is transmitted to a health professional (either a specialist nurse or the regular community team) who then provides advice or makes a referral based on the data.

Regardless of the technology used, compatibility with existing systems, flexibility and fit with current practice are likely to be key considerations. While cost is obviously an issue, the quality of communication is also important. For example, for certain applications, higher bandwidths are likely to yield better results.

Governance and ethical and policy issues

Any telehealth or telecare programme will benefit from relevant and up-to-date clinical, operational and technical policies, procedures, guidelines and standards (covering among other things security, confidentiality, record keeping, data storage, informed consent and legal liability). It may be useful to evaluate, on an ongoing basis, any telehealth or telecare programme, including measures of patient satisfaction.

Using telehealth and telecare as part of nursing practice is covered by the NMC Code of Practice, available from the Nursing and Midwifery Council, in exactly the same way as any other aspect of nursing practice.

This includes:

Nursing staff involved in telehealth or telecare programmes should be aware of local policies (including those that determine appropriate video/telephone behaviour), relevant legislation (including the safety of equipment), professional guidance (such as standards for record-keeping) and any technical standards that might apply.

As telehealth and telecare are relatively new, nursing staff should also consider liability issues and what might constitute poor or unacceptable practice. Patients should be able to expect equivalent standards of care - the same ethical principles apply whether care is provided in person or via information and communications technology.

Health care and nursing practice has traditionally demanded face-to-face contact between patients and professionals. The ethics of remote assessments and treatment have yet to be fully explored.