Necessity is said to be the mother of invention. This certainly proved to be the case when many health professionals had to change the way they worked at short notice, in response to the Covid-19 global pandemic.
Services that had previously been face to face had to be offered differently to minimise the risk of transmission of Covid-19. For many, this required a change to telehealth, which led to an increase in online or phone consultations. Some found this was an effective way to provide health services, and have reported that a number of clients have asked for this service to continue. It reduced the time and cost of attending appointments, including travel time. Telehealth can also help those living in isolated areas receive timely health care.
However, often lessons learned during challenging times pave the way for new and innovative ways of working.
The underlying principle in deciding whether telehealth is appropriate is whether the care delivered will be of the same standard as if it were delivered face to face. An important factor to consider is whether an assessment is able to be completed to a professional standard.1
Nursing assessments rely on a range of technical skills, communication and intuition, all of which can be compromised when not performed face to face. Therefore, nurses need to think critically about whether it is safe and appropriate to use telehealth in any given situation.
Telehealth includes not only the delivery of virtual consultations, but also the transfer of medical information, eg blood sugar readings via digital images, and the delivery of health information and education. So the technology used must have the capability to transmit high-quality images.
So what are nurses’ responsibilities when providing telehealth services?
Before any consultation begins, the nurse must obtain the patient’s consent and advise them of any risks of telehealth.
If a nurse is recording the patient consultation, they must make sure the patient is aware of that. They must also ensure the recording is kept on a password-protected device. The patient’s identity must be confirmed at the start of the consultation.
Nurses remain accountable under the Nursing Council’s Code of Conduct when using telehealth.2
Patient privacy is a key concern and the technology must be capable of ensursing this is maintained. And nurses must be aware that some vulnerable people, such as youth, those in harmful relationships and those with disabilities, may be unable to speak out about a lack of privacy during a telehealth consultation.
Rule 2 of the Health Information Privacy Code (HIPC) requires clinicians to collect health information directly from the individual wherever possible, and to try to ensure the individual has authorised the collection of that information.3
Responsibilities regarding documenting care are as those for face-to-face consultations. Processes should be in place to ensure the continuity of the patient record. This may include a method for uploading any images used to inform decisions to the patient’s clinical record.
Rule 6 of the HIPC requires clinicians to make a patient’s health information available to the patient, if they request it. Therefore, the nurse should ensure any recordings of information can either be stored on the patient’s record, or there is a process in place to document the recording accurately.3 In addition, if a nurse receives patient reports from telehealth providers and has concerns about the standards of care, they must inform the provider of their concerns.
While savings due to reduced travel costs are a positive factor of telehealth, unexpected costs, such as the cost of sending prescriptions directly to pharmacies, should be made clear to patients.
Employers’ responsibilities
Employers also have responsibilities when implementing telehealth services. These include having policies and procedures in place to support safe practice and this way of working, regular training, performance monitoring, and competency assessment and quality improvement processes. With a sudden change from face-to-face to online working, the design of workspaces and the time spent at workstations must be managed, so clinicians’ health and wellbeing are protected.
Ideally, any change in the way health services are provided or health professionals work, should be planned and coordinated. But, as COVID-19 has made abundantly clear, that is not always possible. However, often lessons learned during challenging times pave the way for new and innovative ways of working.
Organisations and individual clinicians must ensure they consider all aspects of telehealth provision and keep the wellbeing and rights of the patient top of mind.
References
- Medical Council of New Zealand. (2020). Telehealth (PDF, 62.5 KB).
- NZNO. (2016). Position statement: Nursing, technology and telehealth.
- Mabbett, C. (2020). Patient privacy needs protecting in world of virtual consults.