Telehealth as ‘Disruptive Innovation’ in Nursing

A patient uses telehealth equipment to communicate with his nurse. Photo courtesy of Janet Grady.

“Telehealth: A Case Study in Disruptive Innovation” is a CE article in AJN‘s April issue. The author, Janet Grady, vice president of academic affairs and chair of the Nursing and Health Sciences Division at the University of Pittsburgh in Johnstown, Pennsylvania, describes the concept of disruptive innovations in nursing and delves into the evolving field of telehealth as a current example.

The article considers the following:

• uses and potential uses of telehealth in chronic and acute care, home care, and rural medicine, and the evidence supporting its use.
• obstacles to wider use and acceptance of telehealth, which include cultural resistance within nursing, licensure issues across states, reimbursement challenges, and the need to adapt nursing curriculum to these new ways of delivering care.
• forces that drive or obstruct disruptive innovations like telehealth.

Here’s the article overview:

Technologic advances in health care have often outpaced our ability to integrate the technology efficiently, establish best practices for its use, and develop policies to regulate and evaluate its effectiveness. However, these may be insufficient reasons to put the brakes on innovation—particularly those “disruptive innovations” that challenge the status quo and have the potential to produce better outcomes in a number of important areas. This article discusses the concept of disruptive innovation and highlights data supporting its necessity within health care in general and nursing in particular. Focusing on telehealth as a case study in disruptive innovation, the author provides examples of its application and reviews literature that examines its effectiveness in both nursing practice and education.

And here’s a snapshot of some uses already being made of telehealth, an umbrella term that encompasses a broad range of activities:

Telehealth nurses may practice in community clinics, schools, prisons, or any setting in which on-site access to health care providers is limited. In a hospital, they may provide direct care at a distance, using a digital stethoscope to auscultate lung sounds or a digital camera to assess and document the progression of wound healing. Telehealth nurses may act as telepresenters, communicating with physicians or other providers through videoconferencing from a patient’s bedside. A home care telehealth nurse has the ability to “see” many more patients through virtual visits. Using a wide range of digital and distance technologies, telehealth nurses enable patients in remote locations to connect with specialized care and resources typically available only near major academic medical centers.

So how best can this technology be put to use? What will you need to know? What are potential pitfalls? This article is a good place to start.—Jacob Molyneux, senior editor