Telemedicine and the practice of Family Nurse Practitioners (FNPs)

The reform of healthcare is ongoing and, as the market continues to expand, it is important for nurses to understand what is available and what is forecast for the future. The term digital health covers a broad range of tools that can improve health care and health options, and promote lifestyle changes. It encompasses solutions including telemedicine, telehealth and remote monitoring.

The rise in telecare could help close healthcare delivery gaps and reduce health disparities in harder-to-reach communities. The world of technology and digital solutions is constantly evolving and it is important for everyone within the healthcare industry to have an awareness of what’s going on. This could be via attending courses, reading sector-relevant documents, or keeping on top of broader developments by reading online magazines and websites.

What is telemedicine?

Telemedicine refers to the delivery of medical care and general health services from a distance.  According to a paper published in The National Library of Medicine, it has been practiced for many years, with increasing evidence that proves it can provide enhanced quality of care for patients, a reduction in hospital readmissions and an increase in savings for both patients and providers. The COVID-19 pandemic resulted in a significant increase in reliance on telehealth for the provision of services, and telemedicine is now well-embedded into the offerings of healthcare providers.

Telehealth services are mainly provided online via internet access on computers, tablets and smartphones. They enable people to talk to their health care provider over a phone or via video chat, and to send and receive messages from a health care provider using e-mail, secure messaging and secure file exchange. Telehealth can also involve remote monitoring so a health care provider can check on a patient at home.

A variety of specialized care is available via telehealth services. It is a very helpful way to monitor and help improve ongoing health issues, such as dealing with medication changes or chronic health conditions. Types of care that are available through telehealth services include mental health treatment. Care delivered this way might encompass medication management; online therapy and counselling; lab test and x-ray results; prescription management; and post-surgical follow ups. Telehealth services can also be used for urgent care issues such as coughs, colds and stomach aches; remote monitoring services to help track health goals and manage chronic conditions, including diabetes and high blood pressure; as well as physical and occupational therapy.

Health care providers are able to send information to help patients manage their health at home, such as suggestions for improving diet, mobility or stress management; notifications or reminders to take medication or do rehabilitation exercises; instructions in how to continue care at home; and encouragement to stick to treatment plans.

The growth in the popularity of telemedicine

The use of telemedicine is growing and, according to the Journal of the American Medical Association, telehealth visits rose from 840,000 in 2019 to 52.7 million in 2020 during the pandemic and, in 2021, 37% of adults used telemedicine. Providers can see that using telehealth services can broaden access to care and digital technology is able to reduce the number of people needed to personally monitor vitals for diagnoses and awareness. It is also possible to use remote capabilities to allow for care at home or in skilled nursing facilities and, as technology is becoming more commonplace in healthcare settings, many services will help on a long-term basis to benefit both providers and patients.

The American Healthcare Association published their digital health care study in 2022 which looked at physicians’ motivations and requirements for adopting digital clinical tools. The first study was undertaken in 2016 and, since then, the use of digital heath tools has increased as physicians become increasingly positive about the advantages they can bring to the care of patients if key requirements are met. Among the findings of the study were that improved clinical outcomes and work efficiency were the most important factors that influenced interest in the digital tools. Additionally, the biggest growth in the adoption of use of the tools was associated with those that help in delivering remote care. The most popular were tools that enable tele visits, followed by using remote monitoring devices.

Determinants of health such as socioeconomic status, level of education and geographic isolation may keep many Americans at risk of health issues. Challenges associated with connecting with healthcare resources mean these populations, especially in rural and medically underserved areas, are at higher risk for poorer health outcomes. Telehealth could offer opportunities to bridge this gap.

Family nurse practitioners and telemedicine

Family nurse practitioners (FNPs) specialize in the primary and speciality care of patients across all ages. They focus on preventative care, assisting physicians and monitoring patients’ long-term health, plus much more. The recent scarcity of family practice doctors has led to increasing demand for FNPs to take on more primary care positions, especially those in underserved communities. With their wide understanding of care across the age spectrum, FNPs are able to develop considerable knowledge of the overall health of the communities in which they work. There are several innovations that are expected within the telecare sector going forward which could affect the way healthcare is provided.

  • AI and machine learning

These innovations help healthcare professionals streamline data analysis processes as well as enable more precise diagnoses and treatments. Some organizations are also using machine learning algorithms to predict future health risks. Doctors and FNPs are also now able to tap into platforms that use machine learning to give them real-time insights into a patient’s symptoms using information such as their health records, claims data and surveys.

  • Remote patient monitoring (RPM)

This enables the simple transmission of information between doctors, FNPs and patients and is helpful with those who need to be monitored for their health condition and for those who cannot travel. RPM devices can be both wired and wireless, and they can track a person’s medical or well-being data which is collected outside traditional healthcare settings. Remote monitors and sensors, such as pulse oximeters and glucose monitors, can now be used by patients at home and offer healthcare professionals a constant stream of quality health data that is easy to access. There is also the Internet of Medical Things (IoMT) which allows real-time remote patient monitoring using trackers and sensory-based devices.

  • Electronic health records (EHR

These are digital versions of a patient’s medical chart and they house information from all of the clinicians involved in the care of that patient. This could include test results, medications and treatment plans.

  • Augmented reality (AR) and virtual reality (VR)

Both AR and VR are being used more often in healthcare, providing physicians with a more immersive experience in relation to patient care, diagnoses, treatments and educational tools. 

How telemedicine can help family nurse practitioners

According to the American Association of Nurse Practitioners demand for nurse practitioners (NPs) is growing with the ageing population and the rise in chronic disease as well as rates of infectious disease. Statistics show that licenced NPs conduct more than 1 billion patient visits annually, and that includes via mobile outreach and telehealth as well as in-person.

The use of telehealth in the family nursing sector offers benefits such as online patient portals, instant messaging, information-sharing, automatic scheduling, email communication and much more. This enables family nurse practitioners (FNPs) to administer patient care by remotely monitoring, following up with, and educating patients, as well as collecting data. 

Family nurse practitioners using telehealth services can do health assessments on online platforms; establish and maintain positive relationships with patients; formulate diagnoses to establish care plans; collaborate with doctors; and streamline administrative tasks.

Telehealth solutions can also enable FNPs to provide round-the-clock counselling and educational resources for patients.

Things to consider when using telemedicine services

There are parameters that need to be established in order to offer the best telehealth services to patients. These include security and privacy requirements to ensure that applications are compatible with the HIPAA guidelines that protect personal data and there is a secure link between the FNP and the patient. It’s also crucial that FNPs are aware of the rules and regulations of the area in which the patient is residing.

Every nurse practitioner needs excellent interpersonal skills but the ways that people interact during phone calls or video consultations is different and this needs to be taken into account. It is useful to send information to patients in advance of the consultation such as the agreed time of the call and whether the caller ID will show as withheld, for example. Nurses may also give an estimate of the likely duration and guidance for patients about where they should take the call. Patients may not be confident with using technology – which could cause anxiety alongside their health condition – so it can be helpful if patients are able to test their equipment and log in process in advance of the appointment to check it works. All this needs to be communicated before the appointment for a better experience.

It is also crucial to understand the etiquette of delivering telehealth to patients, whether it be by telephone or video. It is important to provide the right environment with privacy in an examination room or private office. This can eliminate office noises and other distractions. If done by video, the provider needs to be aware of the position of the camera, ensure they maintain eye contact and display engagement with the patient by looking and leaning into the camera. The provider also needs to ascertain that they are visible on camera throughout the appointment.

Ensuring the equipment is working correctly before appointments is key, and it could be worth logging in as a patient in order to understand how it works from their perspective. This might involve checking how the camera placement works and learning to troubleshoot the system as a patient in order to be able to guide them through it should they need help. 

The patient’s home needs access to the internet and a technological device to conduct a telehealth visit and, although many Americans have the right connection and equipment, some may not have them. This could include some elderly patients and those with fewer socioeconomic resources. For these patients, telehealth visits by telephone can be undertaken.

Becoming a family nurse practitioner

Family nurse practitioners are perfectly placed to work in both traditional settings and to deliver healthcare through telemedicine, and to have a worthwhile and rewarding career with opportunities to make a real difference in the communities in which they work.

There are several steps to becoming a family nurse practitioner through education, certification and clinical practice. People interested in becoming FNPs need to become a Registered Nurse first and then apply for and complete an accredited FNP Program. They then need to apply for the FNP Credential from the ANCC or AANP, and to apply to become a State Certified FNP. They also need to renew the certification when required.

The University of Indianapolis offers fnp online programs to prepare students to elevate their careers as a nurse practitioner. The online Master of Science in Nursing-Family Nurse Practitioner (MSN-FNP) course has a part-time online format that is designed to accommodate working nurses. It also has a clinical placement department to help students secure a local placement site, and proactive support from an advisor to help manage deadlines. In addition, it offers an on-campus clinical intensive to teach students clinical skills including sutures, health assessments, incision and draining techniques, and it can be completed in just eight semesters.

The future for family nurse practitioners

The employment outlook for family nurse practitioners is good. According to the Bureau of Labor Statistics, overall employment of nurse practitioners, nurse anaesthetists and nurse midwives is expected to grow 38% between 2022 to 2023 – which is much faster than the average for all occupations – with approximately 29,200 openings projected each year on average over the decade. As a career, being a family nurse practitioner will develop and change. This is likely to include the increasing use of telemedicine and the benefits it has to offer patients and healthcare delivery systems, allowing FNPs to be at the forefront of making a real difference to those with whom, and for whom, they work.

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