Telemedicine: The Future of Healthcare

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The Duquesne enrollment team spoke with the School of Nursing’s Director of Family Nurse Practitioner program about telehealth and the future of nursing.

Duquesne’s School of Nursing is among the first nursing schools in the country to introduce telehealth education to both its undergraduate and graduate curricula.

Listen in and discover how we are introducing and preparing our MSN students with these new technologies and strategies.

Transcript

Kyle Lepine:

Good afternoon. Everyone wanted to thank you for taking time out of your schedule and participating in our telemedicine, the future of healthcare webinar. My name is Kyle Lepine. I’m an enrollment advisor here with Duquesne, and again, wanted to thank you for taking time out of your busy schedule. Today’s webinar, we’re going to be joined by one of our faculty members, Professor Crimm, but really we want to make sure that we’re gathering some questions from you throughout this process. So please feel free to utilize that Q&A function. That way we can address those questions towards the end. But as soon as you have questions, definitely make sure that you are placing those in there. And we will make sure that we get to those, but enough about me wanting to introduce the director of our FNP program. Dr. Crimm or Professor Crimm. I apologize.

Laura Crimm:

Oh, that’s okay. Hello everyone. Thank you for joining us today. I’m professor Laura Crimm and I am the director of the FNP program here at Duquesne university. I’ve been a nurse practitioner for over 20 years and the family nurse practitioner. Worked in family practice, internal medicine, retail, occupational medicine, geriatric and palliative care, and had a lot of experience, recently with telehealth. And we wanted to share some of that with you today. So, we will go ahead and get started.

Kyle Lepine:

Professor Crimm. I don’t know if you put yourself on mute, but we can’t hear anything right now.

Laura Crimm:

Oh, that’s okay. I wasn’t sure if you were going to ask me the questions or if you wanted me just to go ahead, forward with it. So I can tell you a little bit about telehealth itself. Telehealth utilizes the computers and or mobile devices, and it’s how we’re providing healthcare from a distance now. And it’s very easy to use. It can be utilized in computers, tablets, smart phones, but it’s a delivery of healthcare that’s been utilized for quite some time. They’ve utilized it in the past for psychiatric consults. It’s been utilized in rural emergency rooms.

Laura Crimm:

When you have a patient that presents with stroke symptoms, they can consult a neurologist at a tertiary care center and they don’t have to transfer the patient then, they can try to have the physicians from the tertiary center, evaluate them and determine if they can safely be treated in that rural hospital, or if they do need to transfer them for higher levels of care. And it can also be assisted. It can be utilized in acute care, or it can be used for following chronic illnesses. And in the Pittsburgh area, we utilize a telehealth cart that’s used the longterm care and the treatment of our geriatric population. So we’ve seen a lot of use of telehealth in this area.

Kyle Lepine:

Great. That’s that’s really helpful. So in your opinion, what are the benefits of telehealth?

Laura Crimm:

So, I think for telehealth, as a provider, when we’re taking call, it’s very hard because you have to be dependent on whoever is at the bedside, what kind of assessments they provide on the patient. And then you have to base your decisions on how you’re going to treat them on that. And with telehealth, especially with a telehealth cart in the longterm care setting, we actually get to see the patient. There’s tools and accessories that are available with a telehealth cart, that we can actually do a type of assessment on them.

Laura Crimm:

And then we can form our own definitive diagnosis and decide how we want to treat them. So I think that’s very helpful. In acute care, a patient can see the provider from the comfort of their own home. So if somebody, especially during this time of COVID, if you don’t want people to be leaving their homes, to [inaudible 00:04:07] seen for say a rash, you now don’t have to go into the doctor’s office for that. You can utilize a telehealth format and have that rash treated. And we see it helps with a lot of ways that you’re eliminating the time away from work. It’s eliminating the expense of parking, gas.

Laura Crimm:

It’s just very convenient for the patient. If they can have something going on that can be treated in that type of format. And for patients that don’t have health insurance, it’s very nice because they know what they’re paying because typically the acute care visits have a set fee. So they know ahead of time what they have to pay. So like for some places it might be $55, but they know that’s all they’re paying where if they had to go to the emergency room to be seen, it could be a couple hundred dollars. So there’s a lot of benefits to telehealth.

Kyle Lepine:

Yeah, definitely. And I know with everything going on and with COVID, I know it’s definitely changing. In your opinion, how’s the landscape changing for that? How are these changes being made, and is it a quick process? How’s that going?

Laura Crimm:

I think right now, one of the big things that set it off was back in early March, around March 6th, Medicare actually had this waiver done. It’s the 1135 waiver, but it’s where they started to provide expanded reimbursement for telehealth services. Because prior to that, that was one of the holdup’s with telehealth, with people wanting to get their reimbursement. And if they weren’t going to be able to get that, then they weren’t utilizing the format. But because we were trying to treat as many people as possible, and you were trying to eliminate exposure when you didn’t have to have somebody out. If you had a vulnerable population and an older adult, somebody with a compromised immune system, you didn’t have to bring them into an area that puts them at higher risk for developing COVID. So, if it was safe, you could treat them via telehealth delivery system.

Laura Crimm:

So I think that, you’ve seen that expand where we’re seeing it where it’s providing access to care. So, if you had an older adult that was supposed to come for a routine checkup, or they had an issue like a rash, like a knee pain, something that was not serious, you wouldn’t treat chest pain, you wouldn’t treat abdominal pain, but something that could safely be treated with telehealth, they could keep these people at home and prevent them from being exposed, which was huge. And just by starting this, we’re starting to see a lot of things like Medicare has something called an annual wellness visit.

Laura Crimm:

And what it basically is, is they’re going through and doing a risk assessment on the older adult. And most of the time it’s nurse practitioners that do this in the office. Well, it seems silly to bring somebody in for some sort of preventative screening like that in the midst of COVID. So they started doing these over telehealth. And so these people are keeping up on their screenings, they’re keeping up with these visits, but they’re not getting exposed to potential dangerous with COVID, and many of the psychiatric visits are being done via telehealth right now. And I think that we’re going to see that continue because it’s been successful.

Kyle Lepine:

For sure. And it’s definitely a safer environment. I definitely appreciate your feedback there. Now, another question that we had was, first off we’ll address patients because it seems like that would be a big curve, but how are patients accessing this technology?

Laura Crimm:

It’s really simple. If you have access to a computer, whether it’s a desktop or a laptop, whoever you’re utilizing whatever health system you’re going to utilize to do the telehealth visit, they send them an email with instructions on how to access it via the computer. Now, most people have a smartphone or a tablet, and then you just download an app for that particular health system. And they tell you what you need to download, how you do it. And then you just simply click on the start visit button when it’s your time for your visit and the encounter begins on that device.

Kyle Lepine:

Got it. Is it same for doctors, for nurses? How’s that process looked for them?

Laura Crimm:

For doctors and nurses, they usually will utilize whatever their electronic health record, whatever their patient portal system is for their health system. They have some type of video visit capabilities with that. And that’s usually how they’ll access it through. For those that are maybe a smaller practice that don’t have that sometimes they’ll use things like Skype or I’ve heard of some practices using Microsoft Teams. So, they’re using some sort of video formatting, but something that you have to remember is when they’re doing this, it’s very important, we know is, being in healthcare that you, the HIPAA form that you have to sign you have to protect people’s rights and these same things go along with when you’re using a telehealth, you have to be protecting and it has to be a secure network that you’re using and you have to protect their patient information.

Kyle Lepine:

Of course, of course. Now how much do you think we’re going to be moving into this in the future? Is COVID, is this just going to be a permanent thing? Do you think once everything clears up, this is going to be something that we move on from what are your thoughts there?

Laura Crimm:

I think once you open that door, I don’t think it’s going to close again. I think that providers have found that it’s an effective way to deliver care. And I think the patient, the consumers, the patients, they like, for the most part, they like telehealth. When we get back to that day, that we all get back to go to our regular offices and we get back to our regular lives, it’s hard to take time away from work. If you could take your lunch hour to see a provider and not leave your office, not have to take a sick day at work. I mean, there’s going to be a big need for that. I don’t see it going away. And hopefully by doing this, we’ll also save some healthcare costs because when you have patients that do not have a primary care provider, a lot of times they went to the emergency room. So that increased healthcare costs would be some of those minor ailments could be handled via telehealth.

Kyle Lepine:

Yeah. And that would be great to see. Now, what are we doing here at Duquesne to prepare students for that?

Laura Crimm:

Well, we are very big on telehealth here at Duquesne and have been even prior to COVID. We’re very, very fortunate. We have a very innovative Dean and she purchased a telehealth cart for our school of nursing. So I think we are the only one, I know for sure in our area, but I don’t even know of any more throughout the country that have a telehealth cart just for their school of nursing. So, what her idea was, was she wanted her undergraduate students to have exposure to the cart because really they’re the person at the bedside that’s going to be assisting with that cart and assisting in the assessment of the patient for the provider on the other end of the computer. And then for our nurse practitioner students, we want them to understand what this formats like, what does that car look like? So when they come to campus for one of their residency’s, I walk them through the cart, I let them have some hands on experience with it.

Laura Crimm:

They can play with the different tools with it because this particular cart has a Bluetooth stethoscope, so that you’re able to assess the lungs and the heart from afar, because you just have that nurse at the bedside, put that stethoscope on the patient. And then we far away at a distance can hear their lungs sound, can hear what their heart rhythm is. Is there any murmurs? We can hear all of that. There’s an otoscope to look in their ears. There’s a wound camera, there’s a scanner. There is a 12-lead EKG. So there’s a lot of different tools that they can play with.

Laura Crimm:

And then during their campus visit, we have a standardized patient. And then the students do an acute visit where they’re remotely in a different building. And then with the use of an iPad, and our computer, they are the ones that are interviewing the standardized patient from afar. They have to use their observation skills. Then they have to determine a definitive diagnosis, a treatment plan, what kind of followup they need. And then they write a paper about it. And then later in the semester, I do a live class that, virtually, where the students, I work with the students as they work through several cases in the longterm care setting, using the telehealth cart. So we do a lot that helps to… So, when they come out from Duquesne, they’re familiar with telehealth, it’s not a foreign topic for them.

Kyle Lepine:

Great, perfect. Well, we’ve definitely had some great questions that are already kind of piling in here. So I appreciate anybody who’s started submitting those, but I’d like to kind of pivot and go to our Q&A session. And if you have any questions, definitely use that Q&A feature. But one of the first questions that came in from one of our attendance is, “Is this being introduced to all of our programs or just the FNP?”

Laura Crimm:

No, it’s in the undergraduate program, they’re talking to the undergraduate nursing students on what they would do at the bedside. And then at this point in time, it’s only the family nurse practitioner students from the graduate program that are utilizing it. Although I see that this could be something that they would use in both our new programs coming out, the acute adult Gero as well as the psych mental health program.

Kyle Lepine:

Got it. And another question that’s tightly amended to that, “Are FNP students using telehealth as clinical hours at all?”

Laura Crimm:

Yes. And that’s really come about with COVID that the certifying bodies and credentialing bodies for nurse practitioner programs have all approved that there can be some limited hours in telehealth and yes, our students have been utilizing that.

Kyle Lepine:

Great. That’s great to hear. Let’s look through some of these questions. And another one is, “How does the process of remotely virtual assessments affect the diagnosis and nursing care process?” [crosstalk 00:15:07]

Laura Crimm:

I think that’s going to take you back. It’s an excellent question. I think that takes you back to your original nursing skills because you know every day as a nurse, you have to use your observation that doesn’t go away as an advanced practice nurse. And this is where I really hone in on this with the students, because you have to observe that patient because you can’t put, especially when you’re doing an acute visit, you only have an iPad. You can’t be placing a stethoscope on the patient. You’ve got to watch and see, are they in any respiratory distress? What does the color look like? Are they able to communicate with you? Do they look uncomfortable? All of these things together, along with taking a very thorough history is vital to making a appropriate diagnosis for the patient.

Kyle Lepine:

Okay, great. Great. Now, another question that we had just come through, “What are some potential cons of telemedicine in terms of patients interactions and the outcomes?”

Laura Crimm:

I think that comes down to, and that can be in any format. It’s not just in telehealth your patient has to be honest with you. So, if a patient doesn’t tell you the true story about their history, because say they did research and they know that they have to be sick for 10 days before that it could truly be a sinus infection. So if they make up their symptoms, just so that they can get an antibiotic, that’s not going to be helpful, and you’re not going to make an accurate diagnosis. And another time that you need to consider, you have to have a patient that’s able to give you a history. So if you have somebody that has any sort of mental impairment, somebody with dementia, if they don’t have a caregiver with them, you’re not going to be able to get a good history. And therefore you’re not going to be able to utilize that format for them. I hope that answers the question.

Kyle Lepine:

I think so. And we’re definitely, we’re going through, there’s a lot of questions that everybody’s submitting. So, again, thank you for that. Another question that we had, it kind of relates to what you were just noting in terms of someone who might have dementia. “What are some challenges that you see for maybe someone who’s maybe senior citizen who might be a little bit behind the learning curve? How do you think we’re going to overcome that?”

Laura Crimm:

See that’s I think that’s going to be… You’re going to have to have somebody that’s able to tell you what’s going on, that is going to be able to utilize, first of all, utilize this type of format. So the simpler that we can make it for a patient utilize telehealth, if it’s just a button that they have to click, that’s going to help. But if you have somebody that is completely adverse to using a computer or adverse to using a tablet or smartphone for anything like that, I don’t think that they’re ever going to be comfortable doing a telehealth visit. And if you have somebody that can’t tell you exactly what’s going on, you’re going to need to have somebody with them. They can be the same thing. If you have somebody that has a language barrier if you have somebody that cannot speak, you’re going to need to have somebody with them that’s going to be able to tell you what’s going on to be able to utilize that format.

Kyle Lepine:

For sure. For sure. Now, another great question that we just had is, “Do you see a role for telehealth for pre-licensure students?”

Laura Crimm:

I don’t think so right now. I think right now, because it’s all comes down to reimbursement and in order to get reimbursement, they’re going to have to have a certification and a license. Otherwise insurances are not going to reimburse and people aren’t going to utilize that.

Kyle Lepine:

Okay. Got it. Got it. Now we have a couple more minutes. So if anybody has any more questions, definitely go ahead and send those over to us. I know you want to make sure that we’re not taking up too much of your time, but does anybody have any more questions that you’d like to send over? Give everyone a moment.

Laura Crimm:

Oh, that’s fine.

Kyle Lepine:

Okay. We had another question come through. The student is asking, “How does CMS and state specific regulation telemedicine affect current practice of nurse practitioners as independent practitioners, or is it collaborative with supervised doctors?” There was a lot, and that was a mouthful.

Laura Crimm:

That’s going to depend, oh, it’s okay. It’s going to depend upon the state that you work in because some states have independent practice for their nurse practitioners. So it would translate to telehealth where other states like Pennsylvania, we have to have a collaborative physician. So there would have to be a collaborative overseeing the telehealth visits. And it doesn’t mean they stand over top, but they just review everything, there’s somebody that’s above us. Now Pennsylvania is trying to become independent practice and we’ve had it in legislation, but it hasn’t gone through at that point yet. So it’s kind of a very independent state question.

Kyle Lepine:

Gotcha. I appreciate that.

Laura Crimm:

No, not a problem. And I wish it was something simple. It would be great if we could just say across the board that nurse practitioners are able to practice independently, but it’s just not to that point yet.

Kyle Lepine:

Got it. Got it. All right. Well, I know we’re kind of winding down here and it doesn’t seem like we’ve had a question in a moment or so, so let’s see. Looks like someone’s typing something in.

Laura Crimm:

That’s okay.

Kyle Lepine:

Okay. All right. Well, it looks like that one went away. So just wanted to let you know guys, thank you for your time today. It was really appreciated. You had some great questions here, and if you have any questions, please do not hesitate to reach out to that phone number at the bottom. Your enrollment advisor is here to assist you throughout this process, our wealth of knowledge, we’d love to connect with you and see if this is going to be a good fit for you. So please feel free to reach out if you have any questions lingering, we’ll be here for you. Do you have any final notes, Professor Crimm?

Laura Crimm:

No. Other than thank you very much for all of you taking the time to learn a little bit more about telehealth today. I hope you found it helpful. And I enjoyed speaking with all of you today.

Kyle Lepine:

Yeah. We definitely appreciate your time. You were a wealth of knowledge and definitely, I learned something new today, so we appreciate it.

Laura Crimm:

Well, good! Well, I’m glad to hear.

Kyle Lepine:

All right. Well, thank you for your time everyone, and have a great rest of your day.