By: Dr. Helen Connors
According to the Telehealth Resource Center, Telehealth, in its broadest sense, is a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technology. It includes: long distance videoconferencing; store and forward; remote patient monitoring; and mobile health (mHealth). Recently, the American Nurses Association (ANA) proposed Connected Health as the global term to reflect the broad array of technologies and services used to describe the evolving ecosystem of Telehealth. Connected Health is viewed as the umbrella term to lessen the confusion over definitions of telemedicine, telehealth, and mHealth. In this interview with NLNTEQ, telehealth pioneer Dr. Helen Connors discusses the history of innovative technologies in nursing education and her vision for the future.
- What are the significant milestones in your work as a leader in nursing?
I believe I am best known in nursing for the use of innovative technologies in education and practice, and the ability to marshal change to support the use of these technologies. In the early1990s, as computers and other information technologies became more available and affordable, I began to envision how these technologies could be used in nursing education to reach out to health professional students to better prepare graduates for future practice. I was fortunate to work at an institution that had a very successful telehealth program (University of Kansas) and was able to begin by tacking onto this technology and expertise to expand educational opportunities to nurses in rural communities.
At first we used the interactive television over a T1 line to bring advanced nursing education to clinics and hospitals served by the telehealth technology. By 1995, as the internet was more prevalent, we transitioned several of our nursing courses to the web to make it even more convenient to reach out to students. The biggest challenges at this time were: no internet service provider in rural communities; many nurses in rural communities did not have computers; faculty lacked experience teaching over the internet; and there was no course management system available. We were able to bridge these challenges by working with the legislature to expand high-speed telecommunication connections to serve rural communities; and by partnering with Area Health Education Centers and a rural hospital to provide local resources such as desktop computers and a local dial-up number to a high-speed T1 line.
Philanthropic organizations helped provide laptop computers and other financial support to operate the distance learning program. This was the start of a highly successful distance learning program for nurses around the world. The initial program was recognized by Time magazine and CNN (Heroes of Medicine) in an article titled “The Wired Prairie” (Gorman, 1997). State and federal grants provided faculty support and other resources such as instructional designers to encourage and assist faculty to develop and teach online courses. When introducing disruptive innovation, creating a culture of innovation that addresses faculty support is critical.
The Wired Prairie and other technology projects led to the University of Kansas being awarded a $1.5 million grant from HRSA in 2007. The Health Information and Technology Scholars (HITS) program was a collaborative program with the University of Colorado, Indiana University, Johns Hopkins University, and the National League for Nursing to assist faculty to integrate technology, including telehealth, in the curriculum. Over the course of five years, the HITS program enrolled 265 faculty from 132 nursing schools in 43 states. In turn, these faculty impacted a large number of students and other faculty. The success of the program was due to the strength and leadership of the collaborative partnership. (See Connors, Skiba, Jeffries, Rizzolo, & Billings, 2017).
- What do you see as significant trends or gaps in the use of telehealth in nursing education, from your perspective as an expert in this area?
When we started the HITS program in 2007, very few of the faculty applicants had an interest in integrating telehealth in the curriculum; by the end of the grant period (2012), this interest had increased slightly. Increased interest coincided with national market trends in telehealth, although telehealth programs were few and far between and not readily available for education. The cost of the equipment was prohibitive for most academic institutions, especially when the demand for the skill set was not readily valued in the existing marketplace. Reimbursement and policy were the major challenges to telehealth.
Today, we are seeing greater trends toward the use of telehealth services driven by better reimbursement, policy changes, consumer demand, convenience, and ubiquitous and affordable mobile technology and broadband (Bobinet & Petito, 2015). The rapid growth of managed care, accountable care organizations, and the medical home changed health care reimbursement and the mechanisms by which telehealth services are paid. For these reasons, telehealth is seen as a means to improve quality, lower health care cost, and increase access and convenience.
Although great progress has been made in the adoption of telehealth over the last five years, we still have a way to go. Barriers to wider adoption include licensure and regulatory issues, interoperability across various platforms for data sharing, and provider training and education. Although these issues are being addressed in some fashion, we will not see the full potential of telehealth until the landscape changes. In preparation for the wider integration of telehealth in the health care system, it is imperative for nursing education programs to incorporate telehealth technologies and competences in the curriculum.
- What insights can you share related to the value of technology – specifically, telehealth in nursing education, for health care organizations now and in the future?
Technology, and specifically telehealth, is not new. However, it is advancing rapidly and already transforming the way health care is delivered, and it will continue to do so into the future. The growth in wireless technologies will continue to redefine what we mean by telehealth. One major benefit of telehealth is that it keeps patients out of the hospital and allows them to manage their chronic diseases from home. Some common uses include home health care, pharmaceutical management, follow-up after surgery, patient education, rehabilitation, and monitoring.
A variety of technologies and services are used to enable or complement telehealth. Increasingly, these tools are in everyone’s pocket or home – smartphones, iPads, tablets, and laptop computers. Remote patient monitoring also uses devices to remotely collect and send data to providers or remote diagnostic testing facilities (RDTF).
Nurses can and do play a significant role in telehealth. Here are some examples of nurses showing the value of virtual care: Mercy Nurses Using Virtual Care and Visiting Nursing Service with Telehealth. These videos and other resources are available through the Telehealth Resource Centers (TRC) – a good place to keep current with all aspects of telehealth.
As new models of health care delivery and new payment systems emerge, telehealth will continue to flourish and so will the nurse’s role. The pace of change in technology and existing norms in health care practice have created challenges and opportunities for nursing education. The challenge is to figure out how to incorporate technology and telehealth competencies into an already over-crowded and faculty-driven curriculum, while the opportunity is to educate nurses with the competencies needed for a rapidly changing workforce environment. For some, this may mean critically evaluating pedagogical approaches and the role of partnerships to align with telehealth practices. For others, it may mean finding ways to collaborate with other institutions to share faculty and technology resources, much like the HITS program shared health technology resources and faculty expertise across institutions.
- What advice do you have for nurse educators in the context of today’s health care and learning environments?
Technology is changing all aspects of our lives including health care and higher education. Educators need to be innovative and creative with the use of technology to advance nursing education and practice. As a nurse educator in this rapidly evolving environment, one needs to accept change and tolerate ambiguity as new technologies are integrated into education and practice. It is evident that with proper education and training, nurses can play a huge role in facilitating the use of telehealth and other technologies.
Now, I know that some are thinking – how can I include one more thing in the curriculum? If so, perhaps it is time to rethink higher education with a shift away from a degree-driven pursuit to lifelong learning. Using a scaffolding model, teach the basic content in the degree-granting program and then advance the learning associated with continuing graduate education that includes stackable certificates/credentials to support the needs of the evolving workforce. Think about a certificate in telehealth that can be used in combination with other certificates, such as data management or health policy, to eventually create an advanced degree.
Bobinet, K., & Petito, J. P. (2015). Designing the consumer-centered telehealth & eVisit experience. Office of the National Coordinator for Health Information Technology.
Connors, H. B., Skiba, D. J., Jeffries, P. R., Rizzolo, M. A., & Billings, D. M. (2017). Health Information Technology Scholars Program: From implementation to outcomes. Nursing Education Perspectives. 38(1), 3-8. doi: 10.1097/01.NEP.0000000000000102
Gorman, C. (1997). The wired prairie. Time Special Issue: Heroes of Medicine. 150(19), 61-63.
Helen B. Connors, RN, PhD, Dr.PS (Hon), FAAN – Through her innovative vision and leadership, Dr. Connors changed the practice of nurses through the use of innovative technologies and creative education programs at the University of Kansas, School of Nursing. She expanded the use of advanced information technologies for education and practice, established policy for health information technology and telehealth, and promoted the image of nursing worldwide through publications, presentation and recognition in Time magazine “Heroes of Medicine”. Most recently she led a collaborative HRSA funded project called the Health Information Technology Scholars (HITS) program. This program in collaboration with colleagues from Indiana University, University of Colorado, Johns Hopkins University and the National League for Nursing (NLN) impacted 275 faculty scholars and more than 10,000 students nationally.