Evidence Table 4

Technical and Ethical Issues Related to Telehealth/Telenursing

SourceSafety Issue Related to Clinical PracticeDesign TypeStudy Design & Study Outcome Measure(s)Study Setting & Study PopulationStudy InterventionKey Finding(s)Category of Telehealth Article O = Outcomes M = Monitoring D = Diagnosis/Consultation T = Technical/Ethical
Bell 200421Traumatic brain injury (TBI) patients and their transition to the communityChanging practice projects/researchObservational studies without controls (Level 4) No outcomes relevant to decreasing medical errors and/or adverse events (Level 4)Patients’ homes, TBI patients discharged from University of Washington Medicine.Telephone followup program.Telephone support is a feasible means for followup of TBI patients in the community.T
Boye 200655Risk to patients from use of wireless devices.Literature reviewPossible outcome relevant to adverse events (Level 5)Review of sources of electromagnetic interferences in hospitals.A description of wireless communication devices used in the hospitals and the industry standards.Wireless technologies are deemed suitable for use throughout hospital areas, including ICUs & ORs, given that recommended separation distances from medical devices are observed.T
Britt 200615Access to specialist care for high-risk pregnanciesPretest and post-testObservational studies without controls (Level 4) Other measurable variables with an indirect or unestablished connection to the target safety outcomeAcross the State of Arkansas, high-risk pregnancy patients.Using the ANGELS telehealth program to facilitate care and provider consultations.An increase in telemedical and telephone consultations. A slight decrease in transports to the high-risk clinic, with a decrease in the length of stay for patients.T
Dansky and Ajello 200556The strategic objectives and marketing strategies for telehealthNon- comparative studiesObservational studies without controls (Level 4) No outcomes relevant to decreasing medical errors and/or adverse events29 home health agencies of a Midatlantic State, person at the organization responsible for implementing telehealth.Qualitative interviews were conducted to discover the reasons for telehealth adoption and the marketing strategies.Clinical excellence and cost containment were the main reasons for adopting telehealth. Marketing strategies were broad, but included brochures, articles, Web site content, and fact sheets.T
Ferrante 200526Wireless capabilities available to telemedicine for patient careLiterature reviews, non- systematic/narrativeObservational studies without controls (Level 4) No outcomes relevant to decreasing medical errors and/or adverse events (Level 4)Literature review of current and future technology applications for medicine.Many applications of new technologies exist for telemedicine.T
Frey 200520Nursing shortage having an effect on home health agencies and their patientsChanging practice projects/researchObservational studies with controls (Level 3) No outcomes relevant to decreasing medical errors and/or adverse events (Level 4)Home health agencies of a Midatlantic State.Use of telehealth for home health agency visits vs. traditional visits.Average daily census of patients seen was increased.T
Ganguly 200557The development methodology for interoperable telemedicine systemsChanging practice projects/researchObservational studies without controls (Level 4) No outcomes relevant to decreasing medical errors and/or adverse events (Level 4)School of Computer Science and Engineering, The University of New South Wales, Kensington, NSW 2052, Australia.Development of an ontology- driven, multiagent system for diabetic treatment using diabetes ontology and agent system called Foundations of Intelligent Physical Agents (FIPA) standard- based ontology development.Yet untested design that focuses on a FIPA- compliant model for interoperable telehealth technologies.T
Keeys 200258Overnight pharmacist access in an acute care facilityQuality improvement projects/researchObservational studies without controls (Level 4) Other measurable variables with an indirect or nonestablished connection to the target safety outcome (Level 3)A 340-bed acute care community hospital, hospital staff.Enhancing current after- hours pharmacy on-call coverage with a telepharmacy group.Successful quality improvement.T
Masucci 200659Descriptive study of patients without computer experience and whether they were able to safely and effectively use telemedicine technologyNon- randomized trialObservational study (Level 4) Self-reports (Level 3)44 subjects with little/no computer experience and with hypertension, diabetes, and other cardiovascular risk factors were provided telemedicine systems.Patients with no or limited computer experience were given a 2-hour class in use of the telemedicine technology system.Patients utilized the system accurately and safely using IDs and passwords. Prior access to computers and prior computer experience was not a predictor of use of telemedicine systems. Having access to telemedicine systems may reduce risk for cardiovascular disease.T
McConnochie 200618Social and economic burden of childhood illness/access to health careRandomized controlled trialRandomized controlled trials (Level 1)
Surrogate outcomes (Level 2)
University of Rochester Medical Center primary care practice or pediatric ED, pediatric patients.Three models of telemedicine: basic, simple, and extended.Approximately 85% of visits offered successful telemedicine intervention.T
Miller 200660The use of telehealth technology in home health care for adult persons with developmental disabilities was examined, and algorithm for delivering telehealth services to developmentall y disabled persons developed.Changing practice projects/researchObservational study without controls (Level 4) No outcomes relevant to decreasing medical errors and/or adverse events (Level 4)The researchers examined the utilization of telehealth needed by multidisciplinary clinicians, including physicians, nurses, physical therapist, occupational therapist, and speech language pathologists, etc., to meet the health care needs of rural adults with developmental disabilities.Following an examination of the utilization of services, the authors developed an algorithm for telehomecare for adults with disabilities.A practice-based algorithm and model for telehealth care delivery to meet the needs of rural adults with developmental disabilities was developed. The unique consideration regarding the need to determine the risk-management needs for using telehealth technologies with this population is also described.T
Seren 200561Postoperative nasal airflow pattern detection for the prevention of hospital visitsCase control studiesNonrandomized controlled trial (Level 2) Other measurable variables with an indirect or nonestablished connection to the target safety outcome (Level 3)In-home, 27 patients post septoplasty.Use of Web technology, Web Add, and Odiosoft-rhino programs to record and transmit sound from nasal passages.Significant difference in the sounds transmitted between the group with nasal blockage and those without nasal blockage.T
Suzuki 200625Daily health monitoring of elderlyNon- comparative studiesObservational studies without controls (Level 4) Other measurable variables with an indirect or unestablished connection to the target safety outcome (Level 3)Nursing home, three elderly patients.Use of infrared scanner sensor output in nursing home patients’ rooms, as compared with the reported activities of the patients.The sensors were able to identify the reported patterns of activity.T
Tang 200662Medical errors related to usability and interface designQuality improvement projects/researchObservational studies without controls (Level 4) Other measurable variables with an indirect or nonestablished connection to the target safety outcomeDigital emergency medical system interface prototypes.Heuristic evaluation of interface usability.Heuristic evaluation serves as a useful technique in designing user interfaces.T
Thomas 200413Improved education for surgical patientsQuality improvement projects/rese archObservational studies without controls (Level 4) No outcomes relevant to decreasing medical errors and/or adverse events (Level 4)University of Kentucky Chandler Medical Center/Kentucky Telehealth Network locations Patients undergoing joint surgeryUse of telehealth for preoperative education in addition to the conventional method of education.Patient satisfaction was positive with the use of the telehealth model.T
Wei 200619Access to experienced ophthalmologistsChanging practice projects/researchObservational studies without controls (Level 4) Other measurable variables with an indirect or unestablished connection to the target safety outcome (Level 3)Los Angeles County Department of Health Services, high-risk diabetic patients.Use of Web- based telemedicine system.Web-based architecture successful in capturing and transmitting images.T
Whited 200563Access to routine eye examinations for diabeticsQuality improvement projects/researchObservational studies with controls (Level 3) Other measurable variables with an indirect or unestablished connection to the target safety outcome (Level 3)Indian Health Service, Department of Veterans Affairs, and Department of Defense, diabetic patients.Monte Carlo simulation, modeling the use of the Joslin Vision Network telehealth model vs. conventional clinic-based ophthalmoscopy.The Joslin Vision Network is less costly and more effective in detecting diabetic retinopathy than conventional clinic- based methods.T
Yoon 200564The accuracy of a single finger probe using photoplethysm- ography (PPG) was tested as a digital monitoring device for hematocrit, SPO2, respiration, pulse, and blood pressureChanging practice/researchObservational studies with controls (Level 3) No outcomes relevant to decreasing medical errors and/or adverse events (Level 4)Sample size varied for each type of measurement. Hematocrit testing was performed on 549 patients at Samsung Hospital, Seoul, South Korea. Five healthy adults were used to test the predictive power of the PPG waves for the other parameters.A palm-sized digital health monitor used a finger probe and a light emitting diode (LED) array. The light was measured to obtain PPG signals. Hematocrit, pulse, respiration rate, and saturated oxygen in arterial blood (SpO2) were measured and predictive algorithms developed to measure the clinical accuracy of the PPG diagnostics.The accuracies were within clinically acceptable errors. This work showed that the method and algorithm for multiple physiological signal measurement based on a single LED sensor are valid.T
Zimmer- Galler and Zeimer 200623Adherence in retinopathy screening and treatmentRetrospective cohort studyObservational studies without controls (Level 4) Other measureable variables with an indirect or unestablished connection to the target safety outcome (Level 3)Primary care practices throughout 7 States and the District of Columbia.
Diabetic patients who are not receiving recommended eye examinations.
Use of DigiScope imaging.DigiScope implementation is shown to be a practical alternative for patients not receiving routine eye examinationsT

From: Chapter 48, Patient Safety, Telenursing, and Telehealth

Cover of Patient Safety and Quality
Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
Hughes RG, editor.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.