Telehealth. Health, Medicine, Nursing Research Proposal

Telehealth
Abstract
The increasing need for improved healthcare services has prompted for several strategies aimed at improving healthcare services with the objective of achieving quality healthcare, achieving positive patient outcomes within the shortest time possible, reducing the costs of healthcare, decreasing cases of medical errors and also ensuring safety of the healthcare providers. Telehealth has been among the most common trends in the healthcare service delivery whose implementation in healthcare organization has come along with several benefits. The aim of this project is to explore telehealth as evidence based project to improve healthcare service delivery in healthcare organization. The first section has focused on understanding the need of telehealth in a healthcare organization. The second section is the literature research on research materials published on the successes and need for telehealth. The third section is the telehealth solution described in detail. The fourth section discusses the telehealth change model in an organization. The fifth section is the best approach of implementing a teleheatlth plan in an organization. The last section focuses on how well to evaluate telehealth to ascertain its successes against its implementation objectives and goals in a healthcare organization. 
Section A: Problem Description
Today, it is possible to buy almost everything online: large gifts, expensive vacations, cars, houses as well as leasing. If the technology behind such purchases can be trusted, it also makes sense to utilize telecommunication technology in the healthcare sector in a bid to improve effectiveness in some areas. Telehealth is a type of care whereby the patient can access services from healthcare providers while away from the hospital setting (Kayyali et al., 2017; Taylor & Coates, 2015). Using various modes of telecommunications, including computers and mobile phones, patients and physicians are able to exchange crucial information concerning various health aspects such as diagnosis, treatment and prevention of illnesses and injuries. Moreover, telehealth has been used to educate healthcare providers about various healthcare practices (Young & Badowski, 2017). For the past one decade, the number of individuals in need of out-of-hospital services has dramatically increased. It has been proved that most of incarcerated individuals are unable to attend hospitals for various healthcare services. For instance, in the United States, approximately 1,561,500 individuals were incarcerated in 2014 and this translates to about 500 prisoners per 100,000 residents (Young & Badowski, 2017). Moreover, the number of people suffering from chronic diseases, which would require home attendance, has almost doubled. Also, the number of old individuals who require close attention as a result of increased health complications has tremendously increased. In addition, both natural and man-made disasters have greatly increased and they have led to a great number of casualties, who would require immediate attendance (Lurie & Carr, 2018). Considering all of these facts, telecommunication could play a key role in saving thousands of lives. Cost-effectiveness is another advantage of telehealth, especially as far as the patient is concerned. Sometimes people with chronic diseases are admitted or require visiting clinicians’ time to time, spending huge amount of money in the process (Taylor & Coates, 2015). With telehealth, such costs will be remarkably minimized. Various stakeholders will be involved in telehealth and they include, disaster victims, elderly, individuals suffering from chronic diseases, prisoners, various hospitals and healthcare providers, government, telecommunication companies among others.     The research question is: Among the distant patients, including incarcerated, victims of disaster, elderly, and chronic disorder individual, how does the application of telehealth affect long-term health outcomes as opposed to traditional face-to-face care delivery mechanisms? 
Purpose and Objectives 
The purpose of this research project will be determining how telehealth could affect the health outcome of a section of patients who would require distant health care services. The population that will be covered will consist of incarcerated, elderly, disaster victims, and people with chronic illnesses. 
Objectives include 
• To determine the major mechanisms of telehealth • To identify the role played by telehealth in reducing healthcare cost and how this increases access to health care services, particularly among individuals suffering from chronic diseases and elderly
• To determine whether the quick response to natural and man-made disaster increases the chances of survival of the victims and how telehealth could be integrated into disaster management programs and prison healthcare systems 
• To compare the statistics on the health outcome of traditional healthcare services with telehealth.    
Telehealth is particularly important in the nursing field. There has been a shortage of nurses in the past twenty years due to increase in the number of population (Taylor et al., 2015). Using telehealth, this problem could be addressed since a nurse does not need to attend to the patient physically, and as a result, they can serve more patients than in the traditional system (Nagel & Penner, 2016).      
Section 2: Telehealth Literature Support
The search for literature was carried out using various search engines found in Google such as NCBI and Google Scholar, ScienceDirect, AAFP, Frontiers, and MEDLINE. Since the telehealth is quite a recent term, I did not limit my search to any date range, and I consulted articles from a wide duration of publication. However, I gave the articles written recently first priority to ensure the information used is up-to-date. Also, all articles used are peer-reviewed from reputable databases, particularly medical ones. The keyword extensively used was telehealth, but in some instances, I used the term telemedicine. I first gathered 20 articles all containing at least some sort of information about telehealth. I later selected the eight articles with the most relevant information that would help me in my research.  In this article by Taylor et al. (2015), the design involved examining four case studies of community health services in England that utilize telehealth techniques to follow up on patients with chronic heart failure and obstructive pulmonary disorder. Data collection involved conducting interviews with nurses and other healthcare staff such as managers. The sample comprised of a combination of 84 nurses and Frontline staff and 21 managers. The authors concluded that availability of flexible and reliable technology as well as dedicated resources for telehealth could determine the acceptability of this technique. Also, appropriate training of staff and a partnership approach to execution could play a part in acceptance and success of telehealth. 
Taylor and Coates (2015) used a research design that entailed an evaluation of four case studies of community healthcare organizations in Humber and Yorkshire region that employs telehealth approach to monitor patients. Collection of information was through conduction of interviews with nurses, technical and support staff, managers and telehealth users and careers. Sample constituted nurses, technical and support staff, and added up to 84 individuals. Also, the sample consisted 21 managers, 40 telehealth users, and 12 caregivers. The authors found that various factors influenced the adoption and success of telehealth and they include installation of appropriate technology, effective communication between management, nurses and clients, better planning of the operation of telehealth technique and offering ongoing support and training. 
Kayyali et al. (2017) used a two-step approach research design. The first stage involved comparison of 12 public and electronically telehealth patient information leaflets (THLs) with the available THL guidance. The second stage involved conduction of interviews with both potential users of telehealth to determine their engagement and perception of telehealth concept. Information was obtained from THLs as well as interviews with potential telehealth users. The sample consisted of publicly and electronically available THLs and 14 users of telehealth. The result indicated that there is the presence of some variations and gaps within the analyzed THLs as far as the following aspects are concerned, confidentiality, the cost of service and clients’ choices. The interview results indicated that there is a need for more use of comprehensible terminologies while describing various aspects of telehealth. They also revealed some limitations of telehealth techniques, including insufficient information privacy and confidentiality, equipment and technology failure among others. 
Young and Badowski, (2017) conducted research that involved a search of various articles on different aspects of correctional medicine in the United States. Various publications about the possibility of the use of telehealth to improve health care among incarcerated individuals were analyzed. Information was gathered from various articles about the health of jailed individuals. The sample included various articles corrected from various databases such as NCBI, ScienceDirect, among others. Articles were selected on the basis of the validity and reputability of health databases. The authors found that introduction of telehealth in correctional centers could remove barriers to evidence-based and up-to-date healthcare services among prisoners. Also, telemedicine could dramatically improve medical management, consequently improving health outcomes and cost savings.  
The study by Nagel and Penner (2016) is a qualitative study, which involved evaluation of various articles to determine theoretical frameworks and conceptual models applicable to nursing practice. Information was obtained from different peer-reviewed articles from different databases such as NCBI.  A total of 48 articles from different databases were utilized. For an article to qualify for inclusion, it must have been a peer-reviewed and from a reputable database. From the study, approximately eight published theoretical frameworks, conceptual models or similar entities that can be applied to nursing practice were revealed. Most of the models obtained were found to exclusively focus on the use of telephones. However, none of these models showed the difficulties of integrating elements of nursing and the nursing process in the concept of telehealth. 
Lurie and Carr, (2018) conducted a qualitative study that involved reviewing of available studies on the role telemedicine could play in enhancing medical response to disasters. The study involved a search of articles from databases such as Google Scholar, ScienceDirect, NCBI, MEDLINE, Frontiers, and AAFP, among others. They gathered information from various peer-reviewed articles. 30 articles from various databases were used as a source of information. The criteria used to approve any source included, the reputation of a database and whether it is a peer-reviewed article. They concluded that Telehealth has a tremendous potential to minimize the loss of human lives when a natural or man-made disaster strikes. The government has a massive role to play as far as the elimination of hindrances to the growth of telemedicine culture is concerned with providing telemedicine equipment subsidies, facilitating indigenous ICT research and provision of bandwidth.
Ajami and Lamoochi, (2014) used a non-systematical design to review various articles on telemedicine in disaster and remote areas. The entire process was divided into three stages, which include the collection of literature, assessment, and selection of suitable materials. Various databases available online were used. Information was obtained from various sources available in different databases. After an extensive search, the authors settled on 26 articles, most of which were obtained from NCBI. Like most of the above studies, the criterion for selection was the reputation of a database and whether the source is a peer-reviewed. The key findings include new health communication technologies’ tremendous potential to massively improve the medical responses to mass-casualty incident disasters. Telehealth will immensely minimize the problems related to logistics and safety that usually accompany disasters and remote areas according to the authors.   O’Connell (2015) utilized a research design that involved a review of articles from ProQuest and Medical databases. Most of the articles were obtained using the keyword telehealth. The data collection involved the gathering of information collected from various articles from ProQuest and Medical Complete databases. 34 articles were examined, but only 7 were used after the entire process of filtration. All articles were selected on a basis being peer-reviewed, having full text, written in English language and containing human research and a date range of 2011 and 2014. The main findings include advantages of telehealth outweighed the disadvantages. Some of the advantages include telehealth having increased agility, movability, and flexibility; whereas challenges include appointment taking a long time to enter into a telesystem than handwritten.      
Section 3: Telehealth Solution Description
Using technology to improve the quality of healthcare is becoming inevitable. The general consensus is that using telehealth can help in improving the quality of healthcare. Telehealth refers to “using computing and telecommunication technology to provide health services from a distance”. Telehealth can greatly impact the way healthcare services are delivered. In several countries, the gap in the provision of medical services between the rural and the urban population is relatively large. However, the gap can be bridged using telehealth. 
The Proposed Solution Several researchers have conducted studies to establish the important of telehealth in improving the quality of healthcare. According to Vinson et al. (2011), even though telehealth systems increase working hours, it takes a shorter time to complete “transcription orders”. The researchers also found out that there was a significant reduction in the pharmacy related costs that were incurred and patients also got better services. Tuckson, Edmunds & Hodgkin (2017) that using telehealth presents exciting opportunities for disease prevention, health promotion, and enhancing “value-based clinical care”. The authors appreciate that there are also challenges of clinicians adapting to the new intervention but add that with adequate training, they can be comfortable in using them. Dinya & Tóth (2013) argue that telemedicine can be very helpful to those living in remote and isolated areas. The authors argue that it is possible for patients to get treatment from clinicians without having to travel to hospitals. Allen et al. (2015) established that telehealth can help in increasing care to the vulnerable communities. The authors further add that nurses believe that telehealth systems can enhance their ability to partner with their clients in distant locations. In another study by Stroetmann et al. (2010), the researchers established that telehealth systems can help in addressing the “growing call for better integrated care” especially for individuals with chronic conditions. Lazzarini et al. (2010) established that clinicians find using “telehealth store-and-forward” system useful in improving specialty services, patient outcomes, and clinical skills. 
Whereas the intervention is realistic in the current setting, it may be too costly. Besides, one of the impediments towards its successful implementation is lack of skills among the current clinicians on how best to use the innovation. Therefore, a lot of training will be needed which will add to the cost of implementation. The proposed solution advances the field of technology in healthcare. This is one area in which the community has embraced as people look forward to having effective ways of getting medical care. There are adequate resources that can be used to implement the solution. There are exper...