HI510 Unit 8 Telehealth Application Review Example

Once the Call Ends, Where Does the Encounter Live? A Unit 8 Telehealth Application Review of an Overnight Facility Consult, a Clinic Video Visit and a Week of Home Readings

[Student Name]

Purdue University Global

HI510: Health Information Applications and Systems

Unit 8 Telehealth Application Review

[Instructor Name]

[Date]

Ostervale Health, its vendors, its patients and every time are composite; the regulation and studies cited are real.

Documentation Criteria

Telehealth has grown quickly across settings, and its value depends on whether what happens on the call becomes part of the record the next clinician reads (Dorsey & Topol, 2016). Six criteria were set before the traces were examined.

1. Where the note lands: in the setting's own record, in a vendor platform or nowhere.

2. Time to the record: minutes from the end of the encounter to the note being visible.

3. Form: discrete data that can be searched and trended, or a document.

4. Modality and patient location: whether the record says the visit was by video or phone and where the patient was, which payment rules require for many telehealth services (42 C.F.R. § 410.78).

5. Orders: how orders made during the encounter reach the people who carry them out.

6. Next reader: who will see the result of the encounter, and when.

The traces are presented from the largest gap to the smallest.

Trace 1: An Overnight Video Consult for a Nursing Facility Resident

At 01:50, a night nurse at Ostervale's skilled nursing facility finds a resident breathing fast, with oxygen saturation down to 88 percent. The facility contracts with a tele-physician service for overnight coverage, and the nurse starts a video consult on the facility's cart at 02:05. The tele-physician examines the resident by video, reviews vital signs the nurse reads aloud and gives verbal orders: a diuretic dose, oxygen at 2 liters and a chest image in the morning. The call ends at 02:30.

1. Where the note lands: the vendor's platform.

2. Time to the record: the note reaches the facility as a PDF by secure fax at 07:40, about five hours later, and is scanned into the facility record at 09:15.

3. Form: document.

4. Modality and location: recorded in the vendor's note, not in the facility record.

5. Orders: keyed into the facility record by the night nurse as verbal orders at 02:40, then waiting for the attending's signature.

6. Next reader: the day nurse and the facility's nurse practitioner, who see the verbal orders at 07:00 but not the tele-physician's reasoning until after 09:15.

For almost seven hours, the facility record held three orders and no explanation of why they were given. Telemedicine coverage of this kind can reduce hospital transfers from nursing homes (Grabowski & O'Malley, 2014), so the service is worth keeping. The gap is documentation, not care.

Trace 2: A Clinic Video Visit

A patient with diabetes has a scheduled video follow-up with her clinic physician at 10:00. The visit is launched from the ambulatory record, which opens the video window inside the patient's chart.

1. Where the note lands: the clinic record.

2. Time to the record: the note is signed at 10:35, five minutes after the visit ends.

3. Form: a structured note with discrete fields for vital signs the patient reports and for the medications reviewed.

4. Modality and location: required fields, completed: video, patient at home, consent documented.

5. Orders: entered directly by the physician during the visit.

6. Next reader: anyone in the system with access to the clinic record.

This trace meets every criterion. It is the model the other two should move toward.

Trace 3: A Week of Home Blood Pressure and Weight Readings

A patient with heart failure receives home health and has a remote monitoring kit: a blood pressure cuff and a scale that send readings to the monitoring vendor's dashboard. A home health nurse reviews the dashboard each weekday.

1. Where the note lands: readings stay in the vendor dashboard. The nurse documents a summary in the home health record when a reading crosses a threshold.

2. Time to the record: readings are visible in the dashboard within minutes, but the home health record receives only the nurse's summary, often a day later.

3. Form: dashboard data are discrete but outside the record; the summary is free text.

4. Modality and location: not applicable in the usual sense; the record does not identify which readings came from the device.

5. Orders: the nurse calls the cardiology clinic, which enters any medication change in the clinic record.

6. Next reader: the cardiology clinic sees only what the nurse tells it by phone, and the readings themselves never reach the clinic record.

Comparison and Priorities

The overnight facility consult has the largest gap, because it happens when the fewest people are present and its reasoning arrives last. The monitoring readings come second: the data exist and are discrete, but they sit in a dashboard that only one nurse checks. The clinic video visit is fully integrated.

What the Gaps Cost

The facility consult gap has a direct clinical cost. At 07:00 the day nurse found a resident on oxygen with a new diuretic order and no note, and called the attending, who had not been told about the night's events and asked for the tele-physician's findings. The attending reasonably declined to sign the verbal orders until the note arrived, so the morning chest image was delayed until after 10:00. The monitoring gap has a slower cost. When the cardiology clinic adjusted the patient's diuretic by phone, it did so on the home health nurse's summary of a week of readings rather than the readings themselves, and the next cardiology visit, three weeks later, showed no trace of the home weights in the clinic record. Both gaps also leave the system unable to answer basic questions, such as how many facility residents had an overnight consult last month or how many were transferred to the hospital afterward, because the encounters exist only in vendor platforms.

Recommendations

1. Require the tele-physician vendor to send a structured consult note to the facility record within 30 minutes of the call, through an interface or at minimum by secure electronic delivery to a task list, not by fax.

2. Record modality, patient location and the tele-physician's name in the facility record for every consult.

3. Send remote monitoring readings into the home health record and the cardiology clinic's record as discrete vital signs, flagged as device readings.

4. Measure monthly the time from the end of each facility consult to its note appearing in the facility record, with a target of under one hour.

Limits

The review follows one encounter of each kind on ordinary days. Weekend coverage, holiday staffing and other vendors may differ.

References

42 C.F.R. § 410.78 (2024). https://www.ecfr.gov/current/title-42/section-410.78

Dorsey, E. R., & Topol, E. J. (2016). State of telehealth. The New England Journal of Medicine, 375(2), 154-161. https://doi.org/10.1056/NEJMra1601705

Grabowski, D. C., & O'Malley, A. J. (2014). Use of telemedicine can reduce hospitalizations of nursing home residents and generate savings for Medicare. Health Affairs, 33(2), 244-250. https://doi.org/10.1377/hlthaff.2013.0922