As the COVID-19 pandemic triggered a massive uptick in telehealth use around the country, hard-hit nursing homes also turned to the tool to try and keep patients safe.

A University of Missouri study published this past week found that the turn to virtual care reduced stress for residents and helped increase access to services. At the same time, however, relying on telemedicine had drawbacks, especially from a social perspective.  

"For those with cognitive impairments, they might not understand on a telehealth call why or how their doctor is talking to them through a computer screen," explained Kimberly Powell, an assistant professor in the MU Sinclair School of Nursing and lead author of the study, in a statement. 

"While telehealth can be very convenient and beneficial, it should not be viewed as a one-size-fits-all solution, and this study helped us see various nuances involved," she added.  

WHY IT MATTERS

For the study, published recently in the Journal of Applied Clinical Informatics, Powell and fellow researcher Gregory Alexander interviewed 21 administrators and clinicians from 16 facilities across the country.  

The aim, they said, was to examine the consequences of the rapid telehealth rollout in nursing homes. Their interview subjects cited several positive effects of using telemedicine, including:

• The benefits of avoiding travel for the nursing home resident.
• Saved organizational resources.
• Improved access to care.
• Enhanced communication.  

"Transporting a resident to the hospital can be a very traumatic and stressful experience," said Powell.   

"Whether it’s a fall in the middle of the night or a sudden change in vitals, if a nurse can quickly hop on a Zoom call with a resident and make an assessment, perhaps an intervention plan can be developed that allows the resident to be treated in the nursing home, which saves time, money and an unnecessary transfer to the hospital," she continued.

At the same time, facility representatives pointed to drawbacks of using the technology:  

• Preference for in-person encounters.
• Worsening social isolation.
• Difficulty for residents with cognitive impairment.
• Workflow and tech-usability challenges.
• Increased burden on staff or infrastructure.

"For some nursing home residents, going to a doctor’s office for a consultation or follow-up appointment can be a fun social event, as it may be their only chance each month to get fresh air and go out in the community. So, taking that opportunity away can be difficult for some," Powell explained.  

Interviewees from facilities in rural areas were also more likely to perceive lack of training, poor video and sound quality, and connectivity issues as pitfalls.  

"Going forward, there is also the need for better data integration, so that when clinicians are on a Zoom call with nursing home residents, they can quickly and easily access medical records such as blood tests or lab results," said Powell.

THE LARGER TREND  

In March 2020, federal legislators pointed to the particular benefit telehealth might have for nursing homes in the early days of the pandemic.  

But even before the crisis, several skilled nursing facilities used virtual care technology to keep patients in place, reduce hospitalizations and improve care.  

"Now is the time; actually, now is past the time," Michael Feist, vice president of operations at the Friedwald Center, told Healthcare IT News in April 2019 about implementing telehealth at the facility.

"This is something we really needed to be doing a long time ago – but it’s nice that it’s here now. The great thing about this equipment and technology is that it’s very user-friendly."  

ON THE RECORD  

"As a nurse, I have always been fascinated with how information technology can be used to improve patient health outcomes," said the University of Missouri's Powell.   

"Telehealth opens up so many opportunities for early interventions and allows clinicians to also take into account personal preferences and shared decision-making," she added.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.