Telehealth services in COVID

Table of Contents

Introduction 3

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Statement of Purpose ……………………………………………………………………………. 4

Background and Literature Review.. 4

Theoretical Framework. 8

Intervention and Implementation. 9

Evaluation. 10

Risks and Benefits. 10

Health Policy Implications. 11

Conclusion. 12

References. 13

Appendix………………………………………………………………………………………… 16








​            More than 10 million people in the United States (U.S.) has contracted the Coronavirus Disease (COVID-19), and more than 245,000 have died of COVID-19 (CDC, 2020). The pandemic continues to impact densely in the populated areas since more people are not following the Center of Control Disease protocols regarding preventing the COVID-19 pandemic. Also, reports indicate that the mortality rates are higher in the Latino and Hispanic individuals between the age of 25-44 years old (Rossen et al., 2020). The following synthesis paper discusses the increased morbidity and mortality (M&M) rates related to COVID-19 and the associated restrictions, fears, and limited access to healthcare (Blake, 2020).  The synthesis paper aims to look at the different interventions through telehealth appointment options to increase access to care and continuity of care during Covid-19 pandemic (Muldoon, 2018). Telehealth will also encourage social distancing measures, which will reduce the waiting time and exposure to COVID-19 due to limited availability and access to healthcare (Blake, 2020).

Many providers at the Fairfield Primary Care practice fail to offer appointments options other than in-person appointments. Telehealth has also been successful due to improving healthcare access while reducing healthcare costs (Wootton, 2019). For example, in 2016, 61% of the U.S. healthcare organizations and 40%-50 % of the U.S. hospitals adopted the telehealth systems, increasing by 60 % from 2012 to 2013 (Mahar et al., 2019). Using telehealth will be a significant impact since it allows patients in rural and urban settings to access healthcare without having to walk into the hospital since, due to the COVID-19 pandemic, patients are limited to in-person visits. An estimated 59 million Americans live in healthcare shortage areas, making it challenging to reach their healthcare providers during COVID-19 (Mahar et al., 2019). There will be a reduction of long delays during a scheduled healthcare visit with virtual or telemedicine appointments, meaning continuity of care will not suffer.

Statement of Purpose

This project discusses the increased M&M rates during COVID-19 and the associated restrictions, fears, and limited access to healthcare. The Long-term goal is to reduce M&M rates (Muldoon, 2018). Many providers at the Fairfield Primary Care practice fail to offer appointments options other than in-person appointments. The short-term goal is to initiate virtual or telemedicine appointment options in the COVID-19 pandemic. Also, it proposes a practice policy change intervention to increase access to telehealthcare.

Backgroundand Literature Review

The increased volume of COVID-19 cases in the U.S. continues to impact the entire healthcare system and the shortages in medical supplies and equipment. The increased rate of Covid-19 demonstrates a chilling consequence of disregarding public health safety protocols in preventing the COVID-19 pandemic and the disconnect between public health safety and the healthcare system (Adeline, 2020). The lack of preparation and poor attitude towards protective measures like social distancing and the need to wear masks in public has led to increased COVID-19 infections and mortality. Currently, the U.S. stands as a country with the highest cases of COVID-19 infections and deaths (Sze-Yunn, 2020). Among the challenges that the government continues to face in combating the virus include nursing burnout, shortage of hospital admission wards, and the need to maintain social distancing, and discouraging people from visiting primary care and hospitals.

In this manner, the healthcare system provision has continued to be hampered due to the current COVID-19 pandemic (Valle et al., 2017) The healthcare must use telehealth programs to ensure proper disease management, treatments, follow-up, and communication or execution action using nurses and providers (Quinn, 2019). Telehealth requires usage computer or mobile device to access online healthcare services. Such include technologies readily available at home or ones that the doctor will use to support or improve personal health. The goal of telehealth is to make healthcare accessible to people during COVID-19 and the associated restriction, fears and limited access to health. Also, the goal is to increase access to health care, continuity of care, and make medical services accessibleand convenient for the patients and among healthcare team.

Such telehealth intervention is beneficial and shows that telehealth can incorporate various organizational and situational aspects of healthcare to a particular virtual network through a central clinic.  The telehealth systems are vital because it contains the patient’s medical information and physical locations in different regions, such as central clinics, remote clinics, and private clinics (Monaghesh&Hajizadeh, 2020). With the telehealth systems, providers can now meet patients’ healthcare needs and routine checkups adequately, which allows the hospitals to free up beds, medical equipment, and medical staff needed for patients who are affected by COVID-19 and other chronic diseases.

In this policy change, telehealth will improve patient outcomes and reduce the level of health costs. Through the telehealth service, it will help slow the spread of COVID-19 by restricting patients to high-risk areas of COVID-19 exposure. As the country continues to face insufficient hospital beds, personnel, and medical equipment, the healthcare system moving requires improvisation and innovation in response to the COVID-19 pandemic, thus eliminating telehealth. Also, the management of chronic conditions such as hypertension, diabetes mellitus, or CVD requires telehealth regarding its relative under-utilization compared to other services like specialty telehealth (Arkwright et al., 2019).

Chronic patients require routine visits to the doctor, meaning it is essential to target these patients through telehealth, reducing emergency visits (Mahar et al., 2019). With telehealth, there will be a transition of healthcare from the fee-for-service model to a new model. The new model will determine Medicare reimbursement based on patient outcomes and quality of care (Gajarawala&Pelkowski, 2020). One factor in transiting into a new model is to improve patient outcomes and quality of care. Telehealth outpatient program, telehealth program, was first invented in the twenty-first century to provide patient-centered care, increase access to care, and provide continuity of care (Monaghesh&Hajizadeh, 2020). Telehealth refers to the delivery of healthcare services by the healthcare professional. Factors such as distance are critical, which will require the use of information and communication technologies to convey accurate information (Gajarawala&Pelkowski, 2020). However, telehealth services are supposed to perform in real-time or store and forward methods (Monaghesh&Hajizadeh, 2020). With the accelerated development and downsizing of portable electronics, families will have at least one digital device, which will provide a resource to communicate with their providers (Monaghesh&Hajizadeh, 2020).

When looking at video conferencing, it allows providers to assess and treat their patients remotely who are hospitalized or in quarantine to decrease the risk of exposure to employees and patients (Gajarawala&Pelkowski, 2020). Having the ability to cover various sites with a Tele-nurse can also be better (Gajarawala&Pelkowski, 2020). The mechanism for addressing the workforce challenges experienced during the COVID-19 pandemic. Telehealth programs will come with numerous advantages, particularly when looking at non-emergency and routine care, which does not require in-person patient-provider interaction (Monaghesh&Hajizadeh, 2020). Such interventions include providing psychological and social assistance, patient education, and a reminder of adherence. Also, telehealth is crucial because it allows for healthcare resources and improves healthcare access while reducing COVID-19 disease exposure from one person to another (Monaghesh&Hajizadeh, 2020). Again, telehealth technology will keep the general public, healthcare workers, patients, and caregivers safe (Monaghesh&Hajizadeh, 2020). It is also important to note that the telehealth program is a desirable, productive, and affordable option to continued care for most patients. It will be interesting to see the patient’s response to telehealth, though there are still hindrances to its implementation (Fang et al., 2019).

Many providers at Fairfield Primary Care fail to initiate telehealth appointment options for patients. The telehealth program will require the practice sites to propose a practice policy change intervention to increase healthcare access for their patients. Telehealth is essential as it provides the implication regarding the potentials of consolidation related to the virtual care or telemedicine solutions shortly regarding integrating digital telehealth technology to healthcare delivery. As COVID-19 continues to increase globally, health institutions need to use telehealth technologies to highlight challenging healthcare needs.

The barriers to implementing telehealth programs are payment systems, accreditation, and insurance coverage (Monaghesh&Hajizadeh, 2020). Some providers are also concerned with clinical, technical quality, privacy, safety, and accountability linked to telehealth (Monaghesh&Hajizadeh, 2020). With the advent of COVID-19, telehealth continues to become a basic need for healthcare providers to provide continuity of care during the COVID-19 pandemic (Fang et al., 2019). Telehealth will mostly work so well for patients in quarantine, including self-quarantine.  It allows patients in real-time to get advice and observation from the nurse and the physician regarding their health problems or progress.  It thus becomes essential to look at the role that telehealth services will play in the prevention, diagnosis, treatment, and control of various health conditions during the COVID-19 pandemic.

Theoretical Framework

Kurt Lewin’s theoretical framework applies to the policy change intervention through the three steps model change: unfreezing, changing, and refreezing (Lewin, 1947a). Lewin’s framework is essential for transforming healthcare, especially when implementing new projects or strategies (Lewin, 1947a).In this case, the change process will include creating a perception that a revolution is required in the unfreezing stage, shifting toward the new practice, and achieving a management model where patient continuity of care is guaranteed (Lewin, 1947a). Finally, in the changing stage, solidifying that new behavior is the norm in the refreezing setting (Lewin, 1947a).

Unfreezing:  At this stage, the organization plans for the upcoming change and stresses the importance of adapting to the change (Lewin, 1947a). It will be important that during this stage, the organization also discusses the importance of increasing access to health care via telehealth appointment options.

Changing:During this stage, the organization accepts the newchange, believes in the shift, and embraces the transformation (Lewin, 1947a). The implementation period will be three months of virtual or telemedicine appointment intervention. There will also be sessions for sharing these results at monthly staff meetings showing increasing telehealth appointments utilized by the patients.

Refreezing:  During this stage, the organization begins to institutionalize the change (Lewin, 1947a). The medical team will set up daily schedules to book telehealth appointments with the providers.

Intervention and Implementation

The intervention is a practice policy change developed and implemented by the nurse practitioner (NP) that includes implementing telehealth program options for patients such as TeleStroke, TeleTrauma, Teledermatology, and TeleICU (Fang et al., 2019). The purpose of an intervention is to increase access to care via virtual and telemedicine appointment options (Fang et al., 2019).The telehealth system (Appendix A) practice policy change will be proposed to the medical director to initiate telehealth services starting December 1, 2020 by the NP through the chain of command. The most common delivery mechanism (Appendix B) for telehealth is the connection between the user and healthcare facilities through the web. The policy change will allow access to health care, disease management, managing patients’ healthcare needs, and safety when providing online healthcare services. The most commonprovider-to-patient workflow (Appendix C) will be used though telehealth services. Video call or Facetimephone device will be launch temporarily until proper training and funds are available for a permanently telehealth system. The telehealth system will be used by providers, nurses, medical assistants, and receptions. The telehealth system training will be given by IT on using the program while following the HIPPA policy.

Healthcare providers managed COVID-19 patients through a telehealth system, which allowed them to assess, triage, treat, and follow-up on patients accurately. When looking at healthcare workers, this is going to reduce M&M during the COVID-19 pandemic. Healthcare workers will work remotely and coordinate with their patients while facilitating patient’s access to healthcare advice, second opinion for disease, information exchange, and review labs and radiology results (Gajarawala&Pelkowski, 2020).  The telehealth intervention is the most reliable source to decrease exposure to the COVID-19 while allowing continuity of care and access to essential healthcare services.


The evaluation will include the count of virtual or telemedicine visits during the pilot timeframe of 3 months (Monaghesh&Hajizadeh, 2020). The count will identify the number of scheduled visits done by the np or physician and the number of logins made by the client and providers.

Risk and Benefits

            The telehealth benefit is that it will increase healthcare and continuity of care for patients during the COVID-19 pandemic.  Also, providers will treat patients on time who cannot get to primary care. When looking at telehealth practices in the U.S., telehealth appointment options allow providers to attend to patients’ needs without direct patient-provider interaction with superior decision-making practices among the healthcare team (Gajarawala&Pelkowski, 2020). The telehealth system reduces the M&M rate by restricting the public to environments that are at high risk for COVID-19, like hospitals (Gajarawala&Pelkowski, 2020).  Another significant benefit is looking at elderly patients who cannot access continued care services using telehealth equipment. The lack of telehealth adaptation is due to weak cybersecurity, insufficient training, a program available only in English, and limited physical assessment (Monaghesh&Hajizadeh, 2020). With improved technologies, cybersecurity will improve, and sufficient training will allow the better use of the telehealth system.

Health Policy Implication

Access: Due to restrictions on the number of people visiting the healthcare facilities, the interventions will ensure that patients continue receiving care and monitoring in the comfort of their home.Many providers at Fairfield Primary Care fail to provide telehealth service. The proposed intervention is to increase access to primary care services and continuity of care via telehealth systems. More patients will access and meet their care needs via virtual or telemedicine.The policy change will initiate the telehealth service7 days per week.

Cost:Related to the training of nurses and providers onthe telehealth system, developing clinics application to be used, establishing a patient portal, and the patient follow-up consultations.

When patients lack access to telehealth appointment options, there may be increased M&M, pain and suffering, healthcare complications, and, more importantly, increased health care costs from ER visits, ambulance transportation(what are the data on these costs?), and delays in care.The proposed intervention is to use telehealth servicesto reduce the costs associated with increased ER visits and ambulance transportation.Telehealth servicesare intended to early detectionand prognosis, which will decrease healthcare costs, M&M rates, pain and suffering, and healthcare complications arising from lack of access to telehealth.

Quality:Quality of care and quality of life is low when patients do not have access to the telehealth option duringthe COVID-19 pandemic (Bokolo, 2020). The proposed intervention is to increase the quality of life and care. Quality care will improve since patients and doctors have one-on-one virtual or telemedicine interaction. Healthcare providers will meet their healthcare maintenance, prevention, and screening needs. The telehealth programs will generate an encrypted password for the patient, which will allow them to login into their account to access their health information.


Telehealth technology intervention is crucial. It will provide a practical best-practice example of how the use of telehealth options can help reduce M&M rates during COVID-19 and the associated restrictions, fears, and limited access to care. The long-term goal is to reduce M&M rates, and the short goal is to initiate telehealth appointment options at Fairfield Primary Care. Due to increased cases of COVID-19 in the U.S, the telehealth option is the best approach to increase access to health care and the continuity of care. Lewin’s framework is essential for transforming healthcare and practice policy change to implement the telehealth system (Lewis, 1947a). The NP will propose a telehealth systems (Appendix A &B) policy change to the medical director. The most common telehealth delivery mechanism (Appendix C&D) connectsthe patient to the provider through telehealth systems.The practice policy change will initiate the telehealth system, which is intended to increase access to care and quality of life. The paper suggests that telehealth systems are among the best ways to ensure patients’ continued care, especially those with chronic conditions, while also reducing the spread of the COVID-19 virus.





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