Nominations Open: Virtual Hospital Committee
By Bob Tillerson, October 29, 2020
With the ASRN now accepting nominations for appointments to its national committees, I want to encourage members to consider joining the ASRN Virtual Hospital Committee.
First formed in the 2019 to work closely with the three associations and participate in the development of a Virtual Hospital, the Committee has guided the ASRN’s leading role in consolidating the three national associations visions into one.
With the COVID-19 Pandemic, a virtual hospital offers safe, affordable medical care for 20 million people that no longer can get their health care through work, as well as vulnerable populations.
ASRN’s leadership in the development of a virtual hospital directly affects the success and prosperity of the public, the profession, and our communities.
Today’s members, embrace the call to be advocates and provide a credible and reliable voice to the public health crisis. If you have ever wondered how a major hospital begins, this is your opportunity to shape it.
There are three positions open on the Committee for one-year terms beginning in 2021 (with possible renewal for two subsequent one-year terms). I especially encourage interested ASRN members and Honor Society Fellows to apply.
Nominations are due Friday, December 11, 2020 at 5:00pm EDT. Submit your nomination(s) to email@example.com.
Upload your current resume, a letter of interest, and other (optional) supporting documents to submit the nomination. Please note that you will have to submit separate nominations for each national committee you wish to serve on.
If you or the colleague you nominated aren’t appointed to the Committee, we still encourage you get join and get involved in the Virtual Hospital.
Email the ASRN VH Committee at firstname.lastname@example.org for more information.
Bob Tillerson is chair of the ASRN Virtual Hospital committee.
Virtual Hospital FAQs
Virtual medicine is a small component of telehealth, which is a broader term that encompasses the entirety of electronic technology and/or remote driven healthcare.
Telemedicine is the practice of healthcare whereby one healthcare worker will reach out to a single patient in his/her home or the clinic and discuss healthcare matters. Telemedicine is not new; it has been around for the better part of a few decades. Nurses have been practicing telemedicine by advising patients on health matters over the phone and computers all over the nation. At the same time, the practice of telemedicine was a privilege granted to a few healthcare workers. But with the COVID outbreak, the concept has been expanded to include Virtual Healthcare. With a Virtual Hospital, there is a whole team of healthcare workers in different specialties who manage the patient in one setting. The healthcare workers usually work out from a central call center (or clinic) that is fully equipped with all types of electronic technology to help access the patient across geographical borders. Unlike telemedicine which is a one-stop deal, a virtual hospital encounter is similar to what takes place in a live hospital arena. The patient is continuously followed by a team of healthcare workers - the only thing missing is the physical presence of the patient.
When employed as a virtual nurse, responsibility may include the following:
- Provide telehealth services to patients
- Monitor patient vital signs using electronic technology
- Know how to interact electronically with other healthcare professionals when troubleshooting
- Give patients advice on healthcare matters and when they should seek medical care
- Process insurance claims
- Triage online patients for physicians
- Operate a call center
All virtual nurses must be competent with computer use, have high-speed internet, a microphone, and high-quality video that allows for video conferencing.
Virtual healthcare is here to stay and this branch of medicine now offers nurses added specialization in digital analytics. Virtual nurses need to have broader knowledge about many medical subjects because he or she will be a frontline worker and a source of referral for clinicians. Today, most virtual nurses come with solid training in intensive care as the patient clientele today is quite ill by the time they seek virtual care.
Nursing has always been a physically demanding job but with virtual care, this may help ease the physical demands of the job. With virtual nursing, one will no longer have to lift heavy patients in and out of the bed and this alone will reduce the low back disability that plagues many nurses. It is anticipated that virtual nursing will help reduce nursing turnover and increase the duration of nursing careers.
Today the potential of virtual hospitals is endless. The availability of high definition video and two way communication allows the system to be used in the following situations:
- Monitor patients at home
- Monitor infants in hospital and at home
- Manage emergency units
- Observe post-operative patients at any location. This is of growing importance as many patients are now discharged home the same day after surgery. The virtual hospital can now monitor the patients in their home
- Monitor elderly in nursing homes for falls
- Monitor the safety of patients in mental healthcare institutions
- Monitor critically ill patients in rural areas who are not able to visit tertiary care centers
- Follow patients with chronic disorders
- Virtual hospitals allow for an extra pair of eyes with vast monitoring capabilities. Social workers can assess a patient’s home condition without even going to the residence. The system allows for better connectivity with patients with hopefully long term benefits.
- The virtual hospital has removed many physical barriers. The system is of the greatest benefit to patients living in parts where access to healthcare is not available. By using currently available technology and expertise of better-trained healthcare workers, virtual hospitals offer improved healthcare across geographical boundaries.
- A virtual hospital helps connect patients in secluded areas of the nation where there are no healthcare specialists. In addition, a large number of patients today have limited mobility and others may not have sufficient funds to make the long journey to tertiary care centers. Thus, virtual hospitals may turn out to be a cost-effective option for these populations
- For patients with chronic disorders like diabetes, COPD, cancer, congestive heart failure, arthritis, or coronary artery disease, it can be a real struggle to physically come to the hospital to be seen by a clinician. Now virtual hospitals can make a difference. Because of the possibility of remote monitoring, patients with chronic disorders can minimize the number of real-time visits and instead have their checkup done by a virtual team. This reduces time, costs, and the aggravation of travel. The savings can be real for patients who do not have to make long journeys.
- A virtual hospital means patients do not have to sit for hours in the waiting room to be seen by a healthcare worker; there are no delays seeing a specialist because the virtual team already has specialists on board. There is no need to continuously rebook or cancel appointments for whatever reason.
- Finally and very important, virtual healthcare helps decrease the spread of infections that are so common in real-life hospitals. Not only does it eliminate the spread of injection from the patient to the clinician but also to other patients.
For the most part, Telemedicine is not routine practice and only a few select institutions and healthcare providers have been granted permission to conduct healthcare in this manner. To date telemedicine has been approved by a few states and allows clinicians to attend to the medical needs of patients living in rural areas. For the most part, almost every state has laws that discourage the practice of Telehealth and the same applies to Virtual Healthcare delivery.
The Health Resources and Services Administration (HRSA) of the Dept of Health and Human Services defines telehealth as the use of electronic information and telecommunication technologies to support and promote long-distance healthcare, patient and professional health-related education, and public health administration. Technologies include the internet, video conferencing, webinars, live streaming, use of the landline, and wireless communications. In addition, both Medicare and Medicaid also have certain restrictions on the types of technologies that can be used as part of telehealth. The use of telehealth services is rigidly controlled and enforced by the Office of Civil Rights. And the penalties for those who disregard HIPAA are severe.
However, with the recent COVID 19 pandemic, the rules of telehealth have been relaxed and the covered healthcare providers will not be subject to penalties for violations of HIPAA as long as the rules are obeyed in good faith. Healthcare providers and healthcare institutions have the onus of ensuring adequate security and safety of all medical information during telehealth delivery-there is no exception to this rule; it is mandatory. Further, before undertaking delivery of telehealth, all healthcare workers who partake in this activity must be fully aware of HIPAA rules and be up to date with the latest information on the topic.
At present, telehealth is permitted because of the COVID-19 crisis but when this Notification of Enforcement Discretion will expire is not known. The Office of Civil Rights will issue a notice to the public when it is no longer exercising its enforcement discretion based on the latest facts regarding COVID 19.
In the meantime, healthcare workers are expected to conduct telehealth in private settings like a clinic or an office with a patient who is at home or in another clinic. It is absolutely forbidden to receive or transmit telehealth services in a public or semipublic setting unless there are exigent circumstances. If telehealth cannot be provided in a private setting, the provider should implement reasonable HIPAA safeguards to limit disclosure of protected health information (PHI).
What may constitute bad faith in the provision of telehealth by a covered health care provider, which would not be covered by the Notification of Enforcement Discretion regarding COVID-19 and remote telehealth communications?
Some examples of what OCR may consider a bad faith provision of telehealth services that is not covered by this Notice include: Conduct or furtherance of a criminal act, such as fraud, identity theft, and intentional invasion of privacy; Further uses or disclosures of patient data transmitted during a telehealth communication that are prohibited by the HIPAA Privacy Rule (e.g., sale of the data, or use of the data for marketing without authorization); Violations of state licensing laws or professional ethical standards that result in disciplinary actions related to the treatment offered or provided via telehealth (i.e., based on documented findings of a health care licensing or professional ethics board); or Use of public-facing remote communication products, such as TikTok, Facebook Live, Twitch, or a public chat room, which OCR has identified in the Notification as unacceptable forms of remote communication for telehealth because they are designed to be open to the public or allow wide or indiscriminate access to the communication.
All healthcare workers should be familiar with the platforms permitted and not permitted for telehealth.
As long as the telehealth communication is done in good faith during the COVID outbreak and even if there is a disclosure of PHI to a third party, OCR will not impose a penalty for HIPAA violation but the agency will consider all facts and circumstances before making a decision. The provider needs to discuss with the patient the limitations of electronic technology and the potential for disclosure despite adequate safeguards. The patient must agree to this before telehealth services can take place.
Before undertaking telehealth or the practice of virtual medicine, it is important to speak to the Administrative Dept as to how to conduct Telehealth. Penalties for violating HIPAA are expensive and can ruin a healthcare institution’s reputation.
In the USA, many hospitals are now adopting virtual hospital technology as this has become a necessity since the COVID pandemic. Patients, in fact, also prefer this type of medicine. But at the same time, there is a demand for more computer-savvy nurses- making diagnosis virtually is not always easy. Plus, nurses need to know the limits of virtual care. But for many nurses who are computer literate, this may be a great specialty as it is less physically demanding and satisfying but on the other hand, requires broader medical and computing knowledge.