Connected health technologies continue to change, and nurses are leading the charge using these tools for innovation in healthcare delivery and most importantly, maintaining professional standards to keep their patients safe.
“The telehealth landscape has evolved, with massive technological advances, clinical research, and emerging data that inform our practice,” said Joelle Fathi, DNP, RN, ARNP, CTTS, senior lecturer in the department of biobehavioral nursing and health informatics at the University of Washington School of Nursing.
To reflect that evolution, “connected health” is an umbrella term for concepts that include telehealth and mobile health. It can be defined as connecting clinicians to clinicians, patients to clinicians, and even patients to other patients through various technological modalities. This technology facilitates exchange of information, remote diagnosis and treatment, continuous and intermittent monitoring, and ongoing health management. It also supports patient self-care and the leveraging of providers across large populations of patients. (Based on a definition from Partners Healthcare, a not-for-profit healthcare system.)
To address the needs of RNs in a changing work environment, the American Nurses 
Association (ANA) convened a professional issues panel in 2018 to revise its Core Principles on Telehealth (now Core Principles on Connected Health). While retaining the foundational aspirations of the first iteration, the updated principles reflect current practice standards, terminology, and the care team’s role in patient safety, quality, privacy, and care.
The principles moved from telehealth to a connected health lens, broadening the terminology to allow for technology innovations that improve access, care, and the patient-provider relationship. The updated principles also recognize the shift from a narrower nursing perspective to a wider interprofessional team approach.
Additionally, a new principle focuses on the need to update and modernize policies at all levels of government, as well as respond to the current health-care climate. Among those governmental policies are several that address processes and practices of individuals and healthcare systems, scope of practice for those who are providing healthcare services, billing and reimbursement for those services, health information technology, and laws intended to protect the public.
Meeting patients where they are
Nearly 20% of Americans living in rural areas suffer from a shortage of providers and healthcare facilities. This scarcity of services is detrimental to the nation’s health. “The health consequences for communities that lack resources can be dire,” said Fathi, a Washington State Nurses Association member. Expanding healthcare delivery through connected health creates the opportunity to serve these populations, “with care that is necessary, timely, efficient, convenient, and effective,” Fathi said.
In addition to filling gaps in service for isolated populations, connected health has value for patients in urban and major metropolitan areas. “Connected health is a proven healthcare de-livery model that can provide critical services in acute health crises, preventive care, and chronic disease management,” Fathi said.
Furthermore, both the Affordable Care Act and the 2017 American Health Care Act support the use of connected health and technology to expand access and care delivery. “As providers move toward more value-based, shared-savings, and accountable care models as required in healthcare reform, connected health provides better care coordination, management, and communication with patients,” said Tamara Broadnax, DNP, RN, NEA-BC, clinical operations, Department of Veterans Affairs.
A closer look at the principles
Fathi and Broadnax were among the 13 nurses on the panel’s steering committee, which represented diverse academic and professional backgrounds and brought significant experience administering tele-health services across the country. More than 100 nurses participated in an advisory committee.
“The overarching values of each of these core principles are unchanged but the updated version is in-formed by more than two decades of research and practice in this area,” Fathi said. “The newer principles also address key considerations with the advancement of technology and uphold the protection of patients and their privacy.”
Broadnax added, “Connected health is a delivery system of clinical care. The same clinical standards for patient privacy and clinical outcomes required for a face-to-face encounter apply to the connected health visit.” The revised 2019 ANA Core Principles on Connected Health is a guide for healthcare professionals who use connected health technologies to provide quality care. The 13 principles identify unique issues, such as:
• certain interstate commerce, fraud and abuse, and other applicable state and federal laws not commonly encountered when delivering health-care in person
• the need to meet state-specific regulatory and institutional requirements in accordance with scope of practice
• safeguards when transmitting electronic information and communication conducted using connected health technologies to ensure patient privacy
• updated policies governing the practices and reimbursement of healthcare to allow for the integration, national adoption, and sustainability of connected health.
Nurses: The essential conduit
Nurses have been and continue to be critical catalysts in the evolution and application of connected health. They’re often a patient’s first point of contact when seeking care, and their primary communicator throughout their healthcare journey. This relationship, along with nurses’ diverse skills, key role in care coordination, and long tradition of innovation in care de-livery, makes nursing’s leadership an essential part of connected health.
“In the organizations where I have worked, nurses were initially involved in [connected health] phone triage, collecting images, and re-mote home-monitoring tasks,” Broadnax said. “This has evolved to nurses providing 24-hour surveillance in e-ICUs, connecting re-al-time clinical visits, delivering direct-care patient services, and now building and directing new connected health services and programs.”
The increased adoption of connected health has created space for nurses to lead and provide care out-side of the typical hospital setting. “I’ve seen pharmacies offer nurse-employed telehealth clinics, specialty services offer nurse-led direct care clinics, and insurance companies offer direct access to nurse-led connected health visits,” Broadnax said.
Nurses are vital to the effectiveness and innovation of connected health. Noted Broadnax, “Nurses have to be involved with connected health across the spectrum. From the front end, delivering patient care services, to back-end triaging and care coordination, to providing the overall management and development of new clinical programs and services.”
Read the updated ANA Core Principles on Connect-ed Health at nursingworld.org/cpch.
— Elizabeth Moore is a writer at ANA. Brooke Trainum is assistant director, policy and regulatory advocacy, at ANA.
