TELEMEDICINE FOR HEALTHCARE IN MARYLAND With the current state of healthcare and the need to care for a growing number patients, many healthcare providers are beginning to look at creative options for providing services to their patients. Advances in communication are leading to many solutions that were not available in the past. One of these option is the provision of certain services via telephone and video service providers. The State of Maryland has a law that requires Medicaid and private payers to pay for telemedicine to certain patients under certain conditions, as long as the services are delivered through approved providers (Chiron Health, 2016). This Policy Priority Issue asks that the telemedicine services be expanded to provide certain nursing services by Nurse Practitioners. as well.
Key Points
Patients that require regular monitoring, such as for diabetes, often skip follow up appointments.
Monitoring results, such as glucose monitoring results, can easily be transmitted to the nurse practitioner.
Routine functions such as prescription refills could be done remotely, saving valuable office time for more serious patient issues, and making the process convenient and more likely to be done on time.
Providing certain services remotely helps to prevent the spread of communicable diseases by avoiding overcrowded waiting rooms.
Empirical Evidence
Research supports the use of telemedicine as an effective way to manage ongoing insulin monitoring in diabetic patients. It was found that the social influence of telemedicine had an impact on patient’s willingness to use it and to stick to their prescribed management regimens (Rho, Kim, Chung, and Choi, 2014). A 7-year study found the telemedicine consultations for diabetes care are more cost effective than office visits and are just as effective in achieving management goals (Levin, Madsen, Madsen, and Petersen, et al, 2013). From a patient standpoint, telemedicine saved on traveling costs and missed time from work (Levin, Madsen, Madsen, and Petersen, et al, 2013). These studies indicate that telemedicine is as effective as having the patient travel to the physician’s office for follow-up care. Telemedicine for following up in diabetes patients was proven to be as effective as physical care received in the physician’s office.
Nurse practitioners often perform many of the routines tasks of patient care, reducing the load on physicians. They work under the supervision of the physician, but are capable of many activities that the physician typically performs. One of the main duties of the nurse practitioner is to provide patient education and ongoing support for chronic conditions. A study of patients with atherosclerosis found that a website where a live nurse practitioner could regularly mail the patients was effective as the regular course of care (Greving, Kaasjager, Vernooij, & Hovens, et al., 2015). The website combined with pharmacotherapy, self-management support, and monitoring of the disease resulted in extended quality-adjusted life years and lower costs for patients (Greving, Kaasjager, Vernooij, & Hovens, et al., 2015). The website provides the nurse practitioner an efficient way to monitor and interact with numerous patients at once.
The use of telemedicine in the management of diabetes was found to be an effective way to control the costs associated with management of the disease (Bashbur, Shannon, Smith, & Woodward, 2015). There is strong and consistent evidence that supports the ability of a telemedicine program to improve glycemic control and gestational diabetes, as well as to help patients avoid complications of the disease (Bashbur, Shannon, Smith, & Woodward, 2015). The body of empirical evidence supports the use of telemedicine to enhance control in patients. The evidence also supported the use of nurse practitioners to provide ongoing support via a website and personal correspondence to patients with chronic diseases other than diabetes. There evidence-based support for the use of nurse practitioners using telemedicine as a way to provide routine follow-up are and monitoring for patients with diabetes.
Importance of The Policy Issue to Nursing
The issue of how to manage a growing patient load that needs routine care for conditions such as diabetes, hyper-tension, chronic pain, and other conditions that require long term follow-up care is important. Nurse practitioners provide many of the routine activities of a physician, relieving the physician load so that they can take care of more critical issues, rather than spending their time on routine management. Allowing nurse practitioners to deliver services via telemedicine would help them to manage a larger case load, while still providing excellent quality care to patients.
The healthcare industry is one of the fastest growing sectors of the economy. Currently, there is a shortage of healthcare workers, making the ability to work more efficiently a priority. As the population of the United States ages, baby boomers will place an additional burden on the system as they age. Baby boomers are not entering their retirement years, with many already advanced in age. As they age, they will face chronic diseases with growing frequency. This will place an even greater strain on the already overstressed medical system. Expanding the telemedicine program is one way to help alleviate the stresses being placed on the system, yet still allow nurses and physicians to maintain an excellent standard of care.
Empirical evidence supports the use of telemedicine to provide the same quality of care that patients would receive if they drove to the office visit. It helps make use of staff more efficiently and saves on costs. Telemedicine increases the likelihood that the patient will follow care regimes and protocols, get their prescriptions filled on time, and will develop a greater understanding of their condition through interaction with the nurse practitioner. Telemedicine eliminates many of the problems associated with chronic disease management.
The current telemedicine laws in Maryland are a step in the right direction, but there is much more that could be accomplished using the framework of the program that is already established. For instance, nurse practitioners could deliver effective educational programs to more patients at once. They could operate support groups for patients with certain disease groups and the could extend their presence and influence towards good health habits on a more personal basis.
Expanding the telemedicine laws would be an immediate benefit to all stakeholders in the medical system. It would be good for patients, good for physicians, good for nurses, and good for insurance companies due to reduced costs. The use of telemedicine is growing empirical support and is considered as effective as one on one medical services delivered in person. Improving patient care is a priority for Maryland and for the United States as a whole. The program in Maryland might inspire other states to adopt similar programs. In this way, the program in Maryland could have a larger scope and reach than just the citizens of the state. For these reasons, and to provide better access to care for certain age groups, the telemedicine program in Maryland should be extended to nurse practitioners and the services that they routinely provide for patients.

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