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The NSLIJ Homecare Network provides the delivery of nursing care and services using telecommunications. Their system allows the nurse to work from the office and interview the client through an interactive video system. Patients are closely monitored to promote compliance though an interactive video system. Patients are closely monitored to promote compliance with medications, diet and weight monitoring. Adult clients served by the NSLIJ Home Care Network with a diagnosis of cardio-pulmonary disease are potential candiates for Interactive Home Telehealth and in-home visits. The Admission nurse and the Telehealth Manager will develop a plan of care in collaboration with the patient relating to:
        - Client goals
        - Frequency of home visits and develop a time schedule
        - Client nursing intervention
        - Anticipated length of stay of the equipment
        - Caregiver educational plan
        - Initial and ongoing patient assessments relating to the necessary care that will be provided.
     Another form of telenursing that was utilized at NSLIJ Home Care Network was the use of telephone nursing. Chances are that most nurses that provide recommendations to patients via telephones may not have realized that they were actually pioneers in the field known as telenursing. The nursing staff at NSLIJ Home Care Network calls the patients prior to their home visits to confirm their scheduled appointment. The nursing staff goes over the intent of the visit and to determine which people need to be present during the visit. During this call, patients are reassured that nursing is just a phone call away from any questions that they might have.
     During the CHF telenursing visit, the clinician is able to capture objective data obtained from the American Telecare monitors. This data delivers assessment data directly to nurses for clinical evaluation. Such values as glucose levels, pulse oximetry readings,weights, blood pressure readings are taken and recorded for future data capture.

Objective 4: Explain at least 3 observed practices of Telenursing used at the selected site to meet the holisitc needs of the patient, families, communities and health care providers.

CLINICAL JOURNAL

North Shore LIJ Home Care Network utilizes the inforamtion that the home care nurses enter during their point of care delivery. McKesson Software created the North SHore-LIJ Home Care Network Program entitled, " Homecare V9.0 Advanced Clinicals." Human Resource Management is abe to aggregate data and financial, clinical and administrative reports are produced. From this data, priorities relating to which performance improvement initiatives are addressed. People Soft is also used for human resource reporting. FAZZI is another nationally known survey company that the home care network utilizes to obtain results for patient satisfaction results. Analyzer is a database that is also used in home care to collect and report clinical inforamtion that actually gives a national comparison amongst other home care agencies.

Objective 5: Identify the primary uses of administrative software at the selected health care setting: Reporting, Human Resource Management, Fiscal Resources and Physical Resources.

Objective 6: Trace the progression of at least 20 words/ terms/ phrases used to develop nomenclature amongst the multidiscipline healthcare providers at the facility-designed to improve the quality of patient care.

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After working with the homecare nursing staff during their orientation, computer training classes and working with the Telenursing Specialists, I have witnessed how homecare agencies are successfully using new technologies to improve patient care. With the use of technology they are able to capture patient outcomes more efficiently. By using point of care devices during the patient�s home visit have definitely increased clinician productivity and the efficiency of their operational systems. As technology continues to influence homecare, whether through the transition to point of care documentation systems or use of other technology, clinicians who want to continue visiting patients in their homes must become technologically competent. There seemed to be some resistance with a small population of the nurses when having to learn the use of the laptop computer. Being accustomed to paper data entry and having to learn the use of computer data entry created some frustrations.
The CHF Program has been in use for three years. At that time the product they choose to monitor their patients was made by American Telecare. This monitoring equipment allows nurses to monitor and manage patients via telehealth modalities. It has already proven to be cost-effective and provides better patient outcomes in comparison to home care visits or has successfully reduced hospital admissions. The future of telemanagement of CHF looks promising. In addition, the expansion of the applications of telemedicine will have significant implications for the management of CHF only if we continue to refine and advance in the direction of improving technology modalities.

The North Shore LIJ Home Care Network utilizes the International Classification of Diseases Classification System. The ICD-9 is a classification system that is able to capture the medical reasons for health care. Whether one is entering data on paper or via laptop computer, the ICD-9 system is used by practitioners within the Network to codify a client�s medical diagnoses. The government and third-party payers are able to use this coding methodology to determine whether a client�s diagnoses are eligible for reimbursement and to analyze patterns of diseases in various populations (Englebardt, 2002).