Telehealth Care: An Innovation in Waiting

I often ask my informatics and innovation students to take a guess as to when telehealth was first conceptualized for use. They are often surprised to hear me say that the concept emerged in the 1960’s (60 years ago). Now while we did not have the capabilities for such operationalization of telehealth care at that time, we did have that capability long before March 2020.

The tipping point to integrate telehealth technology services into care delivery was the Covid-19 pandemic and the need to be able to provide care to patients in a safe way that would not put people at risk for contracting Covid (to the extent possible – not all appointments could be televisits).

Prior to March 6th. 2020, telehealth services were not a service that was reimbursable for most visits. The Centers for Medicare and Medicaid Services (CMS), the largest payer of healthcare services in the United States, granted the ability for providers to be reimbursed for telehealth services (temporarily) across the US. This provision opened the opportunity to leverage the technology available, develop new processes and support people with their healthcare needs.

“Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.” (

I’ve long advocated for the opportunity of telehealth to address visit types that may lead to missed appointments or access to care issues. Just this week I had a telehealth follow up visit. I scheduled it at the end of the day and was able to log off of my meeting to log on to my appointment without any need for travel, parking, rearranging my schedule and more. The visit did not require any labs, tests, auscultation or vitals. Therefore, this was an optimal use of telehealth.

Other use cases I often think about

  • individuals who perhaps do not have an effective and/or efficient transportation means for follow up or consult visits,
  • individuals who do not have the funds for parking, or cannot take an afternoon off for such a visit,
  • individuals seeking mental health services who may be too depressed to leave their home and make an in person appointment.
  • individuals in areas where the specialist is in network but not local to the patient

These are just a few use cases where telehealth has likely eased some pressures of patients seeking to access care where being in person was not a necessity. Access to care is essential for optimal outcomes. As we navigate forward toward a post-pandemic healthcare environment, the initial unmet need faced in March 2020 will have changed but this does not mean that there will not be a need to continue to offer such services.

Providing quality care requires patient-centered approaches. Why not continue to make it accessible to receive care?



5 Reasons Why Nurses Need Apps

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“Why do Nurses Need Apps?“

Last week someone asked me, ‘Why do nurses need apps?’ His question made me realize that the need for nurses to have apps to do their day-to-day work taking care of patients may not be obvious to the general public. I often tell nurses that it is our responsibility to inform others of our role and responsibilities, impact on patient care and overall value we bring to the health care industry. We are the subject matter experts and the champions for our profession. So, in the spirit of the message I often send to other nurses, I’d like to offer 5 reasons why nurses need apps to help support their delivery of high quality patient care.

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The problem is big enough that it deserves a solution.

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“How did you know that your idea was good enough to start a business?”


I was asked this question in reference to my idea to create Know My Patient TM and then a business around it, Nightingale Apps LLC. It was a question I hadn’t been asked before. My response at that time was that I never questioned it, rather I just knew it was good enough.


For those who are not familiar, I created Know My Patient TM, Nightingale Apps’ patent-pending mobile workflow nursing solution, in an effort to address the daily challenges faced by nurses each day to access, enter and use information for the purpose of providing their patients with the best care.

Know My Patient


In a world where we, as consumers, rely on our phones to support our own personal information needs, answer our own questions, and allow for quick entry of information to communicate with others, we must bring that to our nurses. After all, our nurses are saving lives each day. Their focal point is the patient and whatever the patient needs, where he/she needs it.


When I came up with this idea several years ago, I could not accept that nurses would continue to rely on workaround solutions with scraps of paper, be bogged down with moving heavy ‘mobile’ carts (as their mobile solution), stay late (most if not all shifts) to catch up on charting, and feel as though they have turned into ‘glorified data entry specialists’. If we continue to make it challenging for nurses to do their work, we will likely end up driving nurses away from the profession. The statistics show we cannot afford to do that and take care of the population.


There are over 3 million nurses in the United States. Nurses become nurses to provide care to patients. Nurses do not go through nursing school, to become nurses,  and subsequently struggle with finding and entering information into electronic charting systems, often referred to as Electronic Health Records (EHRs). Nurses currently struggle to have the information they need about their patients at their fingertips. Yes, EHRs are the way to go in the sense that we need electronic record of information in order to apply more advanced algorithms and analytical reports on the data to improve population health outcomes. I do support the need for EHRs and even wrote a textbook for nurses and health care professionals about EHRs ( to drive quality patient care.

Electronic Health Records for Quality Nursing and Health Care

I have worked in this field of informatics for the last 12 years and enjoy the work but I see how hard it is on nurses providing direct care and it takes a toll on their experience and overall job satisfaction. Thus we need a solution that interacts with the EHR. The solution is to provide nurses with tools that support how they work that improve their ability to be efficient. We’ve created that solution with Know My Patient TM and it has been met with remarkable praise from nurses.


So, what I didn’t say to that person who asked me the question: How did you know that your idea was good enough to start a business?” was that the problem is big enough that it deserves a solution. Additionally, the solution should be developed in such a way that addresses the needs of nurses to alleviate the challenges faced each day (look for my next blog post: 5 reasons why nurses need apps for more specific information).

“You are taking my vitals on a post-it note!?”

“You are taking my vitals on a post-it note!?”

I said these words a few weeks ago during a doctor’s visit. When it was my turn to be seen, I was brought back to a very small room and the nurse said, “I need to take your vitals”. She sat me down and started with my blood pressure. I turned my head to my left to look at what she was doing and that was when I saw it:

the yellow post-it note.


I reacted with: “Oh my, you are taking my vitals on a post-it note!?” The nurse responded, “ Well yes, I have to put them (e.g., my vital signs) in the computer.”


My mind started to race… ‘My vital patient information that can potentially be used over time, to assess my physical health status while under the care of this practice, is being written down on a post-it note.‘

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Nurses need to be cared for too.

I envision a day in the near future where we can support nurses with tools that allow them to spend more time with their patients and less time searching for information needed to provide safe, efficient care.

Nurses struggle to efficiently answer basic questions about their patients, often not just for themselves but also for the patient’s families and the larger health care team.

What basic questions you might ask? Below is a list of a small subset of the many questions nurses get asked each day while providing patient care:

  • Have my (the patient’s) labs/exams/test results come back yet?
  • When is the patient due for meds?
  • Does the patient have any allergies?
  • When can I (the patient) go home?

In each of the above questions, nurses need to provide an answer. How do they find that answer? Well, maybe they know from their memory, but if not, nurses have this trusted tool in their pocket: a piece of paper. 

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It is all about the process.

I am a nurse, an informaticist, and at times, I am also a patient. Last summer, I made an appointment for a vision exam. I was getting into my car to drive to the office when I noticed I had a voice mail. The voice mail was from the office letting someone else know that her glasses were in and she could come pick them up. I thought, ‘well that is strange, I’ll have to let them know when I get there that they called the wrong number’. What I should have done was call right back. Had I called back, I would have found out that my appointment needed to be rescheduled due to a malfunction with the equipment that day. (Instead, I drove to the office and found out in person). Although, had I called when I got the voicemail, I wouldn’t have identified the informatics challenge I saw upon arrival to the office. Read more