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?



Being a Founder and a Female

Article Thumbnail

I am a founder who happens to be a female.

Twice this week I had a conversation about the question I’ve been asked often on panels.

The question is some variation of “How do you manage being a female in business?”

I don’t like this question.

I wish it wasn’t a question that was asked of women.

I don’t think men are asked, “How do you manage being a man in business?”

The reason I don’t like the question is because I don’t think about my gender when I am doing the work I need to do.

I am only concerned with having the knowledge, understanding and skills to be able to do what I’ve set out to do. I also happen to be a woman.

I lead with that every day.

While I don’t like the question, I will continue to answer it that way until it no longer needs to be asked.

“I’ll be back in a few minutes..”

This is the truth… (I chuckled when I read it).

This reminded me of when I’d come back from the cafeteria around 3:30pm (having started at 7am) with something I grabbed to bring back and eat for lunch on the unit. The unit secretary would see me and tell me something like:

“Your patient in room 10 needs pain medicine, room 5 is due in radiology, room 8’s parent is on line 2 and you have new orders for room 1.” I would just look at her and think, ‘how are you keeping a straight face as you are telling me this news? (and I can’t do all 4 of those things at the same timeūüėČ)’.

Nurses are a Blessing

Post originally appeared on Dr. Tiffany Kelley RN on November 28th, 2017

Nightingale’s Innovative Nurse: (November): Amelia Roberts, RN


Meet Amelia Roberts, RN

Amelia Roberts

What do you love about being a nurse?

What I love about being a nurse is the perspective I get! From where I stand, I see life with all that it offers, both problems and solutions. In my nursing role, we deliver patient care in a variety of forms. This viewpoint shows me both challenges and opportunities that patients face in navigating the healthcare system. In my role as caregiver, I have a clear view of solutions that support how care is delivered. Nursing gives such a unique perspective of what works on the user interface side. This viewpoint also shows clearly, what does not work in terms of user experience. Being an end user of a variety of healthcare technologies, I see many well-meaning companies who hope to facilitate communication among providers and disconnected healthcare systems. As a nurse, I feel it is a duty to contribute to solving these and other challenges that impact patient care.

How does contributing to solve these challenges look?

A few years ago there was a Hackathon at a local healthcare facility. I submitted an idea on an app that would facilitate discharge planning. As a finalist, I had the opportunity to see my app go from idea on paper to an experience that I could actually engage with on an iPad! Not much happened from there. Due to various system-level challenges, the app could not be put into practice. Since then I’ve been actively engaged in conversations with a variety of tech companies who offer similar discharge planning solutions. In my role as a provider of solutions, I find joy and connecting such founders with Healthcare Champions and health care decision-makers. My aim in facilitating these conversations is to break down some of the silos that prevent cross-pollination of ideas.

What do you love most about being a nurse?

Thinking of the unique perspective of the registered nurse, I would love for more technology companies to seek out having nurses as part of their team, if not only as a focus group. It would make sense to have these nurse stakeholders part of the conversation during the front end development of Technology as well. Many times nurses are included on the back end in terms of creating workflows for implementation. Many challenges are discovered during implementation that could have been avoided if nurse input was sought earlier in the process.

Related to solving this challenge, ¬†I’ve enjoyed participating in a variety of electronic medical record user-testing opportunities. What I love about nursing is the opportunity that it gives me in connecting the problems I see with solutions that are out there ready to be used. If you would like to continue the conversation, please shoot me an


Business Website

Personal Blog: The Story Behind My Business

Twitter and Instagram @RN_Solutions

Nightingale’s November Newsletter

Did you catch our November Newsletter?

Here’s an excerpt:

While I get to share my story, I also get to offer a perspective that perhaps is new. Yet, I hope that perspective lights that initial spark that can be taken back to the workplace and think differently about how to solve some of the challenges faced in our health care environment. 

You can read¬†the full newsletter¬†here: Nightingale’s November Newsletter¬†. To be added to our mailing list, email us at or sign up on the website!


The power of perseverance.

Perseverance is an essential characteristic when embarking on something new.

I was a PhD student for 4 years. Some students took 5 years to complete the degree. Yet, I knew I wouldn’t be able to sustain a fifth year. I needed to finish in 4 years. I spent the first two years of the program trying to demonstrate that there was value in studying nursing documentation. More specifically, I studied the information needs of nurses before and after an electronic nursing documentation system implementation. I remember being in a class one day and the professor looked at me and said, “no one cares about nursing documentation”. Ouch!

My first paper wasn’t accepted until I was in my 3rd year of the program. Yet, it was accepted with very little changes required to the Journal of Nursing Scholarship. That paper was what caught the attention of a publisher that led to them asking me to write my book, Electronic Health Records for Quality Nursing and Health Care. (So, it turns out MANY people care about nursing documentation…¬†ūüėȬ†). I applied for many external grants before finally figuring out the best way to present the case. I worked tirelessly every day. After that, I had several grants funded with a total of 7 by the end of my PhD program.

I remember thinking (often) ‘would it really happen, would I finally get this PhD degree?’ I also remember thinking it had to be preparing me for something else that would come. I couldn’t think of any other reason why it was so painful and difficult for that long of a time frame. That something else was entrepreneurship. Starting a business from an idea (e.g., Nightingale Apps) requires extensive perseverance (and many other characteristics). Instead of being in one academic setting, your ecosystem is much larger with greater variability in perspective. There aren’t set protocols and when you have something brand new, (e.g., Know My Patient), there isn’t a path already paved for you to follow. You need to be the one to figure it out. You also need to decide who and what to listen to as you go down this path. Everyone will have an opinion but you’ll need to decide which one(s) are aligned with your vision.

“The truth is, there is only so far ‚Äėmotivation‚Äô can carry you and your vision when you are in the grind (especially in the early days). People watch you from afar, some half-expecting you to fail, and after all the good wishes and pep talks, you are only left with yourself ‚ÄĒ and your willingness to keep going.”

3 Secrets to Persevering (When All You Want to Do Is Give Up)

Post originally appeared on Dr. Tiffany Kelley RN on December 4th, 2017