How did you become involved with telehealth and your current role?

I moved to SC in late 2014 to accept a position with the MUSC Center for Telehealth in the School-Based Telehealth program. I was drawn to this role as I have been a pediatric nurse practitioner for over 24 years and have extensive experience in school-based health. I was hired to provide care and to help develop the program. The thought of developing a statewide school-based telehealth program to bring care to children with limited access was what fueled my passion. Once I began providing care via synchronous telehealth, I realized just how effective and efficient telehealth can be and how important it is to our health care system overall. The more I learned about the various applications of virtual care, the more passionate I became about sharing that knowledge with others. My role has since evolved to include telehealth education and providing consultative services to health care providers who wish to incorporate telehealth into their respective practices. I also have special interest in APRN practice and related telehealth considerations.

What do you see as benefits to telehealth?

Telehealth is both efficient and effective. It allows health care providers to extend the care they provide every day beyond the walls of their setting. It is particularly beneficial in bringing care to patients who face barriers to accessing care such as transportation, scheduling and missed time away from work.

What barriers do you think are preventing NPs from being successful with telehealth?

One barrier to NP utilization of telehealth is licensure. Most states require licensure within the state where the patient is located. There is not currently an APRN compact that would allow cross state practice. This is a barrier for many NPs who practice in settings that draw patients from nearby states. Without licensure in the neighboring state, NPs are generally not able to conduct care virtually to these patients in their homes. In addition, reimbursement for telehealth care has long been a barrier to increasing utilization of telehealth. There have been many changes in light of COVID-19 which have improved these areas but it is yet to be seen whether they will remain following the pandemic.

Where do you see telehealth services in 5 years? What changes should be implemented with NP curriculum to support telehealth implementation?

I anticipate that in the not too distant future, telehealth will simply be part of the way care is provided. It will no longer be considered “new and innovative.” The technology is evolving rapidly and there are so many amazing applications of telehealth that it is difficult to predict what telehealth will be like in 5 years.

Nurse Practitioner curriculums at many universities are beginning to include telehealth. I believe this trend will continue, especially in light of the pandemic which has led to increased telehealth utilization. One area that I believe is very important to telehealth education is that of telehealth etiquette or webside manner. Ensuring professional virtual interactions can build trust with the patient and enhance the perceived quality of the encounter for the patient and provider.

How has COVID-19 impacted your current practice?

As is the case for most health care providers, many more of our visits have been converted to telehealth from in-person in light of the pandemic. I traditionally practice in the school setting via synchronous telehealth with peripheral devices including a digital stethoscope, otoscope and exam camera. In light of the pandemic, I have expanded my experience to include asynchronous online visits and video only visits to the patient’s home.

What tips or resources would you give to an NP who is looking into integrating telemedicine into her/his practice?

I encourage all APRNs to be familiar with the nurse practice act, advisory opinions and position statements as well as telehealth legislation in the state where they are located and in the state where the patient is located. Telehealth laws vary by state as does the scope of practice for APRNs. The APRN must abide by the state laws and regulations where the patient is located. If that state has restricted practice and requires a practice agreement, it is important to include telehealth care within the agreement. It is also important to confirm that your malpractice coverage will extend to telehealth care.

The Center for Connected Health Policy is a great resource for state and federal legislation pertaining to telehealth. They are also tracking all of the recent changes related to COVID-19. The National Consortium of Telehealth Resource Centers is a wonderful resource as well. Once you identify your regional telehealth resource center, they can provide a wealth of information with regard to implementing telehealth as well as the associated details within your specific state.