Matching telehealth technology to the work processes of nurses managing the care of children with complex special health care needs

Background: Incorporating telehealth tools into ambulatory care delivery supports clinician management of consumer health between clinic visits. APRN role autonomy encourages innovative use of telehealth to facilitate care delivery.  Task-technology fit (TTF) is a framework for determining how technology assists a person during work processes. Evaluating the TTF of video telehealth for different types of nurses ensures that the depth and breadth of information available with telehealth technology matches the depth and breadth of information needed for care delivery. 

Methodology: The setting is the pediatric health care home where TeleFamilies took place. The TTF of video telehealth for registered nurses (RN) conducting dedicated telephone triage and the TeleFamilies APRN conducting care coordination employed a mixed methods protocol. Ethnographic data collection and directed content analysis described the work processes of triage and care coordination using telephone and video telehealth. Time-motion methodology measured the time of triage and care coordination activities using the two forms of telehealth. Between-group comparison of activity times from the triage and care coordination time-motion samples used Wilcoxon rank sum.

Results: Video telehealth provided visual and non-verbal information not available during telephone telehealth. The triage RN collected and transferred the additional information to the physician for diagnosis and treatment, with a significant difference in the time of telephone and video telehealth triage activities (p <= 0.05). The care coordination APRN synthesized and used the additional information for autonomous diagnosis and treatment, with no significant difference between telephone and video telehealth care coordination activities. RN and APRN scope of practice differences explain the dissimilar results.

Conclusion: Telehealth must provide the right information to the right clinician at the right time. Evaluating the TTF of video telehealth for RN triage and APRN care coordination provides rigorous analysis of whether technology is the right tool for a work process.