According to the American Telemedicine Association (ATA), telemedicine is the "use of medical information exchanged from one site to another via electronic communication to improve a patient's clinical health status."

Remote medical monitoring is what most frequently think of in regard to telemedicine. If fact, the use of remote monitoring has been in place for more than 40 years, and has be highly effective in rural areas.

But the overall concept of telemedicine is to bring a specialist's expertise to a facility "virtually," saving the patient being transported unnecessarily. So much has changed in the healthcare world with the advent of technology and the evolution of telemedicine. And telemedicine continues to evolve as technology becomes more advanced.

Where do nurses fit into this changing landscape? Below are a few examples.

If a pediatric patient is hundreds of miles from the nearest children's hospital, telemedicine can been used for consultation instead of just immediately transferring. Now the potential receiving hospital has instant access to imaging and labs and more definitive decisions can be made about appropriate transfers. This process prevents unnecessary and costly transfers. The nurse, as usual, assists in the coordination of care and insures that assessment information is timely and accurate.

When I was a new nurse working in the ICU, if we had an X-ray taken in the middle of the night for an emergent reason, we had to have it walked down to the ER for the physician to read it. That was just 15 years ago.

Now, X-rays are transmitted to radiologists 24 hours a day, usually at home at night. We no longer have to go to the "X-ray reading room" to take a glimpse of the films. They are integrated right into the electronic medical record and can be accessed by the physicians virtually anywhere. When a nurse calls a provider for a patient's condition change, the patient's record is immediately available to that provider you just woke up in the middle of the night.

Cameras can be brought to the bedside and the physician can "examine" the patient virtually. The nurse becomes a partner in aiding in the examination process and is able to communicate information that may not be readily evident via the video feed.

The eICU concept also provides partnerships with the bedside care team by providing another set of remote eyes and sophisticated computer programs that analyze data and alert staff. This second set of eyes allows the nurse at the bedside to know she has support, especially during nights and weekends when physicians may not be readily available.

Another evolving role for the nurse is providing remote monitoring, support and coaching for chronically ill patients at home. New nursing roles are being created to fill this need. Pacemaker information, vital signs, blood glucose levels and other patient data can now be remotely sent to physicians' offices, case managers or home health agencies — all in an effort to identify patient problems and prevent hospitalizations. The registered nurse is a key healthcare provider perfectly poised to fill this new unique role.

Although the initial fear from patients is that telemedicine will take away from the caregiver-patient relationship, it has in fact increased it as the interactions are more frequent. There can be no replacement for human interaction and patients often need to be reassured of this fact.

Also, nurses and healthcare providers need to not allow the use of technology to take the place of the art of caring. It should just be another tool that is used in an effort to improve patients' lives.

One interesting dilemma that stemmed from the use of telemedicine is the concept of practicing across state lines. Nurses need to be aware of whether they are providing telehealth nursing across state lines. If this were the case, they would need to be licensed in all states in which they will be interacting with their patients.

One solution to this problem is the Nurse Licensure Compact, which allows nurses to practice across compact members' state lines. Currently 24 states participate in the compact.

It is clear telemedicine, in all of its variations, is a continuously evolving area of healthcare. Not only has it provided convenience for providers, but it has also aided in decreasing hospital admissions and emergency department visits.

Despite these advancements, it is imperative to remember that healthcare is not effective without the human, caring aspect. This is where nursing will always prevail, just with some newer, fancier tools to use.