Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Judith A. Johnson


Doctor of Nursing Practice


Accurate reflection of care practices in telehealth care management is the fore runner to the delivery of reportable beneficiary outcomes. Success in delivering Geriatric Care Services (GCS) resides in a partnership between clinician practice and technology tools utilized in telehealth practice. Through in home technologies, telehealth can provide ongoing care needs to underserved populations, and it can support independent aging of beneficiaries who live with chronic care conditions. Tele-health care management, performed through a health plan, presents a unique opportunity to capitalize on the abundance of health data collected on a patient, and maximize the use of that information for clinical decision support. Nursing informatics is the facilitator of telenursing. It is the specialty that integrates and applies nursing science, and respective theoretical models, in identifying, collecting, processing, and managing data. It furthers seeks to process that data to formulate knowledge based decisions and informed care plan actions. Maximizing technology and available data are primary tools a telehealth clinician uses in care management practice. It is imperative that the technology system utilized in practice supports the telehealth interaction by accurately and effectively reflecting the clinician’s practice through data inputs, collection methods, and interpretation logic. This Doctorate of Nursing Practice (DNP) systems change project examined existing telehealth care practice and available technology tools. The project explored options for practice and process improvements in identification and formulation of cases and the development of new clinical technology tools to support the practice. Further, this project implemented practice change to support the organization’s strategic plan to provide efficient and effective GCS case management to our client. In summary, this project produced new clinical technology tools to reflect telehealth practice, gave a voice to telehealth case managers in the technology development cycle, and established a measurement framework for organizational reporting on case management outcomes.