Use XPath. Assuming that $qrda
is your XML document:
$path = "/ClinicalDocument/recordTarget/patientRole/telecom[@use='HP']"
$telecom = $qrda.SelectSingleNode($path)
since that path is pretty long and overly specific we can trim it down:
$telecom = $qrda.SelectSingleNode("//telecom[@use='HP']")