eHealth survey 2010 report - Royal College of · PDF file3 Background The 2010 eHealth survey...

eHealth survey 2010 report

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Contents

BACKGROUND 3

FINDINGS 3

1. Respondents 3

2. Electronic Patient Records 4

3. Social networking 5

4. Training 5

5. Computer access 5

6. IT support 5

7. Supporting patients to use IT 5

8. Telehealth 5

COMMENTS 6

RECOMMENDATIONS 7

APPENDIX 1: RESULTS, RCN EHEALTH SURVEY, 2010 8

APPENDIX 2: FREE TEXT RESPONSES FROM QUESTION 2 26

APPENDIX 3: TEN SYSTEMS MENTIONED MOST FREQUENTLY 26

APPENDIX 4: A SELECTION OF FREETEXT COMMENTS ON HEALTH IT DEVELOPMENTS 27

APPENDIX 5: WHAT PATIENTS BENEFIT FROM REMOTE PATIENT MONITORING 29

REFERENCES 30

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BackgroundThe 2010 eHealth survey was commissioned by the RCN to explore knowledge and understanding of eHealth among nursing staff. The survey ran from 14/07/2010 to 17/09/2010 and was accessed via the RCN website. 1,313 nursing staff from across the UK responded. The respondents were from a wide range of clinical and geographic areas which enhances the richness of the data. The RCN carried out similar surveys annually from 2004 to 20071. The previous surveys mainly concentrated on electronic patient records (EPR) within the NHS. The 2010 survey also included a number of questions on EPR and introduced additional questions around newer developments which are impacting on nursing staff (telehealth, patient access to health information and use of social networking sites). The new survey widened the scope to include nursing staff from all areas of employment. This report presents the survey findings in tables showing the UK totals and individual country breakdown (Appendix 1). The 2007 survey found very little difference in responses according to date of nursing qualification, so this comparison was not repeated. Instead, a selection of key questions have been compared with employer type to ascertain if there are any differences in this area.

Findings1. Respondents1.1. The majority of participants qualified in the 1980s-2000s and were employed in NHS hospitals. Appendix 2 lists the employer type supplied by participants who selected ‘other’. 1.2. Most nursing staff described their field of practice as adult care. A very small number of healthcare assistants and midwives participated in the survey.1.3. The answers to the question ‘Do you work in an informatics specialist post?’ covered a range of clinical specialist roles and patient information/telephone advice, information technology (IT) and communication type roles.1.4. The largest number of respondents by far were in England, with less than 20 per cent from the other UK countries However, this may be representative of RCN membership numbers in general. 1.5. The majority had not participated in previous RCN eHealth surveys.

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2. Electronic Patient Records2.1. The responses demonstrated very high awareness of EPR (98 per cent). This is in keeping with the 2007 survey.2.2. Compared with 2007, the percentage of nursing staff who welcome the introduction of EPR has risen a little. Comparing whether or not nursing staff welcome EPR across employer type gives only minor variation, with participants from non-NHS employers giving a slightly higher negative response (Chart 1). 2.3. Experience of using EPR in current or previous jobs has risen from 39 per cent in 2007 to 57 per cent in 2010. When compared across employer type (Chart 2) general practice nursing staff had more experience of using EPR and nursing staff in non-NHS roles had the least, although they had experience in previous roles. NHS hospital employed nursing staff had the lowest overall experience of EPR.2.4. Of those who reported having no EPR experience only about half felt ready for the introduction of electronic patient records. This has implications for organisations who are in the process of, or planning, EPR deployments.2.5. Overall confidence in organisations to deliver EPR for all patients was less than 60 per cent, although this figure is more than in the 2007 survey (42 per cent).2.6. Consultation with nursing staff about the introduction of EPR is generally considered an essential element of successful deployment. Small progress has been made in this area since 2007 and 54 per cent of nursing staff across the UK are still saying they had not been consulted with. 2.7. Comparison across employer type shows least consultation in NHS hospitals and non-NHS employers, despite the fact that 96–100 per cent of respondents viewed consultation as very, or fairly, important.

2.8. EPR will improve patient safety according to 64 per cent of participants. This is up from 50 per cent in 2007.2.9. Attitudes to patient confidentiality and security of EPR have improved since 2007, but there is still room for improvement. Less than half of nursing staff who responded thought that EPRs are more secure than paper records and 24 per cent still thought that EPRs threaten patient confidentiality. 2.10. Awareness of benefits of EPR is also increasing, for example; saving time and improving nursing care both achieved higher positive responses in 2010 than in 2007. However, less than half agreed that use of EPR improved nurses’ decision making and only 40 per cent agreed that EPR could improve the quality of nursing care.2.11. Nursing staff’s attitude to EPR as a threat to nurse-patient relationship is also improving. This changed from 63 per cent in favour in 2007 to 80 per cent in 2010. 2.12. One benefit of EPR which did achieve high support was the ability to improve how nursing care is reported. 2.13. Almost 60 per cent of respondents received only a little information about IT developments. The majority of this came from their workplace.2.14. Fifty five per cent of participants thought that EPR introduction was a priority at their workplace and 58 per cent thought that the national IT programmes are a good, or very good, use of resources.3. Social networking3.1. A question about the use of social networking applications was asked for the first time in the 2010 survey. Such sites are increasingly used to communicate in personal and professional circles and it seems that nursing staff are joining the growing trend. Fifty four per cent of those surveyed agreed that they use such sites.

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There have been instances reported in the media of professional misuse of social networking sites so it is important that nurses are aware of their responsibilities in this area.4. Training4.1. Ninety eight per cent of nursing staff in the 2010 survey agreed that training in use of EPR and other IT systems is very, or fairly, important. However, over half (52 per cent) said they had not had any IT training within the last six months. This figure is only slightly up from 2007 results, so it would appear that little progress is happening in this area. This is a concern for the safe and correct use of clinical systems.4.2. When compared across employer type (Chart 4), the non-NHS employees received the least IT training and NHS Community the most.4.3. An average of 60 per cent of respondents across the UK felt that they would need extra training to use EPRs. 5. Computer access 5.1. Ninety two per cent of survey participants used a computer at least daily at work and one per cent never used a computer at work. These percentages have changed little since 2007.5.2. It would seem that the number of computers available has not increased much either since 2007. One third of those surveyed reported having sole use of a computer but 40 per cent had to share with five or more others, and 13 per cent with 20 or more others. 5.3. NHS hospitals had the most computer sharing and the least was in the category NHS Other (Chart 6).5.4. Fifty three per cent of participants said they do not have to wait to use a computer which is surprising considering how many others they are shared with.

6. IT support6.1. Seventy four per cent of participants had found IT support to be excellent, good or very good. This is slightly up from 2007 results.7. Supporting patients to use IT7.1. Seventy eight per cent of respondents had never helped a patient to access information using IT but 60 per cent were confident that they have the skills to do so.8. Telehealth8.1. Fifty five per cent of survey participants had not heard of telehealth but a similar number welcomed its introduction. Comparison across employer type shows that survey participants who work in NHS Hospitals, community and GP practice are least in favour of telehealth (Chart 6).8.2. Although more than half of respondents were in favour of telehealth, 85 per cent had no experience of using telehealth in nursing practice. NHS hospital and non-NHS nursing staff had the least experience and those working in NHS ‘other’ had the most experience. Further interrogation of the data for this group show that there was a high proportion working in education, management, clinical specialties and change and leadership roles.8.3. Of the few who had experience of telehealth 75 per cent rated this as positive.8.4. Less than one third of respondents with no telehealth experience felt ready for its introduction.8.5. A large number of those surveyed were uncertain about the benefits of telehealth. More than half did not know if telehealth can improve patient safety or if it threatens patient confidentiality, and 57 per cent were unsure if telehealth is more secure that paper based systems.

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8.6. There is also confusion about whether telehealth will change nursing practice or affect the nurse-patient relationship. Thirty seven per cent agreed that telehealth will improve patient care but only 18 per cent that it will change nursing practice. 8.7. Similarly, 57 per cent of participants were uncertain about the effect of telehealth on workload and caseload size. 8.8. Less than half think that telehealth can support more effective management of patients with long-term conditions, including early intervention to prevent exacerbation, prevention or reduction of hospital admission and improvement in patient self-management.8.9. More than half of those surveyed wanted to know more about telehealth. Fifty three per cent agreed that telehealth learning initiatives are relevant for how they care for patients and 72 per cent were interested in learning more about telehealth.

CommentsAs stated in the introduction, the majority of 2010 eHealth Survey respondents had not participated in previous RCN eHealth surveys so any comparisons with 2007 can only be an indication of direction of travel rather than direct comparisons. The survey was carried out online thereby excluding those with no IT expertise or access to the internet.Despite the fact that less than half of 2010 survey respondents currently use an EPR, attitudes to the benefits of EPR were, by and large, positive and more informed than in the previous RCN eHealth survey in 2007. It is interesting that the majority of participants were aware that use of EPRs can improve information available for reporting but fewer made the link between EPRs and decision making or quality of care, indicating that these potential properties of EPR are not communicated or demonstrated to nursing staff.

Some issues have not changed markedly since the 2007 eHealth survey. Concerns about patient confidentiality continue to be a worry for nursing staff. This may be a perceived concern due to media publicity about security breaches, for example, when a celebrity’s health record is accessed inappropriately. It may also be that the nursing staff are basing their concern on what they see happening, such as log-on credentials shared due to a shortage of computers or confidential information left exposed on a screen. Either way, employers have a duty to educate staff about their responsibilities, ensure that lack of equipment is not a barrier and that there is a well publicised policy for dealing with breaches. Individual staff also have a duty to adhere to their employer’s policies. Consultation with users remained important to the respondents but this was not reflected in the numbers who actually felt consulted. Systems are more likely to be effective and produce better quality data if developed with input from users and deployments will go more smoothly if staff are kept up to date with developments directly affecting them. The majority of respondents did receive information from their workplace but this tended to be a small amount of information only.Similarly, data quality is likely to be better if users are IT literate and well-trained in their system. There are implications for employers when deploying systems and releasing nursing staff from clinical work for training. IT project staff can work closely with clinical colleagues to come up with a variety of training methods to suit all users, for example, web-based modules, expert users or webinars.Forty per cent of respondents had to share a computer with five or more others, a reduction of only 5 per cent since 2007. Although the majority do not have to wait to use a computer, there are still 22 per cent

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who said they have to wait more than 10 minutes to access a computer. Access to a computer at the point of care is important for complete, timely and accurate recording of clinical information.The 2010 survey also explored the topics of the ‘nurse as knowledge broker’. Patients access to their own health record, electronic sources of information about their health condition, support organisations or local health services’ performance are happening now in small numbers. However, depending on NHS IT strategies, patient access to health information is set to increase and nursing staff will need to develop the skills to support patients’ access to relevant and accurate information. Responses to the telehealth questions show that nursing staffs’ knowledge and awareness of this topic is less advanced than for EPR and low levels of experience in using telehealth was reflected by a lot of uncertainty about the benefits of telehealth. While nursing staff working with patients in acute inpatient settings may not be using telehealth directly there is a need for them to be aware of the benefits and properties of telehealth in order to inform patients and carers, for example about the availability of telephone helplines or assistive technology for use in the home.Although there is much empirical knowledge about the benefits of telehealth, there is currently a lack of research evidence about its benefits and economic value. A number of studies are currently underway in the UK which will inform this area. It is noteworthy that a large number of survey participants were keen to learn about telehealth and the RCN has introduced a resource for members on its web based Learning Zone 2.

Recommendations i Consultation with nursing staff concerning eHealth developments must reach all levels of staff and allow for two-way communication to obtain feedback about specific issues.ii Employers must ensure that all staff are aware of their responsibilities about confidentiality of patient information when using EPRs, have clear policies in place and provide adequate equipment to minimise breaches. iii Nursing staff need to be educated about the link between EPRs and quality of care and clinical decision making. Without this knowledge there is a danger that users will view the EPR as merely a data collection exercise and fail to appreciate the full potential.iv Consultation and information for users is an essential part of change management. Regular updates aimed at specific user groups can improve awareness and willingness to engage.v IT training should not be skimped due to cutbacks and new methods of training could be explored to replace the traditional classroom method. vi Organisations should consider how to give nursing staff adequate access to a computer to record patient information. This could include the use of various forms of mobile technology.vii Nursing education should equip nursing staff to support patients’ information seeking using electronic sources and healthcare organisations should signpost patients to trustworthy sources of information.viii Nursing staff need to have education and information about telehealth developments in their area so they can inform patients and carers.

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UK England Wales Scotland N. IrelandN % % % % %

I have no nursing qualification 13 1 1 2 1 0I am a Health Care Assistant 10 1 1 2 0 42000s 308 23 25 23 19 131990s 304 23 22 19 26 431980s 379 29 28 28 36 171970s 266 20 21 24 14 221960s or earlier 31 2 2 2 3 0Total number 1308 1059 57 166 23

Appendix 1: Results, eHealth Survey, 2010 1. When did you gain your first nursing qualification?


NHS Hospital 625 48 48 48 48 61NHS Community 276 21 22 9 20 9GP Practice 104 8 8 11 4 13NHS Other 78 6 4 11 14 9Independent Sector/Univ/FE/HE 69 5 6 3 5 0Other, please specify 158 12 12 18 8 9Total number 1308 1058 56 166 23

2. Which of the following best describes your employer?


Adult care 518 39 39 56 37 43Primary care, community/ public health services

273 21 21 19 17 22

Mental health 128 10 9 5 14 13Children and young people 115 9 9 4 7 0Management, leadership and support services

74 6 6 4 7 4

Learning disabilities 28 2 2 4 2 4Nursing education 25 2 2 2 1 9Other, please specify 150 11 11 7 14 4Total number 1311 1058 57 166 23

3. What best describes your main field of practice?

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4. Which of the following best describes your job?


Staff Nurse 355 27 26 35 34 26Advanced Practice Nurse/ Clinical Nurse Specialist/ Nurse Practitioner

306 23 24 21 22 22

Sister/Charge Nurse/Ward Manager

150 12 12 3 8 13

Community Practitioner (e.g. District Nurse/ Health Visitor)

142 11 11 12 13 0

Nursing Manager 89 7 6 7 9 9Lecturer/Academic Position 24 2 2 2 2 0Nursing Informatics Specialist 13 1 1 2 1 0Nursing Student 12 1 1 3 1 0Health Care Assistant/ Health Care Support Worker

6 <1 <1 0 0 0

Midwife 5 <1 <1 0 1 0Other, please specify 204 16 16 14 9 30Total number 1306 1053 57 157 23


No 1188 93 93 96 90 100Yes (please give job title) 93 7 7 4 10 0Total number 1281 1033 56 164 23

5. Do you work in a specialist informatics post?

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6. Please indicate within which RCN country/ region you work?

N %Scotland 166 13Wales 57 4Northern Ireland 23 2Eastern 77 6East Midlands 79 6London 154 12Northern 52 4North West 158 12South East 197 15South West 141 11West Midlands 106 8Yorkshire and Humber 95 7Total number 1305


Yes 239 18 18 18 23 9No 1064 82 82 82 77 91Total number 1303 1051 56 166 23

7. Did you respond to any of the RCN’s earlier surveys on health IT developments?



8. Before taking part in this survey, had you heard of electronic patient records?


Yes 967 74 75 65 73 70No 84 6 6 9 8 0Don’t know 254 20 19 26 19 30Total number 1305 1053 57 165 23

9. Do you welcome the introduction of electronic patient records?

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Chart 1: Do you welcome EPR, Compared with Employer Type

Employer Type

Wel

com

e EP

R?

NHS Hospital (625)

GP Practice (104)

NHS Community (276)

NHS Other (78)

Independent sector/Uni/College/FE (69)

Other (158)

Yes No Don’t know

0%

20%

40%

60%

80%

100%


I already use electronic patient records 562 43 43 28 46 22I have used electronic patient records in a previous job

180 14 15 16 11 0

I have no experience of using electronic patient records

567 43 42 56 43 78

Total number 1309 1056 57 165 23

10. What is your personal experience of electronic patient records?

Chart 2: Experience of EPR, Compared with Employer Type

Employer Type

Expe

rienc

e EP

R

NHS Hospital (625)

GP Practice (104)

NHS Community (276)

NHS Other (78)


Other (158)

Use EPR Previously used EPR Never used EPR

0%

20%

40%

60%

80%

100%

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11. If you have no experience, do you feel ready for the introduction of electronic patient record?


EPRs already in use in my organisation

473 36 36 30 41 22

My organisation is in the process of introducing EPRs

232 18 19 10 13 13

My organisation is planning to introduce EPRs

166 13 13 9 12 13

There are no plans to introduce EPRs in my clinical area

151 12 11 19 11 17

Don’t know 280 21 20 32 23 35Total number 1302 1050 57 165 23

12. What stage has your organisation reached in its use of electronic patient records?



13. Do you believe the health service can deliver electronic patient records for all patients in the future?

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A great deal 73 6 5 5 7 9Quite a lot 163 12 14 5 7 9A little 361 28 28 21 29 26None at all 698 54 53 66 57 56I do not wish to be consulted 6 <1 <1 2 0 0Total number 1308 1052 56 164 23

14. What consultation has there been with you, in your professional role, about electronic patient records?

Chart 3: Amount of consultation about EPR, Compared with Employer Type

Employer Type

Amou

nt o

f con

sulta

tion

NHS Hospital (625)

GP Practice (104)

NHS Community (276)

NHS Other (78)


Other (158)

A great deal Quite a lot A little None at all

0%

20%

40%

60%

80%

100%


Very Important 1056 80 80 84 82 87Fairly Important 208 16 16 14 15 13Neither Important nor unimportant

20 2 <1 2 2 0

Unimportant 2 <1 <1 0 <1 0Very unimportant 7 <1 <1 0 0 0Unsure 16 1 1 0 1 0Total number 1309 1057 57 165 23

15. How important is consultation with nursing staff about the introduction of electronic patient records?

14


Agree 640 49 48 58 52 70Disagree 302 23 23 21 25 4Don’t know 359 28 29 21 23 26Total number 1301 1051 57 163 23

16.2 Electronic patient records will be more secure than paper-based records



16.3 Electronic patient records will threaten patient confidentiality



16.4 Electronic patient records will save time



16.5 Electronic patient records will threaten the patient’s relationship with nursing staff



16.1 Electronic patient records will improve patient safety

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16.7 Electronic patient records will not change nursing practice



16.8 Electronic patient records will improve nursing decision making



16.9 Electronic patient records will improve the quality of nursing care



16.10 Electronic patient records will improve how nursing care is reported



16.6 Electronic patient records will improve patient care

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My Trust/organisation 514 40 40 26 40 44The RCN 137 11 10 14 14 9My colleagues/word of mouth 120 9 10 4 12 0The media (other than internet)

109 8 10 2 4 13

The internet 96 7 7 14 7 0Leaflets by national NHS IT programme

73 6 6 4 2 0

My immediate line manager 72 6 5 7 6 17Organisations other than RCN (please specify)

20 1 1 2 3 0

I have received no information 158 12 11 28 14 17Total number 1299 1049 57 163 23

19. Who or what is your main source of information about electronic patient records?


Very Important 310 24 24 24 24 26Important 400 31 32 24 27 26Neither Important nor unimportant

276 21 21 16 24 17

Not Important 105 8 8 7 9 9Unnecessary 36 3 2 7 4 0Unsure 173 13 13 21 12 22Total number 1300 1048 57 165 23

21. How important a priority is the introduction of electronic patient records at your place of work?


A great deal 74 6 5 5 8 0Quite a lot 223 17 18 18 13 13A little 774 59 60 49 60 70None at all 235 18 17 28 20 17Total number 1306 1054 57 165 23

18. How much information have you received about IT developments in the health service?

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23. Do you use social networking applications (blogs, Facebook, Twitter, etc.)?


Very Important 1178 90 90 86 90 96Important 105 8 8 10 7 4Neither Important nor unimportant

15 1 1 0 2 0

Not Important 1 <1 0 2 0 0Unnecessary 5 <1 <1 2 0 0Unsure 6 <1 <1 0 <1 0Total number 1310 1057 57 166 23

24. How important is the provision of training for nursing staff to the success of electronic patient records?


A very good use 135 10 11 9 10 13A good use 621 48 47 53 50 57A poor use 262 20 21 11 16 13A very poor use 99 8 8 9 7 0I don't know 187 14 13 18 17 17Total number 1304 1053 56 165 23

22. A significant amount of money is being spent on national IT programmes. Do you think this is a good or poor use of resources?

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Chart 4: Amount of IT training, Compared with Employer Type

None at all Non in work time Half day to 1 day 2-4 days 5-10 days >10 days

NHS Hospital (625)

NHS Community (276)

GP Practice (104)

NHS Other (78)


Other (158)

Amount of IT training

Empl

oyer

type

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%



26. Thinking about the IT skills you have now, do you feel you would need extra training in order to use electronic patient records?


None at all 678 52 51 53 54 78None in working time 109 8 9 12 7 0Half day 284 22 22 19 22 131 day 100 8 8 2 8 42 days 63 5 5 10 4 03 days 21 2 2 0 1 04 days 14 1 1 2 0 05 to 10 days 18 1 1 0 1 010+ days 18 1 1 2 2 4Total number 1305 1053 57 166 23

25. How much IT training have you personally received within working time in the last six months?

19


I have sole use of it 430 33 34 31 32 48One other person 102 8 7 7 10 172-4 245 19 20 15 18 45-10 225 18 18 18 15 411-20 121 9 9 11 10 13More than 20 165 13 12 18 15 13Total number 1288 1041 55 164 23

28. In your immediate clinical area (it could be a hospital or out in the community), how many people share the computer that you use?

I have sole use of it (430) One other person (102) 2 to 4 (245) 5 to 10 (225) 11 to 20 (121) More than 20 (165)

NHS Hospital (625)

NHS Community (276)

GP Practice (104)

NHS Other (78)


Other (158)

Number sharing computer

Empl

oyer

type

0% 20% 40% 60% 80% 100%

Chart 5: Number sharing computer, Compared with Employer Type


Daily or more often 1201 92 92 80 92 91Once or twice a week 54 4 4 4 5 4Once or twice a month 4 <1 <1 0 0 0Occasionally/Rarely 34 3 2 14 3 4Never 16 1 1 2 0 0Total number 1309 1056 57 166 23

27. How often do you use a computer at work?

20


Excellent 221 17 16 14 19 26Very good 381 29 30 19 29 17Good 370 28 29 19 27 26Neither good nor poor 153 12 12 19 13 4Poor 114 9 8 14 10 13Very poor 25 2 2 2 <1 4Don’t know 38 3 2 12 1 9Total number 1302 1051 57 165 23

30. How would you describe the IT support by your organisation when there is a problem with a computer at work?



31. Have you helped a patient use a computer, the Internet, or other IT?



32. Thinking about the IT skills you have now, do you feel you would need extra training in order to help a patient use a computer, the Internet, or other IT?


I do not have to wait 563 53 52 49 57 695 minutes 186 17 18 28 12 1315 minutes 144 14 14 8 13 630 minutes 86 8 8 8 9 645 minutes 17 2 1 2 3 61 hour or more 66 6 7 4 6 0Total number 1062 857 47 139 16

29. If you share a computer, how much time do you have to wait on average to get access?

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34. Before taking part in this survey, had you heard of telehealth?



35. Do you welcome the introduction of telehealth in nursing practice?

Employer Type

Wel

com

e te

lehe

alth

?

NHS Hospital (625)

GP Practice (104)

NHS Community (276)

NHS Other (78)


Other (158)

Yes No Don’t know

0%

20%

40%

60%

80%

100%

10%

30%

50%

70%

90%


I already use telehealth 112 9 7 12 17 9I have used telehealth in a previous job

79 6 6 0 7 14

I have no experience of using telehealth

1108 85 87 88 76 77

Total number 1299 1057 56 164 22

36. What is your personal experience of telehealth?

Chart 6: Welcome Teleheath, Comparison with Employer Type

22

Employer Type

Expe

rienc

e of

Tele

heal

th

NHS Hospital (625)

GP Practice (104)

NHS Community (276)

NHS Other (78)


Other (158)

Already use telehealth Previously used telehealth No experience telehealth

0%

20%

40%

60%

80%

100%

Chart 7: Experience of Teleheath, Compared with Employer Type


Positive 142 75 70 100 90 60Negative 15 8 10 0 0 20Indifferent 33 17 20 0 10 20Total number 190 138 7 40 5

37. If you have already used telehealth, how would you rate your experience?



38. If you have no experience, do you feel ready for the introduction of telehealth?



39.1 Telehealth will improve patient safety

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39.2 Telehealth will be more secure than the paper-based record systems we have at present



39.3 Telehealth threatens patient confidentiality



39.4 Telehealth will save time


Agree 295 23 23 25 20 22 Disagree 485 37 35 37 48 52Don’t know 519 40 42 38 32 26Total number 1299 1055 56 165 23

39.5 Telehealth will threaten the patient’s relationship with nursing staff



39.6 Telehealth will improve patient care

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39.7 Telehealth will not change nursing practice



39.8 Telehealth will allow me to manage my patients with chronic conditions more effectively



39.9 Telehealth will allow me to intervene before a patient’s condition exacerbates



39.10 Telehealth will allow me to increase my caseload



39.11 Telehealth will increase my workload

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39.12 Telehealth will help prevent/ reduce emergency hospital admissions



39.13 Telehealth will improve self management by patients



40. Do you feel telehealth learning initiatives are relevant to you and how you care for patients?



41. Are you interested in learning more about telehealth?patients?



42. Would you be interested in sharing your own telehealth experiences?

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Appendix 2: Free text responses from question 2 A selection of comments from participants in response to question 2 ‘Which of the following best describes your employer?’:

Response category Number of instancesPrivate hospital, hospice, care home 36NHS services, including GP and out of hours 23Charity/ Voluntary sector 18Industry/ Occupational health 14Retired/ Unemployed 13Armed Forces/ Ministry of Defence 8Freelance/ Self-employed 8Agency/ Bank nursing 7Government/ Local Authority 7Student (nursing & PhD) 5Overseas work 4Prison Service 3Royal College of Nursing 3Specialist nursing post 3University 3Fire and Rescue Service 1

Appendix 3: Ten systems mentioned most frequentlyTen systems mentioned most frequently in response to question 17 ‘Which electronic patient record system do you use?’:

Response category Number of instancesSystmOne 71EMIS 66RIO 43PAS 20TrakCare 18Vision 19ePEX 17Paris 14iSoft 12Lorenzo 12

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Appendix 4: A selection of freetext comments on health IT developmentsA selection of comments from participants in response to question 33 ‘Please provide comments on health IT developments’:1. My trust is in the process of transferring all patient information on to EPR at present we are partly electronic and part paper which can cause confusion once we’re all electronic things should be better. The problem of computer access is ongoing.2. Appropriate investment in IT is required to ensure the success of the introduction of IM&T solutions - this means access to appropriate hardware for nurses and robust networks. We have a responsibility to help nurses understand information management and technology (IM&T) in the context of their working environment and to use it sensibly and wisely to support their practice and benefit patient care.3. Welcome them but they must be 100 per cent reliable. Access must be tightly governed - all too often see people leave their computers on without logging off. Some nurses are frightened of IT which I feel stems from a lack of training. Electronic records, in our department, save time and provides instant backgrounds in some cases. Introduction of IT must be coupled with a high level of technological support. Teaching of IT skills and training must be done by people other than the Nurses to ensure success.4. Working in unscheduled care, I find having patient electronic records can help me understand the patient, by knowing basic information on them, i.e. regular meds, ongoing medical problems.5. System often slow or not functioning. Wastes nursing time which should be devoted to patient care. I am not a Luddite but currently IT systems feel a bit “Heath Robinson.”

6. Although I’m not a nursing informatics specialist I am an information nurse specialist and more than familiar with IT and e-health issues. I think little recognition has been given to nurses using technology but doing so ‘invisibly’ within the clinical setting - as they previously used paper systems. The emphasis on the hardware seems to be at odds with what nurses want from technology and such an emphasis alienates nurses from discussing how they feel about technological change in the clinical setting and possibly more importantly the increasingly informed patient and carer and what this means for access to information within the clinical setting7. I feel that constraints of time and putting patient care first will lead to incomplete and therefore unsafe electronic records.8. Surprisingly I have not received any training on the use of the computer!!! I did my NP degree training in the 1990s and learned form my children by trial and error. Computer issues while trying to perform a clinical role are a big headache, and I often discuss with my patients that now I spend 95 per cent of my time inputting keyboard data/printing a prescription rather than focussing on the patient. 9. Media mistrust and concerns about the cost of a national system use this as another stick to beat the NHS with. Therefore evidence and reassurance that this can be provided successfully, at realistic cost, and in what sort of time frame are what I would most like to see.10. I work for NHS 24 and use an electronic record system as part of our regular service to the patient. The training of staff is essential as is the ability of the different software packages to integrate and share information.

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11. For community nursing it has the effect of dividing records into patient held, paper records and e-records. Until reliable mobile working solutions are available we are not able to achieve one patient one record.12. To date far too much money has been wasted on different and some now defunct systems. The NHS should have purchased one system for the UK. As it stands Tesco know more about us than the NHS.13. I am concerned that there may not be sufficient IT support when they are introduced - we currently have no support out of hours or at weekends and patchy help during the working week and it can be very stressful if there are IT problems.14. As a patient I still have reservations on its true security as public bodies have not got a good record on these matters. The systems can disadvantage some groups of the population15. Crucial to the development of healthcare. There is currently so much duplication in the healthcare system that countless hours of patient and staff time are wasted collecting data that already exist somewhere else. 16. The money that has been invested has been wasted - IT has been developed by people who do not fully understand clinical roles and therefore the systems do not enhance clinical practice - they become a burden and take longer to complete and can potentially lead to errors in practice.

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• ADHD children who no longer require intensive input • Allow people to ask health related questions without embarrassment • Allow the patient to be given good advice on how to act with a problem • Antenatal patients - opportunity to introduce CTG telemetry • Any patients requiring regular support and monitoring to allow them to choose where they are cared for • Anyone with complex needs, who needs input from the multidisciplinary teams • Asthmatics, COPD • Busy patients e.g. those in work who would save time by not travelling • Cancer patient to have connections with cancer network • Cardiac conditions, congestive heart failure patients • Care home residents • Carer support • Cellulitis patients • Chronic pain sufferers • Chronic renal failure monitoring • Colleagues have used video conferencing effectively to assess prisoners on remand for suitability of DRR sentencing • Dermatology • Diabetic management • Elderly prevent long tiring journeys, the frail, elderly faller • Emergency patients • End of life/palliative care • Expert patients who don’t need to attend NHS care settings for maintenance • Follow up of medication and general review when physical examination is not needed • High risk of falls • Home care patients with central feeding lines • Home haemodialysis patients • Hopefully remove some of the waiting time at hospital emergency areas • Hyperlipidemic patients • Hypertensives • Immunosuppressed patients • Learning disabled • M S Patients • Mild forms of depression • Nurses treating patients away from their GP can have advice re their on-going treatment

• Oncology patients who have regular outpatient chemotherapy and might experience serious side- effect at home • Paediatrics • Patient with previous heart attack • Patient with previous sickle cell crisis • Patients anxious to continue living at home rather than in a nursing home/hospital • Patients being monitored by specialist nurses or consultants • Patients discharged rapidly following hip/knee replacement surgery • Patients far from a specialist unit • Patients following surgery, urology follow up cases • Patients in rural areas with long term conditions • Patients waiting investigation results • patients who do not attend cardiac rehab clinics • patients with dementia • Patients with frequent admissions to hospital • Patients with renal impairment • People with mental health issues • People who are in between criteria for primary and secondary services, and are on a lengthy waiting list for IAPT • People who may have poor attendance at appointments • Post bone marrow transplant patients • Post chemotherapy patients • Pregnant women in remote areas • Prison health • Psychiatric outpatients • Pts on long term medication eg rheumatology pts • Pulmonary hypertension patients • Returning to work after period of sickness absence, ill health retirement considerations, work place adjustments • Schizophrenics • Smoking cessation • Those presenting to nurse led minor injury units with a complex problem which needs a doctor’s advice • Those who need to take medication each day, • • Warfarin titration • Thrombolysis with stroke patients with decision with consultants on call • Trauma and orthopaedics • Weight loss • Wound care • Young persons looking for immediate help and support in an emergency situation

Appendix 5: What patients benefit from remote patient monitoringA selection of responses to question 43 ‘What type of patients do you think would benefit from remote patient monitoring?’:

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References1. The Royal College of Nursing (2007) RCN eHealth study: Nursix survey of nurses’ views about IT developments in the NHS, RCN: London.2. The Royal College of Nursing (2010) Telehealth explained, RCN Learning Zone. Available for RCN members at: www.rcn.org.uk

Published by:Royal College of Nursing20 Cavendish SquareLondon W1G 0RN

RCNDirectwww.rcn.org.uk/direct0345 772 6100

Publication code: 004 115www.rcn.org.uk/ehealth

eHealth survey 2010 report - Royal College of · PDF file3 Background The 2010 eHealth survey...

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