Home TeleHealth Nursing:

From Silence to Reality

Dr. Antonia ArnaertAssociate Professor, McGill School of Nursing#514-398-5624 / antonia.arnaert@mcgill.ca

Why Bother with the Future?"If you think that you can run

an organisation in the next 10 years as you've run it in the past 10 years you're out

of your mind."

CEO, Coca Cola

The future belongs to the unreasonable ones, the ones who look forward not

backward, who are certain only of uncertainty, and who have the ability

and the confidence to think completely differently.

Why Bother with the Future?

Charles Handy quoting Bernard ShawAmerican Journalist

The point is not to predict the future but to prepare for it

and to shape it

Why Bother with the Future?

How Best to Think about the Future?

FORESIGHTForesight is a method of thinking about the future in order to think about what should be done nowThink of the DRIVERS of CHANGEGather a DIVERSE GROUP together Ask them to think OUTSIDE THE BOXAsk them to make recommendations on what should happen NOW to prepare for the future

FACTS: CanadaCanada's wireless phone industry made huge progress.End of March 2008: subscribers 20.1 million63.7 million text messages per day2007: Total wireless revenues in Canada $12.5 billion

Source: Maravedas. The Canadian Internet Database

20172000

WIRELESS

Increase Prevalence of Chronic Illnesses

Increase Prevalence of Chronic Illnesses

Aging Population

Aging Population

Rising Health Care

Expenditures

Rising Health Care

Expenditures

Changes in Canadian

Healthcare System

Changes in Canadian

Healthcare System

Shortage of Medical

Professionals

Shortage of Medical

Professionals

Environmental Factors

Environmental Factors

Waiting Lists / Overcrowded ERWaiting Lists /

Overcrowded ERIncreased Political

Importance of Healthcare

Increased Political

Importance of Healthcare

Movement of Services to the

Community

Movement of Services to the

Community

New Technologies

E-Health

New Technologies

E-Health

Healthcare Consumerism

Healthcare Consumerism

Forces Changing the Healthcare Landscape

“e-health is an emerging field in the intersection of medical informatics, public health and business,

referring to health services and information delivered or enhanced through the Internet and

related technologies.

In a broader sense, the term characterizes not only a technical development, but also a state-of-

mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to

improve health care locally, regionally, and worldwide by using information and communication

technology.”

What is eWhat is e--Healthcare? ...Healthcare? ...

Source: Eysenbach, G. (2001). What is e-Health? Editorial. Journal of Medical Internet Research, 3(2), e20.

TELEHEALTH & NURSING

Where are we in Canada?

Telehealth Nursing (CNA) = includes all client-centered forms of nursing

practice as well as the provision of information and education for healthcare providers occurring

through, or facilitated by, the use of telecommunications or electronic means.

(1) Telephone Nursing= Provinces and territories have 24/7 telephone

nursing lines.

(2) Telemedicine Encounters

(3) Home Telehealth

Today’s Telehealth Nursing Delivery Models

(2) Telemedicine Encounters• Nurses: a key role in effective integration of telemedicine services• Prior to the tele-consultation, the nurse will make sure to have all

information ready for the consultation, e.g., vital sign measurement, medications and completed lab work.

• During the tele-consultation they assist the physician specialist with the assessments, communicating key information, and serve as patient’s advocate.

• After the tele-consultation, the nurse does the follow-up care and communicates these to the patient, and other healthcare providers.

Research Projects

Nursing Home Tele-Health

Depression

Hypertension

Diabetes

COPD

Palliative Care

Cancer

ISDN

Wireless

Telephone

ISDN

Wireless

Telephone

Cancer

“Any formalized patient education program aimed at teaching skills needed to carry out specific medical regimens and guide health behavior change for patients to control their

disease and improve their well-being”

Knowledge Acquisition↑ Self-Efficacy (Self-Confidence)Adoption and Maintenance of Skills

Behavior ChangesSource: Bourbeau & Nault (2007). Self-Management Strategies in COPD. Clin Chest Med, 28, 617-628.

Self-Management

Using a Chronic DiseaseManagement (CDM) Approach

Expert Managers

Home Telehealth PlatformTelehealth

NursesPatient HOME

High-Speed

InternetCase Managers

Home Telehealth Nursing Services

COPD Patients

Home Telehealth Patients with a New Stoma

“I feel much safer with it [videoconferencing system] there now. I feel more confident”

“ I’m totally at ease and the nurses understandyou and they can talk to you from human to

human, you know?”

“I see her [the nurse] on the T.V., an I’m talking to her expressions, I see her quite a bit. So yes I feel totally at ease with that

[videoconferencing system]

“The advantages is that I’m more comfortable in my own home, you know? And for me to get at SMHC, for example, for my chemo day.

We leave her at 5:30am …, because he [her husband] has to drop me at SMHC at 7:00am, … So I’m there from 7:00am in the morning and I’m not seen till 9 or 10 o’clock. So I’m there for a long time, whereas

sitting here I’ll be fine.”

Home Telehealth NursingDiabetes - Hypertension

“I think it will help people take control, or at least feel that they have more control… over their health, and, and

where their going. And, I believe that …if their doing this constantly and they

have direct feedback from either the machine or from the nurses or a doctor, I think it empowers people

to really take charge of their situation”

“it’s an amazing apparatus”“This should be widespread”

“It’s exceptional, exceptional … And I was so fortunate being on it” “I say it’s

very beneficial”

Home Telehealth Palliative -Oncology Patients

Messaging Device System

Pain & Symptom Management

Telehealth-BELTTM

ARNAERT

Successful Telehealth ServicesWhat do you need?

BELT

Bandwidth Education/

Equipment

Leader Team

TELEHEALTH

WAGNER’S CHRONIC CARE MODEL

Ca

Inter-Professional Collaboration

ChronicDisease

Management

Case Management

TELEHEALTH

PATIENT-CENTRIC CARE

WIN WIN WIN

Telehealth is a TOOL that allows all concerned to WIN!

Home TeleHealth Model

THANK YOU