Making Connected Health Work for Patients and Practice

Kay KaneSenior Professional Development Officer eHealth

RCN & European Centre for Connected Health

Karen McGurkCase Manager, Northern HSC Trust

Terminology

eHealth 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.

Connected Health is a term used to describe a model for healthcare delivery that uses technology to provide healthcare remotely.

ExamplesPatient Information/Service Portals• Health information on the web• NHS Direct• Map of Medicine• Choose & Book

Patient Care Systems• Telemedicine consultations• Picture Archiving• ECR & Summary Care Record

Telehealth : Remote monitoring• blood pressure monitoring • blood glucose monitoring • cardiac arrhythmia monitoring• medication reminder systems.

Context • Strategic

– National, Regional, Local• Advances in technology

– Less expensive– Widespread use

• Demographic– Ageing Population– Working population reducing

• Public demand– Access to information– Feedback on health indicators

Transformation from Industrial Age Medicine to Information Age Healthcare

Person

Family &Community

Primary Care

Secondary Care

Tertiary Care

Person

Family & Community

Professionals as Facilitators

Professionals as Authorities

Doing Supporting

Professionals as Partners

Use of Information & Communication Technologies

Adapted from Malaysian Telemedicine Blueprint

Patient with Clinical Problem

Gains information via internet, own health record, networks

Patient with Clinical Problem

Visit Clinical Team Gains information

Visits clinical team to gain understanding and

discuss options

Before

Now and in the future

Information Age Healthcare Impact on Nursing

• No longer defined by dispensing knowledge and solving problems

• Will become a broker in the patient’s decision process

- educative- interpretive- facilitation- analysis

• Using technology to give direct nursing care

eHealth : Local Context

• Joint working ECCH & RCN- Appointment of eHealth Officer

• Engaging the Nursing Workforce

eHealth: the voice of nurses in NI

AimTo communicate and market new developments in nursing practice emerging from a technology driven healthcare system to nurses in Northern Ireland

Progress to Date

• Workshops for Nurses and 85 Nurses attended • Survey using a questionnaire (n=80) to gather

information on Nurses awareness of eHealth, their access to IT, and their attitudes towards eHealth

• Focus groups • Consensus Seminar for Strategic Nurses Leaders• RCN – Nursing Informatics Forum • Report

Non Trust StaffSouthern TrustWestern TrustNorthern TrustBelfast TrustSE Trust

Trust

40

30

20

10

0

Co

un

t

71% Community Nurses86% Degree Level81.4% more than 15 years experience24.3% more than 30 years experience

Other Specialist Nurse

Service Manager

Practice Nurse Sister/Charge Nurse

Staff Nurse

Which of the following best describes your job?

20

15

10

5

0

Co

un

t

Demographics

Attitudes and PerceptionsRate Statements – positive & consistent

• Impact on relationship Somewhat bene/beneficial = 80.8%

• Confidentiality No effect/beneficial = 80.8%

• Improve Safety Yes/Partly = 88.1%

• Improve Patient Care Strongly agree/agree = 65.7%

Previous Knowledge of eHealth

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

H&C ECR RTNI ePresc ICTStrategy

ECCH Emer CareRec

eReferral PictureArchiving

75% had heard of eHealth 45% had heard at work

Current Practice in NI

• Remote telemonitoring – over 800 patients COPDDiabetesHeart FailureCardiac

• Teledermatology –over 300 patients• Electronic Pen for TVS• eCat• Virtual Ward• eRostering

Connected Health - Rationale

• Healthcare is a safety critical industry• Good safety practice requires proactive work – systems

as safe as design and forethought will allow• Understanding of benefit and risks of using technology

is essential for safe care

Preparing for the future• Guidance and resources to support nurses’ use of

information and engagement in modernisation through connected health

• Nurses are adequately trained and supported to use new systems and to ensure that connected health is integrated into nursing curricula at all levels.

• Integrating connected health into career and competency frameworks and leadership programmes

Learning to Manage Health Information (2009)

Taking Nursing Informatics seriously !

Nursing Informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice.

American Nurses Association's Scope and Standards for Nursing Informatics Practice (2008)

Developing an eHealth culture

• Strategy/Structure – lead and support

• Education - meet the need

• Service – encourage innovation ‘free thinkers’

• Professional bodies - forums/conferences

Your role………what you can do?• Look out for ways you can use technology in your practice -

be a ‘pioneer’

• Develop Nursing Informatics as an ‘extra string to your bow’ a special interest

• Use your knowledge of nursing and patient care to influence design and implementation

• Join the on-line community, sign up for a mailing list

• Volunteer to take a proactive role- join forums- working groups- keep colleagues up to date

YOUR HEALTH, YOUR CARE AT HOME

Aim of Project

• To support the management of people with long term conditions at home.

• To prevent unnecessary admissions to hospital and residential care.

• To facilitate early discharge when hospital admission is necessary.

Long Term Conditions

• Diabetes

• COPD

• Heart Failure

Assistive Technology

• Remote monitoring of vital signs including:-• Blood pressure• Pulse• Oxygen saturation• Weight• Blood Glucose• Peak Flow

Levels of Support

• Level 1 – Supported Self Care

• Levels 2- Disease Specific Care

• Level 3 – Case Managed

Staff Involved

• Continuing Care Nurses

• Acute Care at Home Team

• Specialist Nurses

Benefits for Patients

• Support people with long term conditions to live independently at home for as long as possible

• Support for carers of people with long term conditions

• Early identification of Exacerbations of L.T.C• Nursing staff can initiate early intervention• Maximise use of professional time and

responses to patients needs

Benefits for Patients (… cont)

• Reduce home visits from nursing staff.• Delivery of flexible, person centred packages of

care.• Help reduce fear and isolation and improve

quality of life.• Contribute to developing alternatives to long-

term care in residential/nursing homes.• Prevent unnecessary admissions to hospital or

residential care.

Patients Views

Promotes:

• self management

• continuous monitoring

• Independence