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Arctic Light e-He@lth Conference Tackling the changes accompanying e-health implementation Dr. Marina Lupari LTC Lead / AD for Nursing – R& D NHSCT – Northern Ireland Demographics and the rapid increase in chronic disease 90 million 100 million Western Europe 72 million USA Numbers of People Over 65 33 million Japan 10 million 2002 2025 Source: US Bureau of Statistics • Changed & poor diet • Obesity • Less physical activity • Cardiovascular disease • Poor lifestyle choices • Type 2 diabetes GOOD ADVICE Most smokers know ‘its bad for them’. Most can give you ‘good reasons’ why they do not want to stop right now. When you discuss this it often polarises them into taking a defensive position REASONS FOR SMOKING Managing the Illness Taking medications Changing diet and exercise Managing symptoms of pain, fatigue, insomnia, shortness of breath, etc. Interacting with the health & care system Managing Daily Activities and Roles Maintaining roles as spouse, parent, worker, etc. Managing the Emotions Managing anger, fear, depression, isolation, etc. Patient as partner in care provision not recipient of care Creation of a Chronic Illness case management service Health Stratification Model Case management Disease management & shared clinical care Largely self care Level 3 Patients with highly complex needs and co-morbidities Level 2 High risk patients Level 1 70-80% of LTC population Predictive risk profiling of patients Nurse led generalist model across several chronic conditions (Heart Failure, COPD, Asthma and Diabetes) Least invasive care in the least intensive setting through patient-centred case management approaches AND ehealth Target group- older people identified as being at most risk of avoidable re-admission to hospital( PARR tool) Integration and coordination of the individual’s journey through all parts of the health and social care systems (Integrated Care pathways) Incorporates elements of disease management and selfcare Anticipatory care facilitated through proactive as opposed to reactive care model Adopted remote monitoring telehealth as support system “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.” Patient admitted/discharged Activity recorded on Trust PAS PARR DATABASE Activity downloaded into PARR Via Business Objects, Trust Designed MS Access Database Sifting & criteria applied Risk Level Identified OTHER PATIENT DATA APPLIED CASE FINDING DATABASE Nurse assesses and accepts person onto the caseload Choosing the right telehealth System P O P U L A T I O n + Or High risk V100 Intermediate risk Multiple conditions Intermediate risk V500 Case Manager Specialist Physicians + Case Manager V100 + Case Manager Low risk + Peripherals Peripherals only ECG recorder / transmitter Digital scale SpO2 meter Home-based data transmitter Blood pressure meter Glucose meter Spirometer Enhanced patient self management Reduction of readmission to hospital in 9 month period of 59% Significant increase in HR-QOL ( both patient perception and actual health state) Increase in patient functionality Robust evidence base demonstration costeffectiveness at £20,000-£30,000 willingness to pay Change of working culture for All existing staff e.g. medics, nurses, pharmacists Resistance from existing disease management specialists e.g. medics, nurses, physiotherapists Perception of a territorial threat to existing staff and existing practices Changing the Team Community Community Primary Care Integrated Care Partnership Primary Care Virtual Care Team Secondary/Tertiary Care Changing the Health Record Clinical Medication Demographics Images Documents Tests Home Visits Community Risk Community Primary Care Patient Record Home Monitorin Hospital Patient Referral Management Recall Prescriptions Changing the Patient Care Pathway Primary Care Consultation Primary Hospital Care Consultation Test Hospital Test Hospital Teleclinic Consultation Present with Symptoms Normal or refer Refer to Hospital to different speciality Refer to Hospital Normal or refer to different speciality Hospital Procedure Hospital Teleclinic Follow Up Primary Care Management Discharge Discharge Changing Consultation for Primary Care Patient Advocacy And Support Local Health CHF Professional History and Symptoms General Practitioner/ Consultant Full Clinical History Management Electronic Patient Record Changing Applications for Primary Care Ultrasound Physiotherapy Echocardiography Vascular Obstetrics Express acceptance and affirmation Try to understand how the person sees their problems (reflective listening) Elicit and reinforce self-motivational statements: concerns, desire, intention and ability to change Assess and feedback their readiness to change Affirm the persons freedom of choice Unknown Territory… The power to redesign and improve health care delivery has arrived Technology is a tool in the toolbox that will give patients and nurses more choices. All staff time and effort will be better spent where and when it is needed. Technology provides the means to leverage health care process to improve access to care and facilitate collaboration. Rethink Care Restructure Care Retrain for Collaborative Care Put patients first [email protected]
