National Nursing Informatics Deep Dive Program Patient Engagement, Communication Technologies, and Information Security Dorcas Kunkel, DNP, MS, BSN, APHN-BC University of Minnesota School of Nursing November 19, 2014
Disclosure I have no relevant financial interest to disclose nor am I endorsing any commercial products identified in this presentation.
Objectives Define patient engagement. Describe consumer health literacy, personal health records, emobile health, telehealth, and virtual care delivery. Discuss ethics related to information security and protected health information. Contrast benefits and limitations of different communication technologies and their impact on safety and quality. Examine teaching methods.
Patient Engagement Engaged patients: Seek information about their health and health care Make informed and shared decisions with their health care team Take steps to manage their health and health care Act as partners with their health care team Engaged caregivers also play a key role, especially when patients have limitations because of age, an illness, cognitive impairment, or other reasons. http://www.healthit.gov/sites/default/files/nlc_using_e-healthtools.pdf
"Patient activation" refers to a patient's knowledge, skills, ability, and willingness to manage his or her own health and care. "Patient engagement" is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care or exercising regularly. James, J. (Feb. 14, 2013). Patient Engagement. Health Policy Briefs. http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86
http://si.wsj.net/public/resources/images/iv-aa609a_patie_g_20140605114203.jpg http://essential-design.com/wpcontent/uploads/2014/03/cs_0006_hc_welldoce_page_1.jpg_860x445.jpg http://0.tqn.com/y/medicalsupplies/1/w/e/0/-/- /Insulin_pump_with_infusion_set.jpg http://inhabitat.com/nyc/wp-content/blogs.dir/2/files/2011/06/make-nyc-yourgym-537x357.jpg http://image.minyanville.com/assets/dailyfeed/upl oadimage/010511/biggulp_1294253776.jpg http://www.usnews.com/dims4/usnews/3f1f6d5/2147483647/resize/652 x%3e/quality/85/?url=%2fcmsmedia%2f18%2f8108238606c9d555144d85 588aaa3f%2F45572WideModern_DoctorandPatient_080213.jpg
Patient Engagement What Does This Mean? Patient Engagement, Interview with Jan Oldenburg, FHIMSS
"Health Policy Brief: Patient Engagement," Health Affairs, February 14, 2013. http://www.healthaffairs.org/healthpolicybriefs/
Patient Engagement Framework http://himss.files.cms-plus.com/himssorg/nehclibrary/himss_foundation_patient_engagement_framework.pdf
Discussions at tables Review the two frameworks and think about how your curricula includes learning opportunities for students about patient engagement in both didactic and practice learning. Share several of these with a partner at the table. Identify if there are gaps in your curricula in what students are learning about patient engagement. How might you close those gaps? Use the two Patient Engagement Frameworks in your packets (5 minutes).
Patient Engagement Strategies Access Personal Health Records Emobile Health Health Information Consumer Health Literacy Exchange/Portals Telehealth and Virtual Care Delivery
ACCESS: Personal Health Records An electronic application managed by patients to maintain and manage their health information in a private, secure, and confidential environment. Includes information from a variety of sources, health care providers and patients. Properly designed and implemented, PHRs can help patients become full partners in the quest for good health. http://www.healthit.gov/providers-professionals/faqs/what-personal-health-record
Student Learning Activity Example Describe activity I have junior level clinical groups register for a basic account and take the healtheliving assessment that is part of the VA s personal health record within Myhealthevet. Learning outcome This helps them get a feel for how to engage Veteran s and answer questions such as: How can the healtheliving assessment help me reach my goals?
ACCESS: Health Information Exchange Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient s vital medical information electronically improving the speed, quality, safety and cost of patient care. http://www.healthit.gov/providers-professionals/health-information-exchange/what-hie
Three Key Forms of Health Information Exchange Directed Exchange ability to send and receive secure information electronically between care providers to support coordinated care Query-based Exchange ability for providers to find and/or request information on a patient from other providers, often used for unplanned care Consumer Mediated Exchange ability for patients to aggregate and control the use of their health information among providers http://www.healthit.gov/providers-professionals/health-information-exchange/what-hie
Health IT for You: Giving You Access to Your Medical Records When and Where They're Needed Office of the National Coordinator for Health IT
Student Learning Activity Example 2
ACCESS: Portals A portal simply allows patients to view provider information or communicate with providers and is distinct from a PHR.
Student Learning Activity Example 3
Emobile Health (mhealth) mhealth is the generation, aggregation, and dissemination of health information via mobile and wireless devices (HIMSS). http://www.himss.org/library/mhealth
Emobile Health http://blog.broadcom.com/wp-content/uploads/2014/04/49106_wwwhero- Sensors_BlogImg.jpg http://files.geforcee.geblogs.com/geforcee/files/2011/08/handy-apps-for-your-healthy-life.png Social Media: Facebook, YouTube and Twitter, etc. http://www.designworldonline.com/uploads/imagegallery/sensors-on-a-patient.jpg
Google Glass Vallurupalli, S., Paydak, H., Agarwal, S. K., Agrawal, M., & Assad- Kottner, C. (2013). Wearable technology to improve education and patient outcomes in a cardiology fellowship program - a feasibility study. Health and Technology, 3(4), pp 267-270. Science Roll, The Journey of a Geek Medical Futurist accessed Sept. 2, 2014: http://scienceroll.com/category/google-glass-2/
http://www.iw5edi.com/wp-content/uploads/2013/09/googleglass.jpg
Quantified Self self-knowledge through self-tracking with technology. Quantified selfadvancement have allowed individuals to quantify biometrics that they never knew existed, as well as make data collection cheaper and more convenient. http://en.wikipedia.org/wiki/quantified_self Quantified Self, Gary Wolf (5 min) The Apple Watch Credit: Apple livestream, screengrab http://www.livescience.com/47760-apple-watch-health-activity-tracking.html
Global Surveillance Short Message Service (SMS) is a the text messaging service component of a mobile phone, the Web, or other mobile communication systems. http://en.wikipedia.org/wiki/short_message_service Rapid detection of early stage disease outbreaks via mobile phones employing SIM cards. World Health Organization. (2011). mhealth: New horizons for health through mobile technologies. http://www.who.int/goe/publications/g oe_mhealth_web.pdf
Smart Homes http://m.eet.com/media/1177002/greenpeak%20smart%20homes%20figure%202%20625.jpg
Student Learning Activity Example 4
Telehealth and Virtual Care Delivery Definitions of Telehealth Nursing Telehealth nursing is the delivery, management, and coordination of care and services provided via telecommunications technology within the domain of nursing. (American Association of Ambulatory Nursing 2004) Telehealth nursing is the use of telecommunications technology in nursing to enhance patient care. It involved the use of electromagnetic channels (e.g., wire, radio, and optical) to transmit voice, data and video communications signals. It is defined as distance communication, using electrical or optical transmissions between humans and/or computers. (Skiba, D.J. & Barton, A.J.,2000) Telehealth nursing is the practice of nursing over distance using telecommunications technology. (National Council of State Boards of Nursing, 1997)
Use of Telehealth Home health care - monitoring, education, support Nursing home - specialty consultations Ambulatory care - specialty consultations Hospital consultations - stroke care Prison settings mental health services Mentoring i.e. wound care specialists ICU monitoring neonatal intensive care, cardiac care Health promotion obesity, exercise/ fitness
Role of Telehealth Nurse Nurse presenter ambulatory Nurse case manager i.e. diabetes care Public health nursing Text4babies, Text2Quit Health coach Tele-ICU nursing Clinical tele-health coordinator
Example Nurse Presenter Planning telehealth program i.e. specialty consultations in rural clinic/ hospital Coordinate scheduling patients Evaluating and preparing equipment Assessing patients Presenting patient Facilitating remote exam Documentation Follow up care
Real-time Telehealth Methods Telephone-based limited to education/ counseling Web-consults (two-way audio and video) With or without peripheral devices Store and forward images, audio, video Combination
Telehealth Equipment Phone lines/ internet Phone/ computer with or without camera/ microphone Cell phones Life line Sensor Technology Peripheral devices Peripheral Devices Blood pressure Scales Glucose monitoring EKG/ cardiac monitoring Dermascope Otoscopes Pedometers
Monitoring - eicu Care Baptist - eicu eight ICUs for a total of 142 beds 4 nurses/ shift average 19 years experience Real time vital signs and cardiac monitoring Entire electronic record Alerts if any change that could be a problem Activation of camera and speaker from eicu for visual assessment and communication with the floor staff or patient http://ram.aetn.org/ark_champions_of_change/baptist_eicu
Mr. Smith s House is Calling Caregiver Alerts Voice Prompts Floor Sensors Safety Features Smart Beds Video Monitors Vital Sign Monitoring Medical Condition Monitoring
Ethical/ Legal Issues Competent Care AAACN - Scope and Standards of Telehealth Nursing ATA Standards and Guidelines Devices Center for Telehealth and ehealth Law License to practice
Safety Issues Assess appropriateness of telehealth for the patients ability and status Know equipment Evaluate reliability and effective use of equipment Infection control Information safety Compliment with nurse judgment
Benefits and Challenges Benefits of Telehealth Health care access Financial return Coordination of care Quality of care Challenges of Telehealth Expansion of usage Technology infrastructure/interopera bility Financial investment Licensure and credentialing Reimbursement
Student Learning Activity Example 5
Consumer Health Literacy ehealth literacy is defined as the ability to seek, find, understand and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a problem.
Consumer Health Literacy Type of Literacy Oral literacy Print/visual literacy Information literacy Numeracy Computer literacy Explanation Speaking and listening Writing and reading, understanding graphical and visual information Obtaining and applying relevant information The ability to calculate or reason with numbers Operating a computer or information device
Scope of Health Literacy Extent of problem About half (90 million) American Adults have difficulty processing and understanding complex text. 9 of 10 adults have difficulty with every day health information Implications: Challenges with common health information from insurance forms to medication labels.
Importance of Health Literacy Without clear information and an understanding of the information s importance, patients are more likely to: Have difficulty managing chronic diseases like diabetes or high blood pressure. Not engage in decisions Results: Higher utilization of health services Skip necessary medical tests Poor adherence to treatments End up in the emergency room more often Higher costs range from $106 billion to $238 billion annually Poorer outcomes
Consumer Health Literacy Dave de Bronkhart calls on all patients to talk with one another, know their own health data, and make health care better one e-patient at a time.
Student Learning Activity Example 6
Regulatory Requirements, Confidentiality, and Clients Right to Privacy Protected Health Information Ethics Information Security
Protected Health Information Personal health information (PHI), also referred to as protected health information: demographic information Protecting medical history Health test and laboratory results Information insurance information other data that is collected by a health care professional to identify an individual and determine appropriate care. http://searchhealthit.techtarget.com/definition/personal-health-information
Information Security 1. Use a password or other user authentication 2. Install and enable encryption 3. Install and activate remote wiping and/or remote disabling 4. Disable and do not install or use file sharing applications 5. Install and enable a firewall 6. Install and enable security software 7. Keep your security software up to date 8. Research mobile applications (apps) before downloading 9. Maintain physical control 10. Use adequate security to send or receive health information over public Wi-Fi networks 11. Delete all stored health information before discarding or reusing the mobile device
Student Learning Activity Example 7
Discussion session 15 minutes Paper for participants to record observations and insights What are some of the current strategies you are using in you curricula for students to learn about the topics in this presentation? What new ideas do you have for learning activities? (1 min.) Generate ideas in pairs, building on ideas from self-reflection. (2 min.) Share and develop ideas from your pair in foursomes (notice similarities and differences). (4 min.) Each group shares one important idea with all (repeat cycle as needed). (5 min.) We would like to collect your thoughts and ideas, so please leave your completed papers at table center. Thank you!
Dorcas Kunkel, DNP, RN, APHN-BC Assistant Clinical Professor University of Minnesota, School of Nursing W 612-499-0197 kunk0041@umn.edu