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
Disclosure
I have no relevant financial interest to disclose nor
am I endorsing any commercial products
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.
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.
• "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://essential-design.com/wp-content/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://si.wsj.net/public/resources/images/IV-AA609A_PATIE_G_20140605114203.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 http://inhabitat.com/nyc/wp-content/blogs.dir/2/files/2011/06/make-nyc-your-gym-537x357.jpg
Patient Engagement
What Does This Mean?
"Health Policy Brief: Patient Engagement," Health Affairs, February 14, 2013. http://www.healthaffairs.org/healthpolicybriefs/
Patient Engagement Framework
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
• Health
Information
Exchange/Portals
Consumer Health Literacy
Emobile Health
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.
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.
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
Health IT for You: Giving You Access to Your Medical Records When and Where They're Needed
Student Learning Activity
Example 2
ACCESS: Portals
A portal simply allows patients to view provider
information or communicate with providers
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/mhealthEmobile Health
http://blog.broadcom.com/wp-content/uploads/2014/04/49106_wwwHero-Sensors_BlogImg.jpg
http://www.designworldonline.com/uploads/Imagegallery/sensors-on-a-patient.jpg http://files.geforcee.geblogs.com/geforcee/files/2011/08/Handy-Apps-for-Your-Healthy-Life.png
Social Media: Facebook, YouTube and Twitter, etc.
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/
Quantified Self
•
“self-knowledge
through self-tracking
with technology.
Quantified
self-advancement 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
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
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
Role of Telehealth Nurse
• Nurse presenter – ambulatory
• Nurse case manager – i.e. diabetes care
• Public health nursing– Text4babies, Text2Quit
• Health coach
• Tele-ICU nursing
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
Telehealth Methods
•
Real-time
• Telephone-based – limited to
education/ counseling
• Web-consults (two-way audio and video)
• With or without peripheral devices
•
Store and forward – images,
audio, video
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
Mr. Smith’s House is Calling
• Caregiver Alerts • Voice Prompts • Floor Sensors • Safety Features • Smart Beds • Video Monitors• Vital Sign Monitoring
Ethical/ Legal Issues
•
Competent Care
•
AAACN - Scope and Standards of Telehealth Nursing
•
ATA – Standards and Guidelines
•
Devices
•
Center for Telehealth and eHealth Law
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
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
Consumer Health Literacy
Type of Literacy Explanation
Oral literacy Speaking and listening
Print/visual literacy Writing and reading, understanding graphical and visual information Information literacy Obtaining and applying relevant
information
Numeracy The ability to calculate or reason with numbers
Computer literacy 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
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
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
Ethics
Information Security
Protected Health
Information
Personal health information (PHI),
also referred to as protected health
information:
•
demographic information
•
medical history
•
test and laboratory results
•
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
Protecting
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
