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://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/uploadimage/010511/biggulp_1294253776.jpg

http://www.usnews.com/dims4/USNEWS/3f1f6d5/2147483647/resize/652x%3E/quality/85/?url=%2Fcmsmedia%2F18%2F8108238606c9d555144d85588aaa3f%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?

• 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 • Health

Information Exchange/Portals

Consumer Health Literacy

Emobile Health

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://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/

http://www.iw5edi.com/wp-content/uploads/2013/09/GoogleGlass.jpg

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 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/goe_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

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

• 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/interoperability

• 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 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 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

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

Protected 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