Clinical Informatics Outside the Walls of Healthcare Settings: Telehealth and Consumer Health Informatics

Notes from module 5 of the Interprofessional Health Informatics course I’m working on (plus side reading that I did to fill in some blanks/learn more about some things mentioned in the course). [Note: I posted this on August 5, 2015, but then it disappeared completely from my blog! Thank goodness for Google, as I was able to find a cached version so I could re-post it!]

Telehealth

  • e.g., remote patient monitoring systems – provide continuous monitoring and communicate the data from that monitoring to both the patient and their healthcare providers; this may result in better management of disease and improved health outcomes
  • medical devices are getting better due to miniaturization (making devices more convenient), communications capability (so devices can send information), the ability to converge multiple monitoring functions into a single device, and decreases in battery size.
  • wireless transmission (e.g.,. cell phones, wifi) allows devices to send information
  • once the data is sent, something needs to be done with it! We need diagnostic and analytical software to analyze the data to make it meaningful
  • one challenge is how to manage remote patient monitoring information in the context of multiple IT systems (e.g., personal health records, EHRs, data repositories)
  • telehealth is used in a number of settings
    • e.g., home health, nursing homes, ambulatory care, hospital consultations, prisons, ICU monitoring, health promotion
  • telehealth nurses can have many roles
    • e.g., nurse presenter – sets up patient to “present” to the provider on the other end of the line; nurse case manager; public health nurse, health coach; tele-ICU nursing (monitoring many ICUs)
  • telehealth can be:
    • real-time (e.g., telephone-based, web-consults; sometimes use peripheral devices)
    • store and forward (e.g., x-ray taken and send to someone)
    • combination – real-time consult using images/audio that was previously stored
  • peripheral devices – e.g., blood pressure, stethoscopes, scales, glucose monitoring, pedometers, dermascope, otoscope, EKG, portable ultrasounds, etc. – the device collects data and transmits it to someone who isn’t there
  • can be as simple as an email consult or as complex as remote monitoring of an ICU
  • all kinds of new technologies are being invented – voice prompts to remind you to take your meds, a smartbed to notify patient about to be incontinent; floor sensors for people with walking issues)
  • research shows that telehealth can increase access to health care, financial return, coordination and quality of care
  • challenges include: infrastructure, interoperability, cost, licensing/credentialing, reimbursement, and evalution

Big Data!

  • the online course linked to this resource: The Fourth Paradigm: Data-Intensive Scientific Discovery – full text available online, which I skimmed through and found some interesting stuff!
  • data-intensive science consists of:
    • capture: data can come from lots and lots of places – single laboratories, cross-laboratory studies, big international studies, individuals’ lives (think: the data from your Fitbit) [EHRs, disease repositories]
    • curation: includes “finding the right data structures of map into various stores. It includes the schema and necessary metadata for longevity and for integration across instruments, experiments, and laboratories” (p. xiii); without this, the data will only be usable by a small number of people (e.g., the lab that did the experiment) and will eventually be lost (e.g., when those people retire)
    • analysis: basically, this refers to turning the data into knowledge – e.g., analysis, modeling, predictive analytics, visualization
  • “eScience is where “IT meetings scientists”” (p. xviii)
  • science paradigms (from p. xviii) :
    • 1000 years ago: science was empirical (describing natural phenomena)
    • last few hundred years: a theoretical branch (using models, generalizations)
    • last few decades: a computational branch (simulating complex phenomena)
    • today: data exploration a.k.a., eScience (unify theory, experiment, and simulation; data captured by instruments or generalized by simulator, processed by software, stored in a computer, and analyzed)

Consumer Health Informatics

FitBit

  • Consumer health informatics (CHI) = “consumer-initiated and/or controlled information to manage one’s own health”
  • depends on literacy – but about 1/2 of Americans have difficulty processing and understanding complex text; 9/10 adults have difficulty with “every day” health information (e.g., MI vs. heart attack)
  • has many implications – e.g., do people understand how to take their medications?
    •  if people don’t have the needed information (or can’t understand it), they have trouble managing chronic diseases and aren’t engaged in decisions
    • can result things like in skipping medical tests (because they don’t understand why they are needed), poor adherence to treatment (because they don’t understand how they work – e.g., thinking that once physiotherapy appointment is over, treatment is done; didn’t understand that they need to continue to do the exercise) –> poorer outcomes –> higher costs
  • under the Affordable Care Act, health literacy = “the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions”
  • eHealth literacy = “the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to address or solving a health problem”; includes:
    • oral – speaking and hearing
    • print/visual – reading, writing, understanding visuals
    • numeracy – ability to calculate or reason with numbers
    • computer literacy – operating a computer or information device
  • “universal precautions” = “take specific actions that minimize risk for everyone when it is unclear which patients make be affected” (e.g., if you don’t know who is illiterate, you design your communications so that it will work for those with low literacy and it will work for everyone)
  • consumers are using technology to manage their health – e.g., Fitbit, blood pressure monitors, wifi scales (e.g., a congestive heart failure patient who needs to weigh themselves every day and contact healthcare provider if they gain more than 2 lbs in one day)
  • patient “portal” – allow clients to tap into their own EHR
  • consumers get health information from the web, as well as support group
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