D.U.E., MSc. Carme Hernández Coordinación Atención Integrada Dirección Médica y de Enfermería

1. La enfermería en los nuevos modelos de atención a la cronicidad. La telemedicina como herramienta de soporte Profesionales: Telemedicina, capacitación, nuevos roles D.U.E., MSc. Carme Hernández Coordinación Atención Integrada Dirección Médica y de Enfermería Hospital Clínic Barcelona

2. Agenda El paciente crónico ¿Es el motivo? Capacitación, nuevos roles Nuestra experiencia Conclusiones

3. Factores de cambio de los sistemas de Salud

5. Current Fragmentation of Care Patients experience and clinicians operate in “silos” of care. Referral networks are large and often depersonalized. Barreras por parte de los profesionales, ciudadanos, sistemas de pago y de las TICs Pham HH, O'Malley AS, Bach PB, Saiontz-Martinez C, Schrag D. Primary care physicians' links to other physicians through Medicare patients: the scope of care coordination. Ann Intern Med. Feb 17 2009;150(4):236-242.

6. Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Eff Clin Prac 1998;1(1):2-4.http://www.improvingchroniccare.org

7. Integrated Care Definition Concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency. Gröne, O & Garcia-Barbero, M (2002): Trends in Integrated Care – Reflections on Conceptual Issues. World Health Organization, Copenhagen, 2002, EUR/02/5037864

8. Atención de calidad para la cronicidad La transformación transversal de la organización sanitaria. La introducción de Tecnologías de la información y de la comunicación (TIC's) específicamente dirigidas a mejorar la atención a los pacientes con enfermedades crónicas y a facilitar el trabajo de los profesionales. Una apuesta decidida para desarrollar el trabajo en equipo. Juan J Baztán et al. BMJ 2009;338:b50

9. The Scenario Rediseño de roles de los profesionales

10. Agenda El paciente crónico ¿Es el motivo? Capacitación, nuevos roles Nuestra experiencia Conclusiones

11. Training, education, and skill set of today’s health care personnel is not adequate to manage patients with chronic conditions. There is general consensus that to provide effective health care for chronic conditions, the skills of health professionals must be expanded to meet these new complexities. • Judith Oulton.Chief Executive Officer.International Council of Nurses

12. Five basic competencies for caring patients with chronic disorders

13. Competence 4. Information and communication technology(are essential for organizing and monitoring patients’ responses to treatments and outcomes) Designing and using patient registries Using computer technologies Communicating with partners (The potential to use mobile phone text-messaging technology to remind patients about appointments, medication refills, or test results, is virtually untapped) Basic skills: (using word-processing and data analysis software; searching online and internal databases; retrieving and managing data; being aware of data security systems related to the use of patient information. …) Institute of Medicine. Health professions education: A bridge to quality. Washington DC, The National Academies Press, 2003; O’Neil EH and the Pew Health Professions Commission. Creating health professional practice for a new century. San Francisco, Pew Health Professions; Commission, 1998; Forsstrom J, Rigby M. TEAC-Health: Research-based recommendations for European certification of health telematics services. Studies in Health Technology and Informatics, 2000, 77:288–292

14. Del hombre-filósofo a la medicina-ciencia y de la mujer-cuidadora a la enfermería-arte y ciencia

15. Licenciatura Incorporación de las TIC

16. Carrera Profesional

17. Nursing leadership: bringing caring back to the future. Alison Kitson. Qual Health Care 2001;10:ii79-ii84 doi:10.1136/qhc.0100079

18. Career, Training & Certification Certification in nursing informatics

19. Recommendations of the International Medical InformaticsAssociation (IMIA) on education in health and medical informatics Educational needs for health care professionals to acquire knowledge and skills in ICTs. Different levels of education, respectively stages of career progression Various education methodologies are needed to provide the required theoretical knowledge, practical skills and mature attitudes. Alternate routes to different types of specialization will depend on career choice. The majority of health care professionals need to know how to efficiently and responsibly use information and communication technology, but only a few will choose to have accredited specialization in this field. Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics. First Revision. J. Mantas et al. Methods Inf Med 2010; 49: 105–120

20. Keep-in-Touch care Assessment Screening via questionnaire Clinical view via screen Self-management supporting presence Virtual presence Intervention when risks are signaled Patient feels the need for contact Relapse prevention Tele-monitoring and tele-nursing (knowledge, symptoms, behavior) Prevent derailment Support ADL Answering and monitoring questions “missed” symptoms Care Specialized information on demand Specialized information on website Advice for social needs Triage Self-management advice or second opinion

21. Putting information atthe heart of nursing care When nurses are ICT innovators, Healthcare results will change

22. Las grandes razones para apostar por la enfermería y telemedicina Reputación digital A pie de cama las 24 horas del día Capacidad de liderar grupos y de trabajo en equipo Evaluación global del paciente y capacidad para planificar cuidados Paciente activo (e-patients) Acceder a la información relevante Intervenciones basadas en la evidencia Facilitar el intercambio de información

23. Agenda El paciente crónico ¿Es el motivo? Capacitación, nuevos roles Nuestra experiencia Conclusiones

24. Centro de control de llamadas Historia Clínica única Profesionales Pacientes

25. Adaptation of health services to chronic patientsshared care arrangements across the system Hospital Consultant Emergency team Primary Care Case Manager Mobile teams Home Primary Care Team Patient Relatives & care givers Services providers

26. Modelo de atención Definición Plan de trabajo Basadas en la evidencia Cuestionarios validados Intervenciones individualizadas Control de calidad Utilización de las TICs como herramientas de soporte Seguimiento Evaluación del caso Alta del proceso agudo Identificación del caso Seguimiento post alta hospitalaria

29. Mobile technology: patient’s satisfaction

30. Esquema del Modelo de Servicio de Rehabilitación Pulmonar

31. Redes sociales de pacientes Uso intensivo de materiales de educación sanitaria en formato video o multimedia Redes de enfermedades crónicas Redes de enfermedades raras Redes de hábitos saludables

32. Results

33. Lessons learnt A cultural change of the professionals is mandatory Need for integration of ICT tools Sustainability of the new models of care Extensive adoption

34. Medical devices must meet real needs andprovide clear value(Understanding of the particular needs of health professionals and patients) The urge to apply technologies without proper identification and understanding of the most compelling needs is a frequent source of failure for medical innovation. Training and fostering of collaboration with engineers health care professionals, business and design strategists and social scientists are crucial to the development of scalable, cost effective devices. Assessing medical needs, building capacity and promoting cost-effective innovation will help in realizing technology’s potential for achieving better health in chronic patients. Substantial evidence indicates that when the value of improved quality of life and productivity are considered, investments in health technology offer great returns. Health Technologies and Innovation in the Global Health Arena. Sidhartha R. Sinha, M.D. and Michele Barry, M.D. NEJM 365;9 2011; WHO. First WHO global forum on medical devices: context, outcomes, and future actions. 2011; Health, retirement needs challenge an aging America. Press release of the National Institute on Aging, Bethesda, MD, September 28, 2004 (http://www.nia.nih.gov)

35. Barreras para el uso de las TICs Entender los beneficios Aumento cargas de trabajo Inter-operabilidad entre las diferentes plataformas Temas éticos y de confidencialidad Falta de un trabajo conjunto Falta de entrenamiento Adaptación en función de las necesidades de profesionales y pacientes Ball MJ, et al. Methods Inf Med 2008; 47: 4–7; Hersh W. JAMA 2004; 292: 2273–2274; Hersh W. J Am Med Inform Assoc 2006; 13: 166–170; Hersh W. Yearb Med Inform 2008. pp 157–164.

36. Agenda El paciente crónico ¿Es el motivo? Capacitación, nuevos roles Nuestra experiencia Conclusiones

37. Conclusions The transition from acute to chronic health problems places a new and different set of demands on the health care workforce. In addition to skills that facilitate the diagnosis and treatment of acute illness and injury, today’s workforce needs a core set of competencies that will yield better outcomes for patients with chronic conditions. Medical devices must meet real needs andprovide clear value.

38. “Nada cambia sin una transformación personal”.

41. Entrenamiento duro Trabajo Espíritu de equipo Éxito chernan@clinic.ub.es