Tackling Changes in e-Health Implementation at Arctic Light e-Health Conference

1. Arctic Light e-He@lth Conference Tackling the changes accompanying e-health implementation Dr. Marina Lupari LTC Lead / AD for Nursing – R& D NHSCT – Northern Ireland

2. 90 million 100 million Western Europe 72 million USA Numbers of People Over 65 33 million Japan 10 million 2002 2025 Source: US Bureau of Statistics Key Demographic & Lifestyle Challenges Demographics and the rapid increase in chronic disease BIG Problem • Obesity • Cardiovascular disease • Type 2 diabetes • Changed & poor diet • Less physical activity • Poor lifestyle choices BIG Problem

3. What are the key determinants of health?

4. GOOD ADVICE

6. Giving Advice to Stop Smoking? • Most smokers know ‘its bad for them’. • Most can give you ‘good reasons’ why they do not want to stop right now. • When you discuss this it often polarises them into taking a defensive position

7. REASONS FOR SMOKING

8. Living with Chronic Disease Managing the Illness • Taking medications • Changing diet and exercise • Managing symptoms of pain, fatigue, insomnia, shortness of breath, etc. • Interacting with the health & care system Managing Daily Activities and Roles • Maintaining roles as spouse, parent, worker, etc. Managing the Emotions • Managing anger, fear, depression, isolation, etc.

10. New ways of working….. Patient as partner in care provision not recipient of care Creation of a Chronic Illness case management service

11. Health Stratification Model Level 3 Patients with highly complex needs and co-morbidities Case management Level 2 High risk patients Disease management & shared clinical care Level 1 70-80% of LTC population Largely self care

12. Major dynamics of model • Predictive risk profiling of patients • Nurse led generalist model across several chronic conditions (Heart Failure, COPD, Asthma and Diabetes) • Least invasive care in the least intensive setting through patient-centred case management approaches AND ehealth • Target group- older people identified as being at most risk of avoidable re-admission to hospital( PARR tool) • Integration and coordination of the individual’s journey through all parts of the health and social care systems (Integrated Care pathways) • Incorporates elements of disease management and self-care • Anticipatory care facilitated through proactive as opposed to reactive care model • Adopted remote monitoring telehealth as support system

14. What is e-Healthcare? ... “e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.”

16. Overview of predictive risk Patient admitted/discharged Activity recorded on Trust PAS PARR DATABASE Activity downloaded into PARR Via Business Objects, Trust Designed MS Access Database Sifting & criteria applied Risk Level Identified OTHER PATIENT DATA APPLIED CASE FINDING DATABASE Nurse assesses and accepts person onto the caseload

17. Specialist Physicians High risk V500 Intermediate risk Multiple conditions V100 V100 Intermediate risk Peripherals only Peripherals Low risk Case Manager Choosing the right telehealth System P O P U L A T I O n + + Or + Case Manager + Case Manager

18. Home-based medical devices ECG recorder / transmitter Digital scale SpO2 meter Home-based data transmitter Blood pressure meter Glucose meter Spirometer

19. Configuration to User Needs

20. Benefits achieved to 2011 • Enhanced patient self management • Reduction of readmission to hospital in 9 month period of 59% • Significant increase in HR-QOL ( both patient perception and actual health state) • Increase in patient functionality • Robust evidence base demonstration cost-effectiveness at £20,000-£30,000 willingness to pay

21. Main obstacles or barriers • Change of working culture for All existing staff e.g. medics, nurses, pharmacists • Resistance from existing disease management specialists e.g. medics, nurses, physiotherapists • Perception of a territorial threat to existing staff and existing practices

23. Changing the Team Virtual Care Team Integrated Care Partnership Primary Care Community Secondary/Tertiary Care Community Primary Care

24. Changing the Health Record Clinical Medication Demographics Images Documents Tests Primary Care Patient Record Home Monitoring Home Visits Hospital Community Patient Referral Risk Management Community Recall Prescriptions

25. Changing the Patient Care Pathway Present with Symptoms Primary Care Consultation Refer to Hospital Normal or refer to different speciality Primary Care Test Hospital Consultation Refer to Hospital Hospital Test Hospital Consultation Normal or refer to different speciality Teleclinic Hospital Procedure Discharge Hospital Follow Up Teleclinic Discharge Primary Care Management

26. Changing Consultation for Primary Care General Practitioner/ Consultant History and Symptoms Patient Advocacy And Support Full Clinical History Management Local Health Professional CHF Electronic Patient Record

27. Changing Applications for Primary Care Ultrasound Vascular Physiotherapy Obstetrics Echocardiography

28. Applying motivational interviewing • Express acceptance and affirmation • Try to understand how the person sees their problems (reflective listening) • Elicit and reinforce self-motivational statements: concerns, desire, intention and ability to change • Assess and feedback their readiness to change • Affirm the persons freedom of choice

30. Unknown Territory…

31. What the Future Holds Is Up to you • The power to redesign and improve health care delivery has arrived • Technology is a tool in the toolbox that will give patients and nurses more choices. • All staff time and effort will be better spent where and when it is needed. • Technology provides the means to leverage health care process to improve access to care and facilitate collaboration.

32. Patients as Partners: Changing Culture and Practice • Rethink Care • Restructure Care • Retrain for Collaborative Care • Put patients first

33. Thanks to you ALL for listening….. Marina.lupari@northerntrust.hscni.net