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Does ehealth have a role in increasing the self management of care for those who have experienced a traumatic brain or severe spinal injury? Ehealth as defined by Tan (2005) is:- “The use of existing and emerging e-technologies, to provide and support health care delivery, that transcends physical, temporal, social, political, cultural and geographical boundaries”. [Tan, 2005] The vision of the Primary Health Care Strategy, released in 2001, is: “People will be part of local primary health care services that improve their health, keep them well, are easy to get to and co-ordinate their ongoing care.” Guided by the vision of this Strategy, and the definition of ehealth, this paper explores the question - does ehealth have a role in increasing the self management of care by those experiencing traumatic brain or severe spinal injuries.? By utilizing ehealth, could the patient feel more empowered ? Could the use of this technology encourage a more effective partnership between patient and health professionals? Could this innovative approach result in a reduction in hospital readmissions?
An extensive international literature review was carried out around the subject, to discover how/if other countries were utilizing ehealth to provide a health service to these communities. The search engines of Google - scholar, Alta Vista, Yahoo, and Scirus were used and search words were ehealth, health informatics, traumatically brain injured ,severe spinal injuries, and brain injuries. In addition, chat rooms were visited, databases accessed, and colleagues and authors of articles contacted. This wide search identified that while ehealth is being utilized widely to offer health information and health care in many parts of Europe, including Spain and Italy, Scotland, Ireland, England and Canada there appeared to be a scarcity about its specific role in offering a health service to those experiencing the disabilities specified above. This presentation will deliver the sparse findings found. In order that this exploration may move forward, it will also include information from other health specialties and personal observations regarding successful application of ehealth, which could, with consultation and possibly some adaptation, meet the specific health needs of the community being discussed. The three areas chosen to explore were initial admission, rehabilitation and transfer/discharge and finally future management. Taking each area separately allowed exploration of what tools would be of most value and would benefit the patient most. INITIAL ADMISSION Orlovsky (2006) describes a system called eICU used by Kalieda Health of New York, a private health organisation which owns numerous hospitals throughout many remote parts of America. Using computers and high speed data lines, this eICU system allows ICU experts, i.e. physicians, physiotherapists, anesthetists and ICU nurses, to be contacted at a main base, by these remote regions, for immediate comment and advice, when a critically ill patient is admitted to the unit. Pertinent information on which these health professionals will make their diagnosis and base their suggestions for treatment is also able to be transferred through electronic means including video and digital link ups. It can be seen that access to immediate and skilled health care will increase the likelihood of decreasing the severity of the injuries sustained by a traumatically brain injured or spinal injured patient. REBILITATION AND TRANSFER/DISCHARGE. The report “Mapping the Potential of ehealth: Empowering the citizen through ehealth Tools and Services ” was presented at the ehealth conference in Ireland in May 2004 , providing many examples of ehealth from around Europe and the UK. Ideas have been taken from this report. Some which relate directly to the subject of this presentation. While transfer from ICU is cause for celebration for both the patient and their family, for the patient it can also mean isolation, loneliness and fear. Maybe suffering physical trauma which has affected their independence and made them reliant on health professionals for much or all of their care can cause feelings of isolation and grief to surface. Loneliness can be experienced from being removed from family and friends. In the dark and silence of the night, feeling of fear for the future may surface. According to Nguyen, (2004 ) “virtual social networks of patients and cargivers are easily created, transcending physical borders and timing, to provide individuals with both informal and emotional support in an informal, and non structured setting.” To enable patients who have little or no movement, to use technology to maintain and build social networks, the provision of either touch screen or voice activated communication boards provide access to another world. Two personal thoughts on the means of support which could be offered by ehealth are: Using virtual reality, patients could also ‘visit’ the next rehabilitation venue they are to be transferred to. This could mean orientating themselves to the complete environment, meeting the staff who will be taking over their care and maybe even talking to some of the residents and be encouraged by the progress these people have made. Maybe chat rooms could be set up so support is being provided by these more experienced patients, even prior to the move. Videos, including narratives from patients who have experienced the same disability could be available to the patient especially at night when they finally start to move through the grief cycle and are wanting to view some positive future. FUTURE MANAGEMENT . When returning home, patients have often felt “invisible “and experienced feelings of ‘being stranded”. [Chamberlain, 2006] Close social networks may not be strong, access to health professionals may be limited and employment possibilities may be minimal. Kaiser Permanente, a home health care facility, offers a service where a nurse can ‘visit ‘ her patient with a video link. The nurse is able to converse with the patient, take vital signs and make professional observations and judgments . How valuable would this be to a patient at home to have a personal visit daily rather than remaining almost ‘invisible ‘in the health system. The “home monitoring systems “transports” the patient’s vital signs and statistics, virtually to the healthcare professional, reducing the frequency of readmissions back to a health facility, because problems are sorted out quickly. [Silber 2003] Websites , for support or information of both patients or families/carers are growing rapidly. They provide information ranging from simple information sites to more interactive tools which allow interaction with health professionals and citizen based support. In her paper ”Emerging Trends in Medical Device Technology: Home is where the Heart Monitor is”, Carol Lewis described devices which are activated by tracking eye movements or speech recognition. Regardless of the severity of their injuries, patients would be able to build a support community of health professionals, friends and other support people as necessary. Also described in this paper is an electromyography device, which allows a person with a severe disability to operate machines and perform routine tasks with just the blink of an eye. This could open up many doors of opportunity for those who have been severely injured. This paper has only allowed a brief snapshot of ehealth’s role to the community under discussion . It has not allowed an explanation of the barriers to ehealth for either the patient or the health organization. However, findings presented in this paper, do suggest that ehealth could play a major role in assisting the patient in more effective self management of their health and also enhance the health care service offered to assist in achieving this. The recommendation from this paper is that a comprehensive research project is conducted to explore how this could happen. REFERENCES: Chamberlain, D.(2005) The experience of surviving traumatic brain injury. Journal of Advanced Nursing, Vol 56 (4), 407-417. European Commissions first high level conference on ehealth May 22/23 2003. eHealth the case for eHealth. Retrieved August 26th 2004, from the European Institute of Public Administration website: http://www.ehma.org/fileupload/publications/ehealth. The case for ehealth – FULL.pdf European Institute of Public Administration – ehealth conference 5-6 May 2004 Mapping the potential of ehealth: Empowering the Citizen through ehealth Tools and Services. Retrieved May 6th, 2006, from European Institute of Public Administration website: http://www.ehma.org/fileupload/publications/Mappingthepotentialofehealth-FULL.pdf Lewis,C .(2006) Emerging trends in medical device technology: home is where the heart monitor is. http://www.nursezone.com/Job/DevicesandTechnology.asp?articleID=7392 Ministry of Health. (2001, February) Primary Health Care Strategy. Retrieved June 2005, from the Ministry of Health website:http:// www.moh.govt.nz Nguyen,H.,Carrieri-Kohlman,V., Rankin,S., Slaughter,R.& Stu.M. (2004) Supporting cardiac recovery through ehealth technology. Journal of Cardiovascular Nursing, Fredrick:May/June ,Vol 19 (3), 200 -209. http://gateway.proquest.com/openurl?url_ver=z39.88- Orlovsky,C (2006) Critical care beyond the bedside: the collaboration effort of the eICU team. http://www.nursezone.com/job/DeviceandTechnology.asp?articleID=14299 Riker,J., Rosenthal,M.,Garay,E.,DeLuca,J., Germain, A., Abraham-Fuchs,K., Schmidt,K.Telerabilitation needs: a survey of persons with acquired brain injury. Journal of Head Trauma Rehabilitation. Vol 17 (3), June 2002, p242-250 Tan, J.,(2005) E-Health care information systems. An introduction for students and professionals. San Francisco.Jossey-Bass. .
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