Future Trends in Health Care

A paper presented at HINZ conference 2016


”Scotty beam me up!! Was all I could think of when listening to presentations at the at the Nursing Informatics Congress I attended in Geneva this year.  We heard that trends in the world of health care delivery are rapidly changing. Technology is fast becoming a new way to deliver a health service. Why is this? It could be many things such as populations changing, workforce needs altering -  we need to find ways to manage this.  It is about  having a health system which is progressive and  innovative. It is about having a cutting edge health service focussed on the latest NZ Health Strategy,” All New Zealanders live well, stay well, get well, in a system that is people-powered, provides services closer to home, is designed for value and high performance, and works as one team in a smart system”. It is about harnessing the power of technology to deliver a more accessible, sustainable, cost effective and equal health service   Where would we be without ATMs??? How frustrating it would be not to be able to book airline flights or motels late at night when you have the free time to do so.  Now it’s happening in health care. See your consultant over a video screen rather than driving for three hours for that person to say, your wound is healing nicely.. Or having the district nurse visit you in your own home over an iPad screen from his office in the local town.  I just love the move. It isn’t about replacing in- person  care – it is about enhancing and expanding the service. 

 

Thank you for waiting Doctor. The patient will see you now!

While major hospitals will always have a place in our health system their role is changing. New technologies now allow people to be seen either in home. Also Clinicians are able to see patients from their own home PCs for a consultation utilising a small piece of software called Jabber rather than having to travel back to work. Patients are already taking photos of skin rashes, wounds etc on their phs and forwarding them to a clinician for diagnosis. ECG apps and other apps can be downloaded on to a patient’s ph, and  the results queried through the patient portal and guidance given. Remote monitoring means that patients can take their own BPs, oxygen stats etc and transfer them through technology to the nearest health clinic where they can be read and acted on if 
necessary. There will still be major hospitals but patient numbers will be greatly reduced and even these will be changed by technology. In Western Australia, one large hospital has an emergency centre which provides care to 72 much smaller centres throughout the region - all through technology. 


Smart health

This is a service being offered by the WaikatoDHB. A patient enrols with the service and an app is downloaded to the patient’s ph . The patient can then be actually  seen, as opposed to just talking.  A tablet or android ph, can be used for this.  This allows a much more objective consult for the health professional involved .  With this same app, a patient can also submit a question they need an answer to as well as accessing other health information over this same app. This technology was once laughingly referred to as “having a doctor in your pocket. “ . The first afterhours rural clinic was held two weeks ago from  Hamilton using this app. This has allowed expansion of  emergency rural service care after hours which increases equity of health care.  

 The access provided by this app empowers patients to:
•    manage their own health,
•    gives patients a say in when and where their care is delivered,
•    improves access to timely care no matter who they are or where they live,
•    and delivers services closer to home to make it more convenient to 
the patient. e.g. could be a farmer at the back of the farm having 
chest pain. 

 

New Era of Patient Engagement  

These new patients are known as E-patients. These patients   are actively involved in all aspects of their care, and perhaps even designing what that care should be. They are aware of the latest research, alternative therapies available and have access to and 
Dr Tom Ferguson, a pioneer in self managed care in his book “The Patient will see you now” tells us that e-Patients are more likely to be empowered, engaged, enabled and equipped .These are the patients of the future. Their mantra is:” Nothing about me, without me”.  

 

Kiosks at worksites and in public places. 

These new patient care settings are being developed by large organisations in USA. They will be small rooms set up with technology to be able to access clinicians, and equipment to assist the consult such as BP cuffs, spirometers, scales  etc. These kiosks are seen as: 
Delivering quality care
Reduce time spent travelling and in waiting rooms
Reduces exposure to other infectious patients in waiting rooms
Reduces cost of visit to medical centre or after hour clinics. 
(As a student nurses we had clinic available every week day morning.) 
Online patient communities and forums . Online resources, including advice from other patients have become a significant and increasingly accessed source of information .The website, Patientslikeme was founded in 2004. 
Adults are able to share their personal experiences with others, a process, which is easily facilitated by easy access to communication tool such as Face book, discussion forums and online reviews. This allows both patients and families to gather information from others how they dealt with the condition, medications which were successful as well as those that weren’t . They identify Specialist who were knowledgeable and skilled with the particular illness, especially if the condition was obscure. E-patient Dave , who has written” Let the patient help,”  who through his illness was supported and informed greatly by his online community 
Patientslikeme has also just launched an online platform  to connect patients with scientists involved in early stages of research design in their particular area of illness. They provide well researched and maintained websites which contain current information re the condition, guidelines and databases, top rated specialists, survivor’s stories, current data on clinical trials and guides to medical literature.

 
Support for self managed care 

Increasingly fitbits and other personal monitoring tools are supporting self managed care alongside a clinicians. Used for fitness tracking, sleep patterns, blood pressure and caloric intake, patients are starting to track their own health and enjoying the feeling of control which this gives them, They become “partners” with their health professional, with a focus more on wellness rather than illness. They bring along the evidence recorded on their monitoring tool,  often scanning and sending via their portal or bringing their own peer reviewed research which they have downloaded from Google or sourced from the online community they frequently interact with. The clinician’s role is changing to often that of a coach rather than an all knowing health professional. . Evidence shows that patients who have easy access to frequent support from their health professional alongside their own monitoring, to assist in self management are more like to be successful and more compliant. 

Smart Houses or Sensors 

Technology is allowing us to measure critical health parameters in convenient and inexpensive ways. Tiny wearable sensors collect data without interfering with daily life in order to make better more informed decisions. An area presented at the conference dealt with sensors around the home. Sensors placed on robots which could sense the weather. Suitable for a person with early dementia, the robot could go to the wardrobe and select clothing appropriate for that day. Smart lights which glow softly when a person gets up at 3 a.m. to go to the toilet, which assists in reducing incidents of  slipping and falling. Smart refrigerators which monitor nutrition and smart ovens which assist a disabled person to cook. A wearable camera, speech recognition and wound measurement facilities, allows timely capture of clinical findings when a nurses hands are occupied providing direct wound care, Foot movement and weight sensors placed in shoes which can record gait and activity for the day and transfer these recordings back to a smart ph. Referring back to my opening comment re Scotty beam me up, Star Trek was often mentioned . The amazing technology displayed in this very popular TV programme and how it was used and how now, it is appearing in our worlds. Robots to provide companionship, monitor safety  and provide instructions on timing of medications etc. As you are probably all aware these robots 
have already been trialled in Selwyn village. Designed to look like a baby white seal with big brown eyes the patients really enjoyed them. 


Big Data

Dr Frances Hughes, ICN CEO in her keynote at Geneva, spoke of the need for nurses to become more aware of Big data. There is a lot being collected but little is being done with it. There is no plan or structure. Used effectively big data can transform care, influence nursing policy empower nursing for change.  Nurses need to harness this information for the betterment of nursing. There was a call at the conference for international collaboration to form an action plan for sharable and comparable nursing data  to be gathered for quality improvement and big data science for the advancement of nursing. 


Ehealth awareness

WHO states that eHealth is the use of information and communication technologies (ICT) for health. Examples include treating patients, conducting research, educating the health workforce, tracking diseases and monitoring public health. This links strongly to the statement above relating to Big data. ICN are currently developing an ehealth strategy which will be available to the over 130 national nurses associations associated with ICN. Lucy Westbrook and I were selected as representative from NZ to be on this working group . So far we have met twice. AS ICN is based in Geneva this is where the meetings are chaired from  BUT NO!!! A Skype call is how we manage it rather than first class flights each month to Geneva. 


Nurses as Information Coaches

Increasingly health  games are  being developed to play on phs. These can be  very effective in motivating the patient and collecting  data needed to make informed decisions on daily activities that contribute to their health. Literature shows that approximately 50% of patients with chronic diseases do not follow the prescribed treatment for their condition. Gamified health tracking creates an environment that keeps 
the patient from straying from the appropriate path. Therefore  nurses need to become information coaches. Identifying and having a in-depth understanding of which games would be most appropriate to motivate and excite a patient, which will assist in behaviour change. Knowing how to critique web sites and providing these tools to the patient, being able to assist patients in making best use of the information contained in them, and along with the informed patient, building all of this into a care plan. 

IN conclusion, I opened this presentation by saying this was the future  BUT Is it? Or are we really there??? I would really love to continue this conversation 
 

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