Home Care Technology for Chronic Disease Management

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Home Care Technology for Chronic Disease
Management
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The human body hasnt changed in thousand years,
but how we provide care changes every day
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Statistics

• About 30 of Canadians live in rural and remote
  areas
• 17.9 of all RNs in Canada work in rural areas
• There is a significant number of rural
  communities where nursing care is provided by a
  sole RN
• Approximately 1/3 of Canadas seniors live in
  rural areas and small towns
• Hospitalization rates in remote areas are 25
  higher than provincial average for Ontario

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Purpose of Technology in Home Care

• To improve access to health services (remove
  barriers of time and distance)
• To facilitate communication with healthcare
  providers
• To reduce cost of care
• To promote independence in clients, maintaining
  them in their home
• To decrease the need for hospitalization for
  chronically ill clients
• To provide more frequent access to nurses
  (maintain continuity of care)

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Benefits of Technology in Home Care

• To nurses
• Frequent, immediate access to remote patients
• Nurses can see more patients in one day
• Opportunities for patient education, compliance
  monitoring, and early identification of patients
  problems

• To patients
• Allows for more independence in the comfort of
  own home
• Local access to a greater number of specialists
  to manage own care
• Less time away from work
• Fewer travel-related expenses (gas, meals,
  overnight stay)

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Negatives

• Cost of implementation
• Lack of therapeutic touch
• Inability to complete a thorough assessment
• Power outages, storms, etc
• Technology can be unpredictable at times
• High quality connections (ie. High speed) are not
  available or too expensive
• Potential for breech of privacy and
  confidentiality

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Security Ethics

• Informed consent written consent before
• Private room for telemedicine base nurses
• Multiple access can lead to increased ability for
  outsiders to hack in, should medical records
  stored on separate system from telemedicine
  system?
• Should nurse-client interaction be recorded?

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Equipment

• visual device ie. computer monitor, television
• imaging device ie. camera, web cam
• audio device ie. microphone
• transmission device ie. internet (dial up or high
  speed), satellite signal
• electrical power
• lightening and surge protection for video
  equipment
• adequate lighting for optimum viewing

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Web Of Wisdom

• Wound care
• Regular comprehensive nursing assessment
• Individualized plan of care
• Response and advice from a specialist within 24
  hours

• Cardiac care
• Daily vital signs monitoring
• Customized patient education
• Reduction of anxiety, especially for newly
  diagnosed patients

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Mental Health in the Elderly

• GOALS
• To enhance access to information about
  behavioural issues
• To provide a mechanism for individuals to seek
  assistance privately
• To provide face-to-face interaction with a
  mental health professional
• To provides information concerning education,
  health care, finances

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First Nations

• Over 1/3 of First Nations and Inuit communities
  are in isolated locations
• 2 million National First Nations Telehealth
  Research Project (HTF402 - September 1998 - March
  2001)- a pioneer in the implementation of
  telehealth in First Nations communities.
• Stable, committed staff in the nursing station
  was a key success factor for effective
  implementation of telehealth in these
  communities.

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Rural Kansas Teleconferencing Home Care Program

• Started more than 10 years ago.
• Used to monitor multiple conditions in the home.
• Interactive audiovisual capabilities.
• Nurses visit at regularly scheduled times during
  the week. Often multiple times per day.
• Half cost of average home care nursing visit (30
  vs 60).
• Accept multiple transmission mediacable, ISDN,
  plain old telephone service.

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Nurses Proficiency Ease of Pt Use

• Not all potential clients qualify for integration
  of technology into their plan of care.
• Significant nursing time must be spent on program
  education, equipment installation, and patient
  assessment.
• Nurses must be able to skillfully use their own
  equipment, and explain to the client how to use
  their equipment.
• Patient equipment must be simple, cost effective,
  easy to use and hard to break.

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Possible Technology

• Remote patient management
• and personalized education
• delivered through a patients
• home television (patients own
• personal healthcare TV channel)
• Mobile technology
• for diabetes
• management

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Predict Future

• In the next 10 years home care technology will be
  a standard in the care of patients
• New high tech, easy-to-touch technologies will
  available in homes helping patients self manage
  diseases and stay well.
• People who normally receive home care now will
  have technologies that will help assist them with
  managing their disease

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Predict Future

• New high tech, easy-to-touch technologies will
  available in homes helping patients self manage
  diseases and stay well.
• Chronic patients will be able to be treated and
  assessed at home no matter where they live

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Predict Future

• For Example
• An elderly patient used an ambulatory ECG
  monitor to send readings when he felt an abnormal
  cardiac episode. The off-site cardiac home nurse
  who reviewed his transmitted data talked him
  through the episode. Upon questioning him, she
  found that her advice given during a home visit -
  to "take it slow" - had not been followed as she
  had expected. The patient's idea of "taking it
  slow" was standing outside, fixing his car, in
  frigid winter weather. Using only the ordinary
  telephone, the nurse was able to quickly correct
  this misunderstanding, without a costly at home
  visit or worse, trip to the emergency room.

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Nurse to HomeTeleconferencing in Use
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References

• Britton, B (2003). First Home Telehealth Clinical
  Guidelines. Home Healthcare Nurse, 21(10),
  703-706.
• Munson, T(1996).Picturing the future of
  telecommunications. Health Facilities Management.
  9(9)
• Quality Matters Improving Quality for Rural
  Residents Through Telehealth. Retrieved on
  October 30, 2006 from http//www.cmwf.org/publicat
  ions/publications_show.htm?doc_id360830
• Smith, K (2002). Utilizing Technology The
  challenges and opportunities facing substance
  abuse professionals in rural communities. PMID.
  37(5)
• The National First Nations TeleHealth Research
  Project report. Retrieved on October 25, 2006
  from http//www.hc-sc.gc.ca/fnih-spni/pubs/ehealth
  -esante/2001_tele-rpt/index_e.html