Social Health on line

Rita, who is 79 years old, has congestive heart failure, a chronic health condition that lands many people in the hospital or nursing home. Telemedicine has allowed her to closely monitor important vital signs and stay in her own home.

According to the CDC, approximately 5.1 million people in the United States have congestive heart failure. Close to 1 million are hospitalized every year and 27 percent are readmitted within 30 days — the highest readmission rate of all medical conditions.

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After spending time in the hospital followed by a stay in a rehab facility, Rita returned to her home the end of January. She’s been able to stay there thanks to family, friends and home health care. She also relies on telemedicine (telehealth) to help monitor her congestive heart failure.

Something as routine as getting on the scale every day can be helpful in monitoring for early signs of congestive heart failure. Gaining just a few pounds could mean fluid is building up inside the body. It’s also important to keep track of blood pressure and oxygen levels...

Telemedicine

Androscoggin Home Care and Hospice in Lewiston provided Rita with a monitor, a scale, a blood pressure cuff and an oxygen meter that fits on the end of her finger. The monitor comes on at the same time every morning. “It tells me to stand on the scale,” Rita explains, “and then it gets your weight. Then I put the sleeve on my arm and it takes my blood pressure and the O2 meter on my finger.”

The data is transmitted to Rita’s nurse at Androscoggin Home Care. The monitor, which looks somewhat like an alarm clock, can plug into a phone jack or connect to a cell phone or special tablet provided by the agency. “Our registered nurses are seeing their patients’ vital signs every day,” says telehealth coordinator Shane Levasseur. “In addition, we can see vital sign trends. We could, for example, send a two week trend of vital signs over to a patient’s cardiologist for an upcoming appointment. It’s really powerful for doctor to have that information. Now a lot of physicians who send referrals for home care say they want telehealth.”

More and more hospitals and home care agencies in Maine and around the country are turning to telemedicine for patients. Levasseur says just three years ago Androscoggin had 25 monitors and only four were in use. Today it has nearly 250. Nearly all are being used and more will be purchased this year. ...

Earlier this year, the Governor’s Broadband Capacity Building Task Force issued a report outlining eight recommendations — number two was to help Maine’s elderly stay at home by better utilizing telemedicine.

“Use in-home technologies to reduce the proportion of elderly on MaineCare receiving long-term care in institutions from 65% to 40% by 2015, and to 20% by 2020. This will allow seniors to stay home longer — which is what they want — and at the same time save Maine taxpayers over $100 million in 2015, and over $250 million annually in 2020.”

I recently took on a position of medical journal editor. It is with the Journal of Kentucky Medical Association. It’s been a good learning experience. Part of the job of editorial board members is to write an opinion column. (Check, I’ve done that before.) What follows below was published in this month’s journal.

The editorial board put no restrictions on me. So I decided to write about social media and why it is time that doctors make the leap from analog to digital. (It breaks the less than 500 words rule.)

The Greek philosopher Heraclitus gets credit for the idea that change is central to the universe. Physicians know this doctrine well. For us, in the practice of medicine, change is a constant. And in recent years, a major vehicle for change is the Internet and social media. Facebook boasts more than a billion users, Twitter more than 120 million, and up to 80% of patients go online for health information. Google yourself and you will discover your digital footprint—whether you like it or not.

Social media expert Dr. Bryan Vartebedian (Texas Children’s Hospital/Baylor College of Medicine) writes that there are two realities of online reputation management: 1) you have no control over what people say; and 2) you have 100% control of the story you create. Yet doctors have been slow to embrace social media.

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It’s the same with engaging in social media. In the hyper-connected world of 2014, medical professionals have reached a fork in the road. One path is a road well traveled. On this familiar route, we continue to keep our heads down, stay in the weeds, out of trouble. Don’t wiggle; don’t rock the boat; check the boxes; fill out the forms and accept what comes. Don’t dare engage in the online conversation. Choosing this path is like not treating a disease: less ownership confers less personal risk.

The purpose of what follows is to encourage you to consider the other path: the path of engaging in the online conversation and using the tools of social media to enhance the good that can be done—for patients, for ourselves, and for the profession at large.

As a multi-year participant in social media, I see more benefit and opportunity than risk. Here are five factors to consider while pausing at that fork in the road.

Annual recap of the best healthcare technology infographics of 2013 based on quality of topic, data, design, data sources and relevant key takeaways.

Over the past 12 months, HIT Consultant has covered some of the most in-depth and well designed healthcare technology related infographics in this industry. Infographics provide a great way to display complex information or research data in a visually appealing format. Themes this year covered the gamut of healthcare technology including trends transforming the health IT industry, duplicate medical records, patient engagement and much more.

For our annual recap, we’ve collected 20 of our favorite healthcare technology infographics of 2013 shown below based on the following criteria: 

• Storytelling
• Valuable information
• Data Visualization & Design Creativity 
• Data Sources
• Insightful key takeaways
• Popularity (number of social shares)

From "Telemedicine and e-Health"

To cite this article:
Steven L. Mansberger, Ken Gleitsmann, Stuart Gardiner, Christina Sheppler, Shaban Demirel, Kathleen Wooten, and Thomas M. Becker. Telemedicine and e-Health. December 2013, 19(12): 942-948. doi:10.1089/tmj.2012.0313.

Published in Volume: 19 Issue 12: December 4, 2013

Abstract

[See download of complete article]

I fear the valuable physician progress note will continue to drown in mountains of data and illiteracy...

Death was by electronic data and formatting. The victim was the time-honored physician’s progress note...

Yet, what replaces it sometimes resembles a random collection of information and numbers more than anything readable or coherent. The EHR is drowning in data excess where the truly pertinent information is at best lost is a sea of cut and paste gobbledygook, and at worst, repetitive false information.

The designers of the EHR sowed the seeds of this mess. Initially, computerized health records were created to more accurately bill medical procedures, CPT codes, and hospital services. Clinical information was added out of necessity, but layered on a framework of billing and coding, making a very imperfect marriage as the final product. I have used our office EHR now for ten years, and learned four different hospital systems over the past three to four. Thus, I have seen more than my share of this landscape, and trust me, it is far from pretty.

I have worked with IT personnel to try and make my notes more readable and coherent, using everything from larger fonts, to SOAP formats. But in order to comply with coding requirements for mid-level and higher coding, I am forced by Medicare to throw in stuff that is redundant and clinically useless....

The end result is often a misleading and unhelpful recording of the day-to-day patient’s progress. There seems to be more than enough information in the notes, it’s just that the forest is lost inside all of the trees....

There must be better information systems around. Unless we can free ourselves from being reimbursed by the number of words in a note, I fear the valuable physician progress note will continue to drown in mountains of data and illiteracy.

For the whole read it at its orginibal place! It is worthwhile and revealing!

How psychotherapy came off the couch and into the clouds

The therapist’s couch has long been a staple of books and movies, a place where unpleasant truths are revealed and neuroses untangled. But, almost unnoticed, the delivery of psychological support is being transformed – by the internet.

If you need NHS help for common problems such as anxiety or mild depression, you won’t necessarily meet your therapist face-to-face. You could be at home or even by the pool, typing your emotional secrets into a dedicated instant messaging service. You might be following a computer program that takes you step by step through a CBT (cognitive behavioural therapy) programme, or having a digital face-to-face on Skype.

“The benefits of online therapy are considerable,” says Joanna Bawa, a CBT practitioner with the NHS in Hereford. “Going into the cloud abolishes geography. You can be at home in Brighton and your therapist can be in Bradford.” Timing can be much more flexible, too, she adds. “No more having to miss work, or pay a babysitter, or spend half an hour travelling each way.”

But does internet therapy – or “Skypotherapy”, as it has been termed – work? Surely there is something special about the intimacy of the consulting room? “That’s what many of the more traditional therapists thought,” says Nadine Field, a qualified therapist who set up PsychologyOnline.co.uk several years ago. ..

We find people become disinhibited much more quickly,” she says. “Messaging is like writing in a diary just for you. The therapist’s comments pop up but you needn’t worry about what they think of you. And patients get a print-out of their conversation which helps them remember and learn from the insights.”..

Next a short review of research after effectivness of such, and alas no references of sources!

When John "Chuck" Lenferink was being readied to fly from Campbell County Memorial Hospital to Denver in August, he turned to Angela Roesler and said, "This is going to kill me, isn't it?

The nurse looked at her 68-year-old chronically ill patient and told him "yes." If he didn't make some big changes, and soon, his chronic obstructive pulmonary disease (COPD) and congestive heart failure would be the death of him.

At the time, Lenferink was averaging one hospital stay and at least two emergency room visits per month. If he wasn't in the hospital for heart failure, it was for COPD. He was overweight, he couldn't breathe without oxygen and things were only getting worse.

Lenferink is stubborn. He'll be the first to say he doesn't like being told what to do. But faced with his own mortality, he knew he needed to listen to his favorite nurse.

"When he came home, he was a changed man," Roesler said.

Roesler loves being a nurse, and she also loves to teach. When the hospital decided to create a transition care program in May, she was ecstatic.

"It's the best of both worlds," she said.

Roesler had been an acute care nurse in the medical surgical department since 2009, but the change to a transition care nurse was easy.

"It's about the people," she said. "I love my patients, and I love this job."

...

participating patients must be 65 or older and have one of the 10 most common diagnoses for readmitted patients, which are: congestive heart failure, COPD, coronary artery disease, diabetes mellitus, stroke, hip fracture, peripheral vascular disease, pulmonary embolism, chronic back pain and cardiac arrhythmia.

The nurses meet with at-risk patients while they're still in the hospital and then do a home visit once they are discharged.

"We don't do any acute assessments. We don't take blood pressures. We don't do what public health and home health agencies do," Roesler said. "We don't compete with them. We're kind of an adjunct to them."

The nurses act as a liaison between the patient, their doctors and the hospital. Their main goal is education and empowerment.

During the first home visit, the transition care nurses go over the discharge information that the hospital gave the patient and come up with an action plan.

The biggest challenge during the first visit is medication reconciliation, Roesler said. The nurse and patient go through all the patient's medications together and outline which pills the patient should be taking, how often and why.

... "This is a great program. I'm very thankful the hospital decided to do it," Roesler said. "It's definitely made a difference in the lives of real people." ...

It's not a time-driven program, so you get time with your patients, and you get to invest in them and in their success," she said.

Patients are taking control of their health, and the hospital is seeing its readmission rates go down for patients 65 and older.

"I think it's a good fit for every community, honestly," Roesler said. "It probably works well here because we are a community-focused hospital. We're it. So when people go to the hospital, they're going to come here, and when they go home they're going to look back to us to help them succeed at home."

Read more here: http://www.kansascity.com/2014/01/09/4739811/nurse-helps-patients-take-control.html#storylink=cpy

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The hospital doesn't charge patients to use the service, and it's not getting reimbursed for it. The hope is that the program will work so well that the hospital will continue to provide the service once the grant stops paying the nurses' salaries.

"It's the right thing to do for the patients, and that's what I love," Roesler said. "If it's the right thing to do, then let's keep doing it."

Read more here: http://www.kansascity.com/2014/01/09/4739811/nurse-helps-patients-take-control.html#storylink=cpy

Survey, Experience Confirms Continuous Electronic Monitoring With Capnography Boosts Patient Safety and Lowers Healthcare Costs

Though continuous electronic monitoring of all patients receiving patient-controlled analgesia is not a universal practice among the nation's hospitals today, a new survey indicates it may become one soon.

At our presentation on Nov. 13th at the Partnership for Patients annual conference, we discussed the results of the "First National Patient-Controlled Analgesia Survey of Hospital Practices" conducted by A Promise to Amanda Foundation and the Physician-Patient Alliance for Health & Safety, and the track record of "event-free" monitoring by St. Joseph/Candler Hospitals in Savannah, Ga., which is now almost approaching its tenth anniversary.

The National PCA Survey found a strong positive correlation between continuous electronic monitoring and a reduction in adverse events and/or costs and expenses (including litigation costs). Of the 168 hospitals responding to the survey from across 40 states, 137 said that they continuously monitor some or all of their patients.

Of those hospital that monitor, 65 percent believe that continuously electronically monitor experienced positive results — either in terms of a reduction of overall adverse events or have had a return on investment when measured against costs and expenses (including litigation costs). The other 35 percent of those that monitor say it is "too early to determine or have not determined" whether they have seen a reduction in adverse events, costs or expenses.
...
As SJ/C implemented the system, it recognized that the safe use of PCA required both correct pump programming and monitoring of patients' individual respiratory response to opioids. Early in the decision-making process, SJ/C's respiratory care team was called in to address monitoring options. SJ/C believed that having respiratory care involved was critical because respiratory therapists have strong clinical assessment skills, they understand capnography monitoring and its limitations, and they are able to apply solid clinical judgment as they guide the care of patients suffering from respiratory issues.  SJ/C also made sure that its nursing staff had an active role in the process, which greatly increased the staff's knowledge of and willingness to use the new monitoring modules.

After a six-month beta testing revealed that capnography, not pulse oximetry, provided the first indication of opioid-related respiratory depression, SJ/C decided to require a capnography module for each PCA infusion and to use a pulse oximetry module for selected PCA patients with preexisting comorbidities.

Early on in the evaluation process, a problem was identified: Staff noticed that the capnography monitor would alarm, indicating a high respiratory rate of 40 breaths per minute even though the patient's actual rate was just 20 bpm. SJ/C resolved that issue by collaborating with the device's manufacturer to decrease the monitor's threshold so that true breaths and not fluctuations in the respiratory pattern would be counted as breaths. Also early on, SJ/C developed a new cannula, designed specifically to provide an increased surface area for CO2 sampling — and as a result, improve the accuracy of the monitoring.
...
Also early on, SJ/C developed a new cannula, designed specifically to provide an increased surface area for CO2 sampling — and as a result, improve the accuracy of the monitoring.

As SJ/C's clinicians grew more comfortable with capnography, a wealth of benefits from the technology was realized. The clinicians were far better equipped to identify unforeseen risk and undiagnosed clinical conditions that predispose patients to respiratory complications from IV opioids. In particular, capnography enabled them to identify such "high risk" situations as:

    Narcotic overdose leading to respiratory depression
    Apnea alarms
    Undiagnosed sleep apnea
    Post-op pneumonia and atelectasis
    Congestive heart failure
    ...

There has been a quiet but steady movement in the healthcare industry for about 10 years or so now, which is only going to continue to grow and expand. With the passing of the Affordable Care Act, it is absolutely the wave of the future in Western healthcare and medicine, in my view. 

It’s called e-health, and it means what the term implies: healthcare practice supported by electronic processes and communication. Whether we like it or not, technology, the Internet, and social media are here to stay. It is, without question, the functional foundation of our entire society, and our healthcare system is certainly no different.

The case about health apps by IMS, stated in 4 infographics, regarding patient empowerment, health information needs etc.

@IMSHealth is using Ow.ly! View all of this user's images and documents.

Digital health is the convergence of the digital and genetics revolutions with health and healthcare. As we are seeing and experiencing, digital health is

A study found just five apps account for 15 per cent of all downloads in the healthcare category, an example say the authors of a significant skew in how the market works.