Connecting Health Immersion of Digital into eHealth

Abstract

Globally, in most countries the deployment and integration of national eHealth programmes is at an advanced stage. Digital progression in society is recognised as inevitable. Consequently, there is a growing awareness amongst nurse leaders for prioritisation of strategies relating to digital leadership and use of informatics competencies within the profession. As artificial intelligence, machine learning and robotics progress at an accelerated rate in society, thought leaders and policy makers turn their attention to consider how such technology can support healthy behaviors and health care delivery. Considerable efficiencies have been realised by deployment of digital in specific business domains such as fast food outlets, the hospitality and transport industries. Automation of passenger check in for example through air travel security has realised better use of staff time in processing of routine tasks and functions. The natural question is can such efficiencies be realised in the domain of healthcare? Large-scale deployment of digital within the health care domain lags somewhat behind other industries. Health administrations engaged with strategic business cases are deliberating on how the digital transformation can assist with planned service improvements from a macro, meso, and micro systems perspective. A key enabler in targeted service planning is the need to advance shared patient centric integrated care through interdisciplinary care service delivery. In this chapter we consider from a practical perspective the seismic impact of digital health, and how it will influence contemporary nursing practice.

Appendix: Simulation Exercise and Review Questions

• 1. Review the scenario case study presented in this chapter. Complete this case based exercise which is linked to Box 2.3 and Figs. 2.3a, 2.3b as a role playing simulation and consider the value proposition on the use of connected digital sensors in the home from a patient safety perspective.

• 2. What are the benefits of implementing digital devices as described in the simulation exercise?

• 3. What are the potential barriers to implementation and how can they be address?

Appendix 1 of Chapter 2 Detail is as follows;

2.1.1 Additional Scenarios Case Study

John wakens from a fitful sleep and is conscious he needs to go to the toilet as a matter of urgency. He gets out of bed puts his slippers on and uses his Zimmer frame to go to the toilet.

Day of Week & Time	Location	Activity—Patient	Monitoring/Sensors in Place in Location	Action from Sensor	Nurse/Carer Activity
Saturday Morning 02:30hrs	John’s bedroom Bathroom	Sleeping for short periods waking to go to the toilet—urgency to pass urine. Restless Legs	1. Motion sensor—bedroom 2. Plug paired with strip light 3. Fit Bit Watch 4. Sleep Tracking Mat 5. Toilet sensor	Status—monitoring all sensors	Carer in bed
Saturday Morning 02:45hrs	John’s bedroom	John sits up in the bed and begins to get out of the bed John places his feet onto the floor and he attempts to put on his slippers and get his Zimmer frame	1. Motion sensor 2. Plug paired with strip light 3. Fit Bit Watch 4. Sleep Tracking Mat Toilet sensor	Status—monitoring 1. Motion sensor activated 2. Light strip activated in bed room	Carer alerted by alarm Carer responds to alarm
Saturday Morning 02:50hrs	John’s walks/shuffles from bedside to bathroom using Zimmer frame	John walks to bathroom and puts on light and enters the bathroom with his Zimmer frame. Goes to the toilet after flushing the toilet washes his hands	1. Motion sensor in bathroom activated 2. Toilet Flush sensor activated 3. Fit Bit Watch	Status—monitoring 1. Motion sensor activated 2. Light in bathroom activated 3. Toilet Flush sensor
Saturday Morning 02:55hrs	Bathroom	After flushing the toilet John washes his hands- water spills on to the floor and he then slips as he turns to reach for the towel which is on the bath (Zimmer frame is occupying circulating space)	1. Motion sensor in bathroom activated 2. Falls alert sensor device		Carer arrives having been alerted to John being out of bed and being on the move at 0245hrs

03:00hrs	Bathroom	John is assessed for injury post fall—no HI or evidence of bony injury. John manages to get himself up off the floor with the assistance of the carer and a chair is brought into the bathroom for him to rest on for a short while.	1. Fit Bit Watch 2. Ambient lighting or SMART lighting		Clinical assessment post fall
03:15hrs	Bedroom	John is escorted back to bed with his Zimmer frame and made comfortable. He is feeling a little shaky following the fall. BP recorded, reassured and drink offered before settling.	1. Motion sensor 2. Plug paired with strip light 3. Fit Bit Watch 4. Sleep Tracking Mat Toilet sensor 5. Digital BP Cuff		Assessment complete. Zimmer frame and slippers are placed by bed appropriately by carer

Physical Props Required for Scenario 2	Actors Required for Scenario 2	Technology IT Props Required for Scenario 2
All sensors active as listed Links to Hub working Curtains/blind closed Slippers Pyjamas Zimmer frame Drink at bedside Towel in bathroom on side of bath Small chair to move into bathroom post fall	John (service user) Carer Observer	• All sensors active as listed • Links to Hub working • Messaging device to alert carer to motion sensor being activated—mobile phone send text message—Carer located in CeIC Centre

2.1.2 Scenario Background 3

At 07:30hrs John begins to get himself out of bed as per his normal routine—his Zimmer frame and slippers are always left beside his bed.

Day of Week & Time	Location	Activity—Patient	Monitoring/Sensors in Place in Location	Action from Sensor	Nurse/Carer Activity
Sunday Morning 07:30hrs	John’s bedroom	Awakening- keen to get up and get his breakfast.	1. Motion sensor—bed room 2. Plug paired with strip light 3. Fit Bit Watch 4. Sleep Tracking Mat	Status—monitoring	With other service users in other location
Sunday Morning 07:40hrs	John’s bedroom	John sits up in the bed and begins to get out of the bed John places his feet onto the floor and he attempts to put on his slippers and get his Zimmer frame	1. Motion sensor 2. Plug paired with strip light 3. Fit Bit Watch 4. Sleep Tracking Mat	Status—monitoring 1. Motion sensor activated 2. Light strip activated	Carer alerted by alarm Carer responds to alarm
Sunday Morning 07:45hrs	John’s walks/shuffles from bed side to kitchen on his way to the bathroom	John walks/shuffles to the kitchen and fills kettle with water, puts mug out with tea bag and puts bread in toaster—shuffles to bathroom	1. Motion sensor in bathroom activated 2. Fit Bit Watch	Status—monitoring 1. Motion sensor activated 2. Light strip activated in bathroom
Sunday Morning 07:55hrs	Bathroom	John walks to bathroom and puts on light and goes to the toilet after flushing the toilet washes his hands and is distracted in the bathroom. Toast burning in the kitchen	1. Motion sensor in bathroom activated 2. Toilet Flush sensor activated 3. Smoke sensor activated in kitchen from toaster
Sunday Morning 08:00hrs	Kitchen	John returns to kitchen carer arrives and toaster turned off and smoke sensor deactivated	1. Motion sensor in kitchen activated 2. Fit Bit Watch 3. Smoke sensor in kitchen		Carer arrives having been alerted to John being out of bed and being on the move.
	Bedroom	John returns to his bedroom assisted by carer—John uses his Zimmer frame and is complaining of feeling a little light headed.	1. Motion sensor in bedroom activated 2. Fit Bit Watch 3. BP & HR & Temp recorded

Physical Props Required for Scenario 3	Actors Required for Scenario 3	Technology IT Props Required for Scenario 3
All sensors active as listed—including Smoke Sensor for this scenario Links to Hub working Curtains/blind closed Slippers Pyjamas Zimmer frame Drink at bedside Towel in bathroom on side of bath Toaster, Kettle, Mug Bread/Butter/Jam, Tea Bags, Sugar Plate Knife Milk	John (service user) Carer Observer	• All sensors active as listed • Links to Hub working • Messaging device to alert carer to motion sensor being activated—mobile phone send text message—Carer located in Reception of Skills Centre • Sensor data recorded and visualisation accessed through John’s profile

Glossary

Architecture

A specific design approach to determine how the information system will work. A variety of architectures exist such as conceptual, operating system, software, etc.

CARE

An acronym within nursing informatics initially devised by Hannah and Ball and adapted within this text to refer to Connected health administration research and education

C-HOBIC

Canadian Health Outcomes for Better Information and Care

Clinical intelligence

The electronic aggregation of accurate, relevant and timely clinical data into meaningful information and actionable knowledge in order to achieve optimal structures, processes, and outcomes” (Harrington 2011, p. 507)

eHealth

The use of information and communication technologies (ICT) for healthcare delivery WHO defines it as the transfer of health resources and healthcare by electronic means

EHR

Electronic Health Record

Health Informatics

Health informatics is the intersection of information science, computer science and health care. Health informatics is the intersection of clinical, IM/IT and management practices to achieve better health Source http://www.imia-medinfo.org/new2/node/66

HRQoL

Health-related quality-of-life

IHE

IHE is a world-wide initiative created by healthcare professionals and industry to improve the way computer systems in healthcare share information by working together on interoperability use cases. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care

Information

Facts provided or learned about something or someone

Interoperability

IEEE in 1990 defined Interoperability is the ability of two or more systems or components to exchange information and to use information that has been exchanged IEEE 1990

IoT

Internet of Things

mHealth

A collective term used to describe cellular type of mobile technology

Nursing Data

Any information element obtained by a nurse during an encounter relating to the assessment of a client’s health state, diagnostic of ailments/diseases and/or treatments

Nursing Informatics

Nursing Informatics science and practice integrates nursing, its information and knowledge and their management with information and communication technologies to promote the health of people, families and communities world wide” IMIANI.

OECD

Organisation of economic co-operation and development

PREMS

Patient Reported Experience Measures

PROMS

Patient Reported Outcome Measures

SDG

Sustainable Development Goals devised by the United Nations

Self Efficacy

People’s judgements of their capabilities to organise and execute courses of action required to attain designated types of performance. It is concerned not with the skills one has but with the judgements of what one can do with whatever skills one possesses (Bandura 1986, p. 391)

Self Management Support

An approach providing education and support to optimize patients’ self management and ability to make informed decisions about their health

Theory

An abstract generalisation that presents a systematic representation about relationships among phenomena

UN

United Nations

Use Case

An integration profile used as a guideline for implementation of a specific process called use case. The use case provides precise definitions of how standards can be implemented to meet specific clinical needs for a specific purpose. For example, integration profiles organize and leverage the integration capabilities that can be achieved by coordinated implementation of communication standards, such as DICOM, HL7, W3C and security standards in Digital Health

WHO

World Health Organisation