e-Health

The Royal College of Nursing

Perspective

Shařon Levy

RCN Informatics adviser

With a membership of over a third of a million, the RCN is the largest professional association and union of nursing staff and students in the UK.

The RCN promotes nursing interests on a wide range of issues by working closely with the Government, parliament, unions, professional bodies and voluntary organisations.

The RCN campaigns on behalf of its members and the people they care for, and is a leading player in the development of nursing policy and practice, and standards of care.

…the propaganda goes…

…but what is e-Health???

Internet/Intranet

E-mail

Mobile/ Hand-held devices

ECDLIntegrated Care Pathway

Telehealth

Decision SupportEPR/EHR

Computers

Hardware/Software

Operating System

RAM/ROMErgonomics

Databases

Spreadsheets

Broad-Band

Change

Empowerment

Self Care

Effectiveness/EfficiencySecurity/confidentiality

NHS24

Equity

Best Practice

e-Health Definition

“eHealth encompasses much more than the deployment of computer technology. It conveys the message of electronics in support of health and stimulates thought and discussion about the broad range of issues and opportunities that technology offers in the health care setting to both healthcare professionals and patients” (NHSScotland 2004).

e-health covers all aspects of working with information and with information and communications technologies to improve outcomes and enhance people’s experience of healthcare.

e-Health Definition

e-Health Definition

“e-Health … characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology…The distinct feature of e-health is that it is driven by non-professionals, namely patients” (Eysenbach, 2001).

• The rational study of the way we think about patients, and the way that treatments and care are defined, selected and evolved. It is the study of how healthcare knowledge is created, shaped, shared and applied.

(after Coiera 1998)

Health Informatics Definition

The ‘e’ gaze:The victory over the machine is secured once Keanu Reeves is able to mentally detach himself from the false simulated reality and strip bare the Matrix into lines of machine generated numbers. It is this ‘Gaze’ that offered humanity hope for a better future.Can numbers offer nursing a better future in a fast changing technical world? Can we represent everything that nurses do as lines of numbers?

Modernising IM&T in the NHS in Scotland

• “Our vision is to have the right information under the right safeguards at the right place and time using the right ways and means. And our plan is to exploit computing and communication technology to help us work towards this vision”

NHS MEL (1998) 84

Figure 2: Chart Showing Percentage of Nurses Who

Believe Computers Will Reduce Paperwork

(N=509)

"Computers Will Reduce Paperwork"

Strongly Agree

Agree

Don't Know

Disagree

Strongly disagree

Missing

Per

cent

70

60

50

40

30

20

10

0

12

61

1410

Figure 3: Chart Showing Percentage of Nurses Who

Believe IT Will Improve Communication

(N=509)

"IT Will Improve Multi-Disciplinary Communication"

Strongly Agree

Agree

Don't Know

Disagree

Strongly Disagree

Missing

Perc

ent

70

60

50

40

30

20

10

0

14

66

15

Figure 5: Percentage of Nurses Who Believe Current

Practice of Gathering Patient Information is Efficient

(N=509)

"Current Practice of Gathering Information isEfficient"

Strongly Disagree

Disagree

Don't Know

Agree

Strongly Agree

Missing

Pe

rce

nt

50

40

30

20

10

0 5

39

5

44

6

Figure 6: Perceptions of Current Data

Gathering Efficiency by Staff Type

"Current Practice of Gathering Information Is Efficient"

Strongly Disagree

Disagree

Don't Know

Agree

Strongly Agree

Per

cent

60

50

40

30

20

10

0

Staff Type

Non-Managerial

Managerial

29

54

12

5

43

5

43

4

Changing epidemiological landscape

Rapid improvements in (healthcare) technology

Ageing population

Increasing expectations

Rise of ‘Consumerism’ philosophy

‘ THE TIMES THEY ARE e-CHANGIN '

RCN Survey on NHS IT Developments

2020 respondents

February 2004

Q10. In your opinion, what effect will the integrated electronic health care records development have on clinical care?

N %

Significant improvement 1028 51%

Slight improvement 378 19%

No change 60 3%

Slight worsening 22 1%

Significant worsening 13 1%

Unsure 507 25%

Q11. What effect will the integrated electronic health care records development have on your working life?

N %

Significant Improvement 786 39%

Slight Improvement 396 20%

No difference 213 11%

Slight worsening 59 3%

Significant worsening 26 1%

Unsure 527 26%

Q9. How much information have you had about the integrated electronic health care records development?

N %

Fully adequate information 46 2%

Reasonably adequate information

337 17%

Inadequate information 470 23%

No information but I know something about it

402 20%

No information but I have heard of it

456 23%

This is the first I have heard of it 528 26%

Q8. How much information have you had about NHS IT Developments?

N=2020Managers

Fully adequate information 2% 5%

Reasonably adequate information 22% 39%

Inadequate information 22% 22%

No information but I know something about it

27% 20%

This is the first I have heard of it 26% 14%

Q15. As a professional, what consultation has there been with you about integrated electronic health care records?

N %

More than adequate 39 2%

Adequate 128 6%

Barely adequate 251 13%

Inadequate 278 14%

None 1273 63%

Unsure 38 2%

N=2020 Managers

More than adequate

2% 5%

Adequate 6% 12%

Barely adequate 13% 19%

Inadequate 14% 17%

None 63% 47%

Unsure 2% 1%

Q16. How important is consultation about integrated electronic health care records with individual practising clinicians?

N %

Very important 1368 68%

Fairly important 475 24%

Neither important nor unimportant 45 2%

Unimportant 3 0%

Very unimportant 42 2%

Unsure 72 4%

Q17. How important is the provision of training to the success of integrated electronic health care records?

N %

Very important 1861 93%

Fairly important 98 5%

Neither important nor important

8 0%

Very unimportant 19 1%

Unsure 14 1%

Q18. How much IT training have you received within working time in the last six months?

N %

No training at all 1023 51%

No training in working time 234 12%

Half a day or less 414 21%

1 day 134 7%

2 days 91 5%

3 days 26 1%

4 days 23 1%

5 – 10 days 26 1%

10 + days 37 2%

Q20. How important is "around the clock" technical support to the success of IT implementation in the care environment?

N %

Essential 1472 73%

Very important 374 19%

Fairly important 118 6%

Neither important nor unimportant

12 1%

Unimportant 5 0%

Very unimportant 7 0%

unsure 23 1%

Concerns

Clinical ownership: • The RCN has called for greater transparency and

for more information about the Programme’s progress. Concerns were also raised by members about the levels of clinical engagement and about the fact that cardinal lessons have not been learnt from previous large-scale implementations, particularly the importance of ownership by clinicians of clinical systems.

Token engagement: It appears that the rhetoric is set to address clinical concerns yet the speed of implementation, the tight delivery schedule and the fact the contracts are awarded (without clear evaluation framework to measure clinical ‘buy-in’) is of concerns to members.

Concerns

Messages for members (and staff who are supporting them)

Are you e-competent?• (communication)• Information sharing• Facilitating patient, client and carer access to and use of

information• Needs assessment (individual and population)• Record keeping• Clinical reasoning; decision making using evidence• Evaluation and audit• Using technology in your practice• (resource management & workforce planning)

Messages for members (and the RCN) to take to system providers

Making IT SAFE • Does the technology and the way it is used conform

to Standards?• Is it Acceptable to patients, clients, carers?• Is it Fit for purpose and practice?• What Evidence is there for the above?