term used to describe the gap between those who have and those who do not have access to online information
digital divide
term used to reflect age disparities in computer connectivity
grey gap
the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
health literacy
developed to address the growing need for managing health information and to promote technology as a means of improving health information exchange
eHealth Initiative
- have patient education stored electronically so that changed can be made as needed
- sponsor health promotion education classes to market their facility
HCO Approach to Engagement - promote education via waiting room
- secure patient portals
- provide opportunities for peer-to-peer support for similar diagnoses
- increasing social media use
HCO Approach to Education
- embrace the internet as a source of health information for patient education
- patients are increasingly turning to the internet for “instant” information
- support the development of nutrition education programs as interactive computer games (edutainment)
promoting health literacy
the two most common symbols that power users look for
HONcode and Trust-e
nearly 75% of online searchers do not check the date or source of information they are accessing on the web
The Pew Internet Survey
website that has a tutorial for learning how to evaluate health information and an electronic guide to web surfing
Medline Plus
- audio and video podcasts may become more commonplace in health education
- voice recognition software
- multiple language access to health information
Future directions in education
prescriptions of focused, evidence based information given to a patient at the right time to manage a health problem
information prescriptions
wide range of health services that are delivered by telecommunications-ready tools, such as telephone, videophone, and computer
(does not always involve clinical servies)
telehealth
-demographics
- healthcare worker shortages
-chronic conditions - new educated consumers
-excessive costs
driving forces for telehealth
the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status
telemedicine
-homebound
-limited transportation access
-rural or remote populations
-reduce hospital length of stay
-managing patients in a major disaster
telehealth patient populations
- central stations/web servers
- peripheral biometric devices
- telephones
- video cameras
- personal emergency response systems
- sensor and activity monitoring systems
- medication management devices
tools of home telehealth
a record developed by healthcare professionals in the process of providing patient care
primary data source
- data derived from the primary patient record, such as an index or a database
- provide information that is not easily available by looking at individual health records
- generally aggregate data and can be used as needed without risking confidentiality breach
secondary data source
data in the health record that relates to a particular patient identified by name
patient-identifiable data
Data extracted from individual health records and combined to form de-identified information about groups of patients that can be compared and analyzed
aggregate data
users of secondary data located within the healthcare facility
(medical staff, administrative, and management staff)
internal users
users of patient data located outside the facility
(state data banks and federal agencies)
external users
report from a database that enables health records to be located by diagnosis, procedure, or physician.
index
contains patient-identifiable data such as name, address, date of birth, dates of hospitalization or encounters, name of attending physician, and health record number.
- avoids issuance of duplicate record numbers
- enable the facility to quickly retrieve health information for specific patients
master patient index
A listing in diagnosis code number order of patients discharged from the facility during a particular time period.
disease index
listing arranged in numerical order by the patients procedure codes
- the surgeon may be listed in addition to, or instead of, the attending physician
operation index - listing of cases in order by physician name or identification number
- enables users to retrieve information about a particular physician including the number of cases seen during a particular time period
physician index
a collection of a limited set of information about a patient, often disease specific
registry
method of determining criteria for cases that should be included in a registry
case definition
method of identifying patients who have been seen or treated in a healthcare facility for the particular disease or condition of interest to the registry
case finding
a registry that includes only cases from a particular type of healthcare facility, such as a hospital or clinic
facility-based registry
a registry that includes information from more than one facility in a specific geopolitical area, such as a state or region
population based registry
file is made up of acute-care hospital and skilled nursing facility claims data for all medicare claims
- demographic data on the patient
- data on the provider
- information on medicare coverage for the claim
- total charged
- charges broken down by specific type
(limitation: only contains data about medicare patients)
Medicare Provider Analysis and Review
- developed to address the lack of information on malpractice decisions, denial of medical staff privileges, or loss of medical license.
- mandated under the Healthcare Quality Improvement Act of 1986
National Practitioner Data Bank
validity, reliability, completeness, and timeliness
data quality factors
users of secondary data will need to remove identifying data so that data can be used without violating the patients privacy
- the covered entity can strip off certain elements to ensure the information is truly deidentified
- the covered entity can have an expert apply generally accepted statistical and scientific principles to minimize risk
deidentification
registry not covered under HIPAA
central registries
the process of keeping data safe from unauthorized alteration or destrcution
data security
the extent to which personal health information is kept private
data confidentiality
falls into groups or categories.
(zip code, ethnicity, marital status, race, gender)
nominal level data
order of the numbers is meaningful, not the number itself.
(heart failure classification I, II, III, IV and level of education)
ordinal level data
represents observations that can be measured on an evenly distributed scale at a point other than true zero
(temperature
interval level data
data with a defined unit of measure, a real zero point, and with equal intervals between successive values
(blood pressure, age, LOS, weight, height)
ratio level data
reports patient activity for a 24-hour reporting period
census
an infection acquired by a patient while receiving car or services in a healthcare organization
nonsocomial infection
a presentation of data in rows and columns is a __.
table chart
a graphic display technique used to display part of a whole is a __.
pie chart
a graphic display used to show trends over a time is a __.
line graph
a graphic display technique used to display categories of a variable is a _.
box plot
a graphic display technique that may be used to show the age distribution of a population is a __.
stem and leaf plot
a graphic technique that can visually compare the range of a variable between two categories is a _.
box plot
a graphic display that can help one determine if there is a relationship between two variables is a __.
scatter chart
the vertical stretching of a distribution
kurtosis
the horizontal stretching of a frequency distribution to one side or the other
skewness
A benefit for healthcare professionals of using technology for patient education is
To improve the compliance and documentation of education
Individuals having the capacity to obtain, process, and understand health information is known as
Health literacy
The gap that exists between the consumers who have Internet access to information and those who do not is known as
Digital divide
Disease registries are collections of secondary data related to patients with a specific __
Diagnosis, condition, or procedure
When persons living with a chronic disease use the Internet for blogging about their health challenges or participating in online discussion forums, this is known as
Peer-to-peer support
Telehealth is provided for
Homebound patients or those with limited access to transportation, rural populations that lack access to primary care, and those recently discharged from hospitals
Health literacy skills include the ability to
all of these are correct
Linda is an occupational therapist who works for a home health agency based in Pennsylvania, very near the Ohio border. She is assigned to monitor the home telehealth patients for one week to cover for another therapist who is on vacation. Which of the following is correct?
Linda must be licensed to practice occupational therapy in both Pennsylvania and Ohio if telehealth patients are located in both states
A unit of measure that reflects the services received by one inpatient during a 24-hour period is called (IPSD) which is an abbreviation for
Inpatient Service Day
Technical security under HIPAA involves issues such as whether sensitive data need to be protected. __ is a method of scrambling data so that they cannot be read without first being decoded. An AIDS registry, for example, might want to use this specific method to protect patient identifiable information since AIDS data are considered extremely sensitive.
Encryption
Which of the following is not considered a Case-Finding method?
Medication Lists
(T/F) Population-based registry is gathering information from more than one facility within a geographic area such as a state or region
True
(T/F) UMLS is of particular interest to the HIM professional because medical classifications such as ICD-9-CM, CPT, and the Healthcare Common Procedure Coding System (HCPCS) are among the items included.
True
(T/F) The data from an HIE are aggregated rather than patient specific and are not used primarily for patient care
True
Not all registries and databases are covered under HIPAA if they do not bill for patient care services. __ registries would be an example of a registry that is not covered under HIPAA.
Central
(T/F) Public health is the area of healthcare dealing with the health of populations in geographic areas such as states or counties
True
Telehealth is a cost-effective approach that may reduce the number of patient hospitalizations
True
(T/F) A physician’s use of social media is an acceptable method for interacting with his/her patient to promote and provide health education
True
Databases developed by public health departments provide all of the following information except
public health survey
_ Is the termination of hospitalization through the formal release of an inpatient by the hospital
Inpatient discharge
(T/F) Within inpatient Census Data:
Average daily census = Total number of inpatient service days for a given period / Total number of days in the same period
True
( T/F) Inpatient admission: is a patient who is provided with room, board, and continuous general nursing service in an area of an acute-care facility where patients generally stay at least overnight
False
Within healthcare statistics and data collection process of Inpatient Census Data, Daily Inpatient Census is
The result of the official count taken at midnight. This is the number of inpatients present at the official census-taking time each day
Telemonitoring systems can be set in an acceptable range of values for an individual patient enrolled in the monitoring program. If the patient’s levels go above or below predetermined amounts, the program will alert the appropriate party. This explains what type of improvement in home telehealth software?
Triage
The gap between those who have access to online information and those who do not is called the
Digital Divide
(T/F) The digital divide in developing countries can be changed by delivering unique interventions and ideas
True
Which factor will support the increased use of telehealth in the future?
Aging Population
Hands-on interactive approaches to health education are more likely to appeal to
Active Seniors
Employers may use telehealth in a wellness program to
All of these are correct
Integrating standardized discharge instructions and patient education materials into the clinical system helps
Both improve the compliance with and documentation of education, and streamline the workflow of healthcare professionals
Which of the following The National Practitioner Data Bank (NPDB) does not provide in its database?
Medical licenses suspension actions
What is the driving force for the increased use of telehealth care?
All of these are correct
A major goal of the eHealth Initiative is to
Empower consumers to understand their health needs
Which domain name do Internet users consider to be a reliable source of quality health education information?
.org
Telehealth interactions help to ensure that professionals can
replicate usual clinical interactions in all specialties across a distance
The challenge for consumers and healthcare professionals is
the proliferation of information on the Internet and the need to learn how to recognize when information is accurate and useful for the situation at hand.
explore consumer information and education needs
and how technology may help to meet those needs and at the same time create ever increasing demands for health related information
Consumer Demand for Information Trends
include empowerment, patient engagement and connected health—people taking control of their health and seeking their own information
Healthcare consumers are embracing
electronic technologies, such as patient portals offering current and past health statuses, lab results, and secure messaging with providers; social media interactions; health related games; wearable technologies for tracking health; apps; remote monitoring; and telehealth
The Pew Internet and American Life Project survey report of 2013
indicates that 8 in 10 of Americans who are online have searched for health information.
69% of Internet searches
are related to a specific disease; weight, diet, and exercise (60%); blood parameters or sleep patterns (33%).
online diagnosers
over half of them (those who search online for information about medical conditions) reported that they shared their Internet findings with their healthcare providers and 41% reported that their findings were confirmed by a clinician
Pew survey does not
reflect the health information needs or demands of those who are not online.
Digital divide
term used to describe the gap between those who have and those who do not have access to online information
Grey gap
term used to reflect age disparities in computer connectivity; fewer people over age 65 use computer technology than in younger age groups
The goal of health literacy
for all is one that is widely embraced in many sectors of health care, is a major goal of Healthy People 2010 and is continued in the health communication and health information technology objective of Healthy People 2020
informed patients
have better outcomes and pay more attention to their overall health and changes in their health than those who are poorly informed
Health Literacy
is defined in the Institute of Medicine report Health Literacy: A Prescription to End Confusion as ‘The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
The eHealth Initiative (eHI)
was developed to address the growing need for managing health information and to promote technology as a means of improving health information exchange, health literacy, and healthcare delivery.
Health Care Organization (HCO) Approaches to Engagement
One approach is to have patient education information stored electronically so that changes can be made as needed; information can be better tailored to the specific patient situation, then printed out and reviewed with the patient
HCOs sponsor health promotion education
classes as a way of marketing their facilities and showcasing some of their expert practitioners.
HCOs are taking advantage
of the fact that patients and families are captive audiences in waiting rooms and promote education via pamphlet distribution, health promotion programs broadcast on TV, and health information kiosks
approach to education
just because the information is made available
does not mean that people will participate or that they will understand what they have experienced
approach to education HCO
HCO Approaches to Education
-Secure patient portals: allow patients to access their EHRs to track lab results and view records
-Provide opportunities for peer-to-peer support for people with similar diagnoses
-Increasing use of social media to engage patients
Dynamic Websites of Organizations
-Most offer physician search capabilities, e-newsletters, and call center tie-ins.
-Must have a sincere commitment to keeping information current and easily accessible.
-Web designers must pay particular attention to the aesthetics of the site, the ease of use, and the literacy level of those in the intended audience
Promoting health literacy in school-aged children
-presents special challenges to health educators.
-E-health programs need to be developed specifically to appeal to the generational (highly connected and computer literate) and cultural needs of this group.
Children’s Nutrition Research Center
responded to these challenges by supporting the development of nutrition education programs as interactive computer games, video games, and cartoons referred to as edutainment
Health Games Examples
-Healthy Habits Games
-Learn About Allergies
-Staying Fit
-Exercise and Eating Healthy
-The National Library of Medicine maintains a site dedicated to health learning games for both children and adults
Promoting Health Literacy
-Healthcare professionals need to embrace the Internet as a source of health information for patient education and health literacy.
-Patients are increasingly turning to the Internet for “instant” information about their health maladies.
The Health on the Net (HON) Foundation Survey (2005)
describes the certifications and accreditation symbols that identify trusted health sites.
HONcode and Trust-e
were identified as the two most common symbols that power users look for
Pew Internet Survey (2006) indicates
-Nearly 75% of online searchers do not check the date or the source of information they are accessing on the Web.
-3% of online health seekers report knowing someone who was harmed by following health information found on the Web
MedlinePlus
The US National Library of Medicine and the National Institutes of Health sponsor __, a website that has a tutorial for learning how to evaluate health information and an electronic guide to Web surfing that is available in both English and Spanish
Audio and video podcasts
may become more commonplace in health education and be provided as free downloads from the websites of HCOs
Voice recognition software
used to navigate the Web may reduce the frustration and confusion associated with attempting to spell complex medical terms.
Multiple language access
to health information and decision-support tools
Interactive behavior change technology (IBCT) for diabetes management
-The goal is to improve communication between patients and healthcare providers and provide educational interventions to promote better disease management between visits.
-Use a combination of electronic medication reminders, meters that track glycemic control longitudinally, and personal digital assistant-based calculators to promote behavioral interventions necessary to better manage the diabetes
Information Prescriptions
-Direct patients and families to credible websites
Government and HCO websites
-Suggest wikis and blogs that may help with understanding their health issues or allow them to share information with and seek support from others who have similar issues
-“Information prescriptions are prescriptions of focused, evidence-based information given to a patient at the right time to manage a health problem.” (D’Alessandro, 2010, p. 81)
Telehealth
A Tool for Connected Health
-A wide range of health services that are delivered by telecommunications-ready tools, such as the telephone, videophone, and computer
press release by IMS Research
(2013) reported that telehealth monitoring was used for 308,000 patients in the U.S. in 2012 and that the demand worldwide is expected to reach 1.8 million by 2017.
Driving Forces for Telehealth
-Demographics
-Nursing/healthcare worker shortages
-Chronic conditions
-The new educated consumers
-Excessive costs of healthcare services that are increasing in need and kind
More driving forces for telehealth
-The American healthcare system spends $1.4 trillion/year on conventional medical care.
-This amount should be expected to increase in the coming decades.
-A solution is to develop a new clinical model for American healthcare that includes technology.
-Telehealth technology should be included to fill the gap resulting from an overabundance of patients and a scarcity of healthcare providers.
American Telemedicine Association Definition
“Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status. Closely associated with telemedicine is the term “telehealth,” which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, and nursing call centers are all considered part of telemedicine and telehealth.”
Store and forward
Digital images, video, audio, and clinical data are captured and stored on the client device; the data are transmitted securely to a specialist or clinician at another location for interpretation.
Real time
Real-time or live interaction
Remote monitoring
Devices are used to capture and transmit biometric data
Telephony
Monitoring via telephone
Clinical Applications Examples
-Transmitting images for assessment or diagnosis: transmission of digital images of wounds for assessment and treatment consults
-Transmitting clinical data for assessment, diagnosis, or disease management, especially vital signs, blood glucose, and weight
-Providing disease prevention and promotion of good health behaviors, such as telephonic case management and patient education
-Using telephonic health advice in emergent cases
Performing teletriage in call centers
-Using real-time video
Exchanging health services or education live via videoconference
Real-Time Clinical Telehealth
-Telemental health
-Telerehabilitation
-Telehomecare
-Teleconsultations
-Telehospice/telepalliative care
Telehealth Patient Populations
-Homebound
-Limited access to transportation
-Rural or remote populations with a lack of primary care and emergency resources
-To reduce hospital length of stay
-Managing patients in a major disaster, large scale nuclear/biochemical attack, or in the case of an outbreak of highly infectious disease
Chronic Disease Patients
At significant risk of having an acute episode when subtle but significant changes in their medical condition occur
Common categories of patients currently monitored include
-Congestive heart failure (CHF)
-Chronic obstructive pulmonary disease (COPD)
-Diabetes
-Patients who require long-term wound care
Elder Care Telehealth
-In assisted living facilities or subacute care centers, a kiosk can be used to obtain vital signs for large groups of people.
-Vital sign reports can be forwarded on a regularly established schedule to physicians and others involved in the patient’s care.
Employers/Wellness Programs
Monitor workers and offer telehealth options as a wellness program to
-Reduce absenteeism and increase productivity.
-Lower healthcare costs and associated insurance premiums.
-Create financial incentives for achieving healthcare objectives such as appropriate weight, reduced blood pressure, and levels of exercise.
Tools of Home Telehealth
Central stations/Web servers are key components to telehealth that can be as minimal as a single screen display or as comprehensive as software applications that provide various functions, including triaging the data according to medical alerts that allow clinicians to quickly identify patients requiring immediate attention
Peripheral biometric devices
can consist of fully integrated systems such as a vital signs monitor or they may be stand-alone telecommunications-ready devices such as blood pressure cuffs and blood glucose meters
Telephones
are already the most familiar household communications tool used in telehealth.
-Can be augmented for easier use by patients, as needed, with a lighted dial pad, an auto-dial system, and/or louder ringer
Video cameras and videophones
are easily available consumer items that can be used in telehealth for show-and-tell demonstrations by nurses for patients, or to capture wound healing progress, among other applications.
Personal emergency response systems (PERS)
are signaling devices worn as a pendant or otherwise made easily accessible to patients to access emergency care when needed, usually in case of a fall.
Sensor and activity monitoring systems
can track activities of daily living of seniors and other at-risk individuals in their place of residence
Medication management devices
can address a well-recognized, major problem in healthcare today: medication management and compliance
32 million people
are taking three or more medications daily; typically even more medications are taken by those 65 years of age or older
Policies and Procedures address
-Patient enrollment, education, and equipment setup
-Home assessment
-Patient informed consent, privacy, and confidentiality rights
-Clinical plan of care that is specific to patient needs
Legal and Ethical Aspects
-Healthcare professionals must be licensed to practice in all of the states in which they provide telehealth services.
-Scope of practice and accountability for practice must be defined.
-Professionals must be vigilant about keeping extensive documentation of their visits on- and off-site.
-Telehealth Resource Center: overview of licensure and scope of practice issues
Confidentiality and Privacy
-Information systems must ensure a high level of data security.
-Patients and families should have the opportunity to revise consent after they fully understand the intrusiveness of home monitoring.
-All involved parties, including the technical staff assistants, must have appropriate training in privacy and confidentiality issues.