Making information from your Personally Controlled Electronic Health Record, health organisations and health diary easy to access and understand will encourage healthier decision making.
YOUTUBE VIDEO: "eHealth" APP ENTRY TO 2013 HISA CONTEST
YOUTUBE VIDEO: "eHealth" APP ENTRY TO 2013 HISA CONTEST
Figure 1: “My eHealth” app homescreen (tablet format)
Introduction
The “My eHealth” app is a way to view a range of personal details to best manage your health. This includes information from your Personally Controlled Electronic Health Record alongside specific and generic advice from private and non-profit health organisations. This concept brings together existing information and tools to greatly improve communication between health professionals and consumers.
Situation
Providing health professionals with quick and easy access to information reduces the time it takes for a patient to receive optimal treatment. While patients are encouraged to have easy access to information, and improve their health literacy for better outcomes, health professionals have expressed a preference to control what degree of information is available to patients.
In most cases written advice or printed education material is provided to patients from different health professionals in an ad hoc manner. Written details may not capture information the patient requires, and there is no central record of questions patients may have asked in relation to their treatment. Many people rely on what they remember to ask a heath professional on the day of an appointment to determine what information is needed to make a healthy decision.
Background
The rise in chronic disease during the latter half of the 20th century has seen a change in the dynamic between health professionals and patients. This has changed the emphasis in many cases from “curing” disease, to instead “managing” it. With patient based care the need for people to take ownership of their health is paramount. People are now encouraged to ask questions and become empowered, however too frequently this is sourced from unregulated websites. Advances in technology have been poorly implemented to support this change in values.
Assessment
“My eHealth” app places the patient in the centre of advice received from different health professionals for the conditions they are managing. It separates treatment received and preventive or secondary preventive actions taken and has the ability to link specific information from comprehensive databases to make finding information easy for the patient.
Information is centred around an image of a generic body. Dots indicate current or previous locations of health issues. Systemic problems such as skin or blood pathologies are indicated by a dot located between the front and back images. The colour of the dot indicates its current severity with green = stable, yellow = moderate risk, and red = high risk of health impact. When pressed, the condition is highlighted and information is filtered according to that specific health condition.
The app includes a way to record questions relating to a health condition, notes on advice provided by health providers, and links to information from other organisations about how it is best managed. The interactive design will allow people to take greater responsibility for their health, and provide support for better health related decisions. It can also be opened up to allow non-identified details to be used for research and marketing.
Recommendations
The ““My eHealth” app will be marketed to all people to manage health needs for themself and immediate family. There is a particular benefit for patients living with chronic disease who will have a tool to coordinate information.
The app will be implemented in the following stages:
Stage 1 – integrate static information from the PCEHR, non profit organisations and an open field for personal note taking. The suitability of the interface with a range of patients is assessed before progressing from this stage.
Stage 2 – Professionals to have an electronic option for providing small notes to patients through the app. This will include an interactive feature to allow questions to be asked to health professionals in between set appointments, and for these to be answered prior to, during or after a consult with a specific professional. The accuracy and perceived value of this information to patients is assessed before progressing from this stage.
Stage 3 – Include an option for non-clinical health coaches to provide intermediary advice on questions raised and options to seek support. This will include review of self monitoring data to identify if a complication or poor compliance to a treatment program is observed.
The accuracy and perceived value of this information to patients is assessed before progressing from this stage. Also review parameters for automated notification of physiological or behavioural data to be sent to the relevant health professional.
Stage 4 – The available information is expanded to include details from the treatment “options” column, and prevention “support” columns. Health professionals can have specific treatment suggestions according to a database of research, quality improvement projects and recommendations from governing bodies. Patients will also have the option to speak to other people from a similar demographic who are managing the same condition.
The suitability and privacy of information generated through a database feature is assessed before progressing from this stage.
Stage 5 – Integrate the option for private marketing of products and services ranked based on peer-reviewed outcomes measured for the average patient.
The suitability of products being marketed, and how well they are compared for actual results achieved is assessed at this stage.
EXAMPLE: MANAGING HEART DISEASE
The “My eHealth” app should be trialled for a specific condition to start with, such as Heart Disease. An elderly person who is managing heart failure would derive the following benefits at each stage:
Stage 1 – see at a glance what advice has been received from different professionals. Notes can be taken by the individual during the acute, recovery and rehabilitation phases for information perceived to be important to refer to in future. The option to share these notes with health providers is optional. Also a record of current medications is available to refer to.
Stage 2 - The GP can see at a glance advice provided from specialist, nursing and allied health professionals to assess compliance with recommended treatment. This is available immediately after it has been included in an individuals record. Questions can be reviewed immediately prior to a consult and answered at the time alongside a short answer being provided in the individuals record.
Stage 3 – if the patients weight increases more than 1.5kg in 2 days an alert is automatically sent to the GP who makes contact with the patient to assess if review or early hospital admission is required. This would quickly address changes in fluid loading which may be an early indication of the condition worsening. Similarly, if the patient notes they have been eating high salt foods this can be flagged as an issue to cover at the next consult with a professional.
Stage 4 – the patient can see information from the National Heart Foundation on what treatment is recommended and why. This is the same information given to health professionals to guide their treatment plans. Also they can link to other people in the nearby area who are also managing heart failure for social support.
Stage 5 – private services are marketed which provide peer-reviewed and evidence based positive outcomes such as gentle exercise, relaxation, or health management services.
The expected outcome would be a patient who has a better understanding of why different treatment is being provided, and improved behaviour to manage the condition. Health professionals would save time and be able to provide more tailored information for the patient. Automating some information to be flagged for health professional review would reduce unnecessary hospitalisations and improve the quality of life for the person.
Authors Note
My experience in providing support to people managing chronic disease has highlighted that even a small piece of the right information and support can make a big difference to an individuals health. Time constraints limit the ability for professionals to develop a system for sharing targeted health information to patients and health providers, and as a result more reliance is made on “Dr Google” by patients to seek advice.
This observation is primarily from working as an Exercise Physiologist. With this app design I have attempted to create a simple interface which is based on the patient experience. From listening to many patients my recommendation is to place their ability to understand and synthesise information as the highest value.
Health professionals also need to improve how information is packaged. This app will assist to increase peer networking to support a professional to succinctly express advice to a patient in a usable format (i.e. no jargon), design suitable treatment plans and refer them to suitable complimentary treatments. The ability to easily share consistent information with carers can greatly reduce communication breakdown and increase social support for healthy behaviour change.
Despite starting to learn how to code apps earlier this year, I have realised that the scope of experience needed is too wide to effectively bring the level of detail needed to the app marketplace. This concept is being shared with HISA [1] to at least generate more conversation about the need to better communicate relevant information to improve professional competence and patient outcomes.
This app concept represents an option to address issues which I have seen raised in many online telehealth forums. This post has been formatted according to the ISBAR communication tool [2].
References
[1] Health Informatics Society of Australia, App Challenge 2013.
[2] ISBAR handover
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