Will using a mobile app work for all patients?
How can we break down the financial barriers for rural care?
Featured image courtesy of Wikipedia.
Featured image courtesy of Wikipedia.
Chronic diseases are a global epidemic. Three out of five Canadians over the age of 20 have at least one chronic disease and many others are at risk of developing one. Caring for this group poses a heavy burden not only on caregivers, but also on the patient themselves. Many organizations who care for patients with chronic diseases have implemented technologies that make it easier for everyone involved. Mobile apps can be used for various purposes. The entire care team can connect in one place which fosters better communication and information sharing. Some platforms can be integrated with home health devices that the patient can use to monitor their conditions. They can share this information with their care team in real-time. The ability to monitor a patient’s condition remotely means that care providers can track their health and intervene when necessary. When an intervention takes place before the condition has the chance to get worse, it can avoid an emergency room visit or a trip to the doctors office. In this blog, we will be highlighting four posts explaining the various benefits an organization can have from using a mobile app for chronic disease management.
As mentioned previously, some apps allow for health monitoring through bluetooth devices. This post details the impact that encouraging your patients to use these devices for monitoring their chronic conditions can have. aTouchAway by Aetonix is a platform that supports real-time updates using various home health monitoring devices. These consist of a step counter, a fall detection/wandering bracelet, a pulse oximeter, a weight scale, a blood glucose meter, and a blood pressure monitor. They are easy to set up and use from the comfort of the patient’s home. When they patient has used any of these devices to monitor themselves, their results will be available to whoever has been permitted to view them. Care providers also find it especially helpful when the results can be represented in a graph or chart format. This makes it easy to spot any sudden changes in the pattern and make changes to routines/prescriptions if necessary.
This post features an interview we conducted with one of our clients. Laura Schauer, a registered nurse with the Thamesview Family Health Team, sat down with us to share her experiences with using a mobile app for her patient’s chronic disease management. One story she told us particularly stood out. Laura explains that she has a patient with congestive heart failure who uses a weight scale and blood pressure monitor at home to share their results with her daily through aTouchAway. She noticed this patient suddenly had very low blood pressure readings. When she called the patient to discuss, they reported they had been feeling dizzy. Based off this information, Laura was able to discuss with the patient’s physician and agree on giving them a lower dose of their blood pressure medication. The physician was able to remotely adjust the patient’s prescription and the patient was feeling back to normal two weeks later. This is just one of many examples where healthcare practitioners are able to observe their patient’s health information through an app and take action.
Care plans are essential for patients with multiple chronic illnesses. They provide individualized guidance for the patient and their care team. This post details how digital accessibility to a patient’s care plan can improve the way their team provides care to them. When the whole team is kept up-to-date and informed of progress in one place, it is much easier to stay on track with the patient’s goals. Getting the patient set up on a mobile app along with the rest of their care team will help to ensure that the patient is kept at the centre of their care.
It’s no secret that hospital readmissions are part of what is so costly to our healthcare system. Especially when they are avoidable or unnecessary. This post looks at how using a mobile app helps to reduce these hospital visits. Patients who deal with a condition like COPD may be likely to go straight to the emergency room when they’re experiencing breathlessness. This is not always the right call, especially when there are other options available. Patients like these may take comfort in being set up on an app that connects them to their family and professional caregivers. If they are having trouble breathing, they are able to call someone close to them who can get a visual representation of how they’re doing and coach them on next steps.
If you or your organization are considering using a mobile app for your patient’s chronic disease management, we hope these posts will help give you further insight into the benefits it can offer you. Please feel free to look at our blog page for more articles on caregiving for patients with chronic conditions.
It happens far too often. A hospital will give a patient brief instructions upon discharge. The patient leaves saying they understand. When the patient follows up with their physician afterwards, they are unable to remember what exactly they were told. They tell the physician what information they think they can recall – which, of course, may not be as accurate as they think. This is just one simple example of what happens when health practitioners rely solely on the patient to deliver information from one end to the other. As you know, when a patient gives inaccurate information to their care provider, this can cause a lot of other difficulties and frustrations. It happens too often where information is not articulated properly or certain providers are not kept up to date. Patients may be given the wrong prescription doses or have to undergo unnecessary tests among many other inconveniences. When a patient’s care team are not connected and rely solely on the patient, this is where information gaps occur. In this blog post, we are going to look at three ways to close this gap and foster better communication within care teams.
When an organization brings up the idea of introducing a new technology, the staff will naturally have questions. How do we know it’s secure? How easy will it be to implement? Will our patients be able to use it too? The key is finding the right technology that allows for all of this. These organizations take on more of archaic approach to communication at the moment, still using phones and fax machines. Although it may be effective, it can make the process of sharing information longer than it needs to be. For example, if a clinician needs to contact a physician for a consultation and the physician is not immediately available, they will likely have to go through other people whether it be a unit clerk or hospital call centre. By the time the message gets to the physician, it will have taken much longer than a direct text message would have. A recent study showed that 39% of physicians interview believe that time is being wasted because text messaging is not allowed. Although text messaging from their personal devices may not be permitted, there are some applications that allow for secure texting. The right mobile app will allow for much more than just texting too. A mobile app is the perfect platform to connect all members of a care team in real-time. It’s a platform where they can view the patient’s care plan and progress. The patient can even video conference with multiple members of their care team from the comfort of their home.
In order for a care team comprised of members from various organizations to work in sync, they must know the most efficient ways to reach each other. All organizations operate differently with communication. The physician must know the best way to contact the patient’s pharmacist who, in turn, must also know how to contact the patient. This study shows that 1 in 5 Canadians with chronic conditions have experienced prescription errors or duplications. Should there be a change in a patient’s prescription, the physician cannot rely solely on the patient to pass this message along. The physician should establish a clear line of communication to the patient’s local pharmacist along with others in the care team.
There are some situations, such as a sudden emergency room visit, that cannot be planned in advance. However, many other events can be. If the patient is about to undergo an operation, their physician should be informed if they are not already. In addition, a close loved one should not only be informed, but also know the proper pre/post operative care the patient may need help with. Many patients with multiple chronic conditions rely heavily on their informal caregivers to take care of them at home. The caregivers need to be given the information to properly do so. When everyone is kept in the loop about a patient’s care, it is much easier to avoid complications. Planning ahead can also consist of taking note of planned absences or vacations. Nothing will delay diagnoses and test results more than waiting on a practitioner who is on a two week vacation. Patients should not have to wait multiple weeks for important test results. In this case, it is helpful to prepare for any care team members absences and ensure that the patient will have a way of receiving their results. Working in the healthcare industry, you should inform your patients and their care team of any absences beforehand when possible.
It is clear that healthcare practitioners do not communicate enough with each other and even less with their patients. When a patient and their whole care team are kept up-to-date, it’s much easier to avoid complications. Whether these complications result from misunderstood instructions, inability to reach a care team member, or a lack of information, one thing is for sure: communication is key.
A Project Manager plays an essential role in the healthcare system. They are responsible for creating a detailed plan once a new program is established. This means that they are involved from start to finish and also have to prepare a quick solution should a problem arise. As you can imagine, it’s quite a busy and demanding role. Other tasks include reporting on progress and supervising other members involved in the project.
In this blog post, we would like to introduce you to Joshua Hambleton, a Project Manager with the Arnprior Region and Ottawa West (AROW) Health Link. The Health Links are an initiative established by the Ontario government to provide coordinated care to the top 5% of healthcare users across the province.
Unlike other approaches, the patient is put at the centre of their own care. Their team of providers will establish a care plan and the patient and their family will work together with them to ensure the patient is receiving the care they need. Caring for this specific group of patients with complex needs is essential. If they are not getting the care they require or something goes wrong, they are likely to end up back in the emergency room. Hospital readmissions are especially costly on the system. By providing more accessible and frequent care, more patients are able to manage their conditions at home. Joshua has worked with patients like these during his time at the AROW Health Link for the past four years. He sat down with us to share more about managing complex patients and how using a mobile healthcare app has impacted this role.
When asked to begin by defining his goals as part of the organization, he responded, “we focus on client goals, the care teams, and connecting the care teams around the client’s priorities”. His role as an implementation manager is to make sure the organization is taking on a patient-centred approach – this includes anything from business planning to the actual implementation and evolution of the approach. “I first became interested in Health Links as I was exploring opportunities to work between agencies,” he explains. “I’ve worked in acute settings, primary care, community care, and I recognized that where I’m able to contribute the most is working in a space that there was a greater opportunity to apply my skills and experience.”
What interested him particularly about working in a Health Link is the opportunity to close, what he refers to, as the “gap”. “I became involved with a Health Link focused on working between agencies in the gap where often the relationships were referral based or dependent on the patient to carry that information from provider to provider,” Joshua says. As you can imagine, when healthcare providers rely solely on the patient to keep them up-to-date, there may be gaps in information.
Working in a network of different specialists and organizations is much different than working in a single agency. “One of the biggest challenges is getting people to think outside of their organizations and how we go broader,” he says. “Whether it might be mental health, an acute setting, or geriatrics, how do we link these networks together so that we’re sharing information and have better communication across providers?”
What makes this even more complicated is that each organization has their own proprietary health records. Joshua adds that communication between these organizations is usually still done through fax or phone – a more old-fashioned approach. “How do we share information and make it as real-time and relevant in that environment as possible?” he asks. They may have found the solution… and it comes in the form of a digital platform.
The AROW Health Link (and many other Health Links) have been using aTouchAway in an attempt to bridge the gap. aTouchAway by Aetonix is a remote communication platform designed to help manage the care of multiple patients with complex needs securely. According to Joshua, aTouchAway has been effective for enhancing better communication, “whether it’s sharing documents like discharge summaries or just general updates about home visits or the updated coordinated care plan”.
Many times, healthcare information systems don’t include the patient (and their family) in their own care. This is both surprising and slightly concerning considering families provide the majority of care to chronically ill patients. In fact, there are more than 8 million informal caregivers in Canada alone. How do we solve this disconnection? “Aetonix allows for a way to have informal caregivers be part of the care team with access to the care plans and to the broader professionals,” he says. One reason why patients and their families may not be able to be actively involved in their care is a lack of communication tools. Many patients have mobility issues or live in rural areas which may prevent them from being able to frequently see their health team. Since Joshua’s Health Link is able to work together with Aetonix’s partners (Samsung, Boehringer Ingelheim, and Bell), they can provide patients in their homes with tablets and a cellular connection. This way, even patients who previously had no internet connection at home have the ability to reach out for care whenever it’s necessary. Simple tasks such as follow-ups, appointment confirmations, and education can now be done through the software without the patient having to leave home.
Joshua also uses the application himself for various purposes. “I tend to go to the app for sharing different client information with care teams and with those care coordinators,” he says. Since most of his work is done on a program level (and not a direct care level), he is more focused on engaging the care teams with the software and getting them to communicate through it more often. “It’s a new technology,” he explains. “So both in terms of whether it’s a care coordinator, the care teams, the clients, we have different levels of engagement. Even having the tablet there is a comfort and a reassurance for clients. Despite having, say low usage on the app itself, it’s just a knowledge that they can be connected should there be a challenge that they come across or they need to reach out.” He says they also have clients who use aTouchAway much more frequently. This use is mainly for connecting with their care team; both formal and informal.
He recalls some really positive experiences patients at his Health Link have had with the app. “A great story that I heard recently was this woman who was able to be connected to her daughters who lived across Canada, one on the East Coast, one on the West, I think someone in Calgary as well,” he explains, “this woman was able to not only connect with her family and her daughters, but was able to see their apartments for the first time due to not being able to travel.” For patients with mobility issues or who live far from their families, it is small things like this that will make using the technology worthwhile for them.
If you provide care to patients dealing with chronic conditions, you know it is not an easy job. Fortunately, with advances in technology, this doesn’t always have to be the case. More healthcare professionals and facilities than ever are using digital technology in their practices. And for good reason – a study from Ricoh Research shows that 74% of hospitals that use mobile solutions to collect and share data are more efficient than those who don’t.
Aetonix’s mobile app, aTouchAway, has been deployed in various healthcare organizations for this purpose. The app connects the entire circle of care on one platform, allowing for seamlessly sharing updates on the patients’ health in real-time. This ensures that everyone is up-to-date and actively involved in the patient’s care. The patient also has the ability to self-manage their own care. aTouchAway’s integration with home health equipment allows for the patient to monitor their own condition. For example, a physician could set up a customized protocol (workflow) that asks their patient with diabetes how they are feeling on a scale of one to ten. If their response is lower than five, the physician can instruct them to use a pulse oximeter to measure their blood oxygen levels. When set up with the proper equipment, the patient will be able to do this themselves from the comfort of their home.
The Thamesview Family Health Team is an organization based in Chatham, Ontario, who use aTouchAway with their patients. They are a family health team made up of 16 family physicians and more than 23,000 rostered patients. Other roles in the team include nurse practitioners, registered practical nurses, administrative and reception staff, social workers, and more. We sat down to speak with Laura Schauer, one of their registered nurses, about the work she does for her chronic patients using digital technology.
As a registered nurse at the Thamesview Family Health Team, she has a lot of daily tasks. “I do many regular ‘hands on’ nurse work such as injections, dressings, and blood pressures,” she says. “I also draw blood work, perform foot care, monitor our INR clinic, health and wellness checks, and am a smoking cessation counsellor and Health Links care manager.” Her role is essentially managing, supporting, and caring for their complex patients. These include people with multiple health issues, who are often elderly, isolated, or tend to end up in the hospital or emergency department more frequently than others.
Reports show that seniors with three or more chronic diseases use three times the amount of healthcare resources than those with none. “I do feel that with the number of rising seniors in our population, the number of people with ever-growing list of chronic health problems will also grow,” Laura says. As chronic diseases are on the rise, healthcare organizations must do what they can to keep these patients out of the hospital. Hospital readmissions are both costly to the system and stressful for the patients.
This family health team is part of the Health Links. Health Links is an Ontario initiative to provide better, more coordinated care to those with complex conditions. Organizations caring for patients involved in the Health Links must work to ensure that patients have a coordinated care plan (CCP) and ongoing care. The Thamesview Family Health Team is part of the Chatham-Kent Health Link. According to Laura, “In the beginning, our four RNs here actually were all involved [with Health Link patients] and we all had a designated ‘patient list’. As the Health Link role has expanded, we have found it much easier to have one main RN dedicated to the program and the rest help support the role.”
Of course, taking on the role of managing many complex care patients can come with its complications and challenges. Laura states that her biggest challenge is time. She and other nurses also have to factor in driving time for home visits and there are only so many hours in a week. They are challenged with trying to see as many patients they can with the amount of time they have.
Fortunately, she does not always have to drive to see the patient in person. Using aTouchAway allows Laura to monitor her patients remotely. “Currently, I have a few different uses with my patients for aTouchAway,” she says. “Most notably is a patient with congestive heart failure (CHF) – they have their own blood pressure monitor and weight scale. They get their numbers for me every morning and enter them where I can then access them.” She is able to watch for trends and when she sees a sudden change, she can step in. Looking at the data, she noticed one of her patients began having low blood pressures. When she called the patient to discuss this and check in on them, they complained that they had been feeling dizzy. “I had to discuss with the patient’s physician and they ended up needing a lower dose of their blood pressure medication.” After the physician was able to remotely adjust the patient’s prescription, the patient reported feeling back to normal two weeks later. No in-person visits were required. In situations like this, it helps that multiple members of a patient’s care team can connect on the same platform.
“For someone flaring with their CHF,” she adds, “their weight may begin to climb, as might their blood pressure, and perhaps also their oxygen levels may drop as well. Having a nurse reviewing the trends of these numbers regularly gives us an idea as to what is going on, and a chance for early intervention.”
Another advantage she gets from using a mobile app for healthcare monitoring is the ability to send and receive photos. “We are also in the works of using aTouchAway for photo exchange,” she explains. “I have a patient that frequently gets cellulitis and they live far away. To have the ability for them to send a photo of the wound/potentially infected area and be able to get in touch with their physician quickly can mean an avoided hospitalization because we had a quick intervention.”
When asked about her personal experiences with the technology, she states “luckily the training to use the technology was pretty easy, which is helpful when trying to explain how to use it to others. Of our patients that currently have it, they have caught on pretty quick and are able to communicate with me, answer their reminder questions, and even upload their daily weight and blood pressures.” Of course, there are some patients who will still prefer the face-to-face visits instead. When finding the solution that fits best for your patients, ease of use is essential. Laura explains that some patients who have cognitive deficits or dementia, for example, may not remember how to use the system or operate a tablet.
Recent advances in technology may be the key to simplifying complex care. Laura Schauer has taken advantage of what mobile solutions can offer. “For patients with complex, chronic health conditions such as COPD or CHF, mobile health monitoring with vitals (blood pressure, heart-rate, oxygen, weight, etc.) is very helpful as changes to these numbers are sometimes the earliest indicators that something is amiss or an exacerbation is looming.” The ability to check-in on her patients without actually being there allows her to provide the same quality of care but in much less time. Not only does a mobile app save time for everyone involved, it allows patients to self-manage and still live independently. They are able to monitor their condition from the comfort of their home. Although chronic diseases are on the rise, with so many new technologies and programs available, there is reason to believe they can be managed easier than ever.
Featured image courtesy of eMedCert.