Arctic Light e-He@lth Conference
Tackling the changes accompanying
e-health implementation
Dr. Marina Lupari
LTC Lead / AD for Nursing – R& D
NHSCT – Northern Ireland
Demographics and the rapid increase in chronic disease
90 million
100 million
Western Europe
72 million
USA
Numbers of People
Over 65
33 million
Japan
10 million
2002
2025
Source: US Bureau of Statistics
• Changed & poor diet
• Obesity
• Less physical activity
• Cardiovascular disease
• Poor lifestyle choices
• Type 2 diabetes
GOOD ADVICE
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Most smokers know ‘its bad for them’.
Most can give you ‘good reasons’ why
they do not want to stop right now.
When you discuss this it often
polarises them into taking a defensive
position
REASONS
FOR
SMOKING
Managing the Illness
 Taking medications
 Changing diet and exercise
 Managing symptoms of pain, fatigue, insomnia,
shortness of breath, etc.
 Interacting with the health & care system
Managing Daily Activities and Roles
 Maintaining roles as spouse, parent, worker, etc.
Managing the Emotions
 Managing anger, fear, depression, isolation, etc.
Patient as
partner in care
provision not
recipient of care
Creation of a Chronic
Illness case management
service
Health Stratification Model
Case management
Disease management
& shared clinical care
Largely self care
Level 3
Patients with highly
complex needs and
co-morbidities
Level 2
High risk patients
Level 1
70-80% of
LTC
population
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Predictive risk profiling of patients
Nurse led generalist model across several chronic
conditions
(Heart Failure, COPD, Asthma and Diabetes)
Least invasive care in the least intensive setting through
patient-centred case management approaches AND ehealth
Target group- older people identified as being at most risk
of avoidable re-admission to hospital( PARR tool)
Integration and coordination of the individual’s journey
through all parts of the health and social care systems
(Integrated Care pathways)
Incorporates elements of disease management and selfcare
Anticipatory care facilitated through proactive as opposed
to reactive care model
Adopted remote monitoring telehealth as support system
“e-health is an emerging field in the intersection of medical
informatics, public health and business, referring to health
services and information delivered or enhanced through the
Internet and related technologies.
In a broader sense, the term 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.”
Patient admitted/discharged
Activity recorded on Trust PAS
PARR DATABASE
Activity downloaded into PARR Via
Business Objects, Trust Designed MS
Access Database
Sifting & criteria
applied
Risk Level Identified
OTHER
PATIENT
DATA APPLIED
CASE FINDING DATABASE
Nurse assesses and accepts
person onto the caseload
Choosing the right telehealth System
P
O
P
U
L
A
T
I
O
n
+
Or
High risk
V100
Intermediate risk
Multiple conditions
Intermediate risk
V500
Case Manager
Specialist
Physicians
+
Case Manager
V100
+
Case Manager
Low risk
+
Peripherals
Peripherals
only
ECG
recorder / transmitter
Digital
scale
SpO2 meter
Home-based
data transmitter
Blood pressure meter
Glucose
meter
Spirometer
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Enhanced patient self management
Reduction of readmission to hospital in 9
month period of 59%
Significant increase in HR-QOL ( both patient
perception and actual health state)
Increase in patient functionality
Robust evidence base demonstration costeffectiveness at £20,000-£30,000
willingness to pay
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Change of working culture for All existing
staff e.g. medics, nurses, pharmacists
Resistance from existing disease management
specialists e.g. medics, nurses,
physiotherapists
Perception of a territorial threat to existing
staff and existing practices
Changing the Team
Community
Community
Primary
Care
Integrated Care Partnership
Primary
Care
Virtual Care Team
Secondary/Tertiary
Care
Changing the Health Record
Clinical
Medication
Demographics
Images
Documents
Tests
Home Visits
Community
Risk
Community
Primary Care
Patient
Record
Home Monitorin
Hospital
Patient
Referral
Management
Recall Prescriptions
Changing the Patient Care Pathway
Primary Care
Consultation
Primary
Hospital
Care
Consultation
Test
Hospital
Test
Hospital
Teleclinic
Consultation
Present with
Symptoms
Normal
or refer
Refer to
Hospital
to different
speciality
Refer to Hospital
Normal or refer
to different
speciality
Hospital
Procedure
Hospital
Teleclinic
Follow Up
Primary Care
Management
Discharge
Discharge
Changing Consultation for Primary Care
Patient
Advocacy
And
Support
Local Health
CHF
Professional
History and
Symptoms
General Practitioner/
Consultant
Full Clinical History
Management
Electronic Patient
Record
Changing Applications for Primary Care
Ultrasound
Physiotherapy
Echocardiography
Vascular
Obstetrics
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Express acceptance and affirmation
Try to understand how the person sees their
problems (reflective listening)
Elicit and reinforce self-motivational
statements: concerns, desire, intention and
ability to change
Assess and feedback their readiness to
change
Affirm the persons freedom of choice
Unknown Territory…
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The power to redesign and improve health care
delivery has arrived
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Technology is a tool in the toolbox that will give
patients and nurses more choices.
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All staff time and effort will be better spent
where and when it is needed.
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Technology provides the means to leverage
health care process to improve access to care
and facilitate collaboration.
 Rethink Care
 Restructure Care
 Retrain for Collaborative Care
 Put patients first
Marina.lupari@northerntrust.hscni.net