lecture 10: digital health

Nursing Informatics science and practice integrates nursing, its info and knowledge, and their management, with Information and Communication Technologies (ICT) to promote the health of people, families and communities worldwide”.

The use of Information and Communication Technology (ICT) in

support of health and health-related fields.

The broad scope of Digital Health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine. These technologies can empower consumers to make better-informed decisions about their own health and provide new options for facilitating prevention, early diagnosis of life- threatening diseases, and management of chronic conditions outside of traditional care settings.

ehealth, health informatics, artificial intelligence

telemonitoring, tele nursing, telemedicine

1950-1960s: ICT in Health - computers, focus on corporate support, industry agnostic

1960-2000s: practice management, focus on organization, corporate applications

2000-2020s: system wide info, focus on whole health system, provider centered, healthcare as process not outcomes

2020s: decentralized, patient centered, empowering individuals, big Data, sophisticated analytics

• Electronic Medical Records (EMRs) vs. Electronic Health Records (EHRs)

• “A record specific to a clinician’s practice or organization. It is the record that clinicians maintain on their own patients, and which detail demographics, medical and drug history, and diagnostic information such as laboratory results and findings from diagnostic imaging. It is often integrated with other software that manages activities such as billing and scheduling”.

• Examples• Oacis & Vsign

• MedUrge• InteleViewer

• Medesync

• References for clinical practice• Integrating & synthesizing research for evidence-based best practice guidelines (often combined with institutional policy)

• Examples• UpToDate

• Lexicomp• Epic Systems (EMR outside of Quebec)

• Involves real-time data & analysis

• Philips Continuous Patient Monitoring• Surgical Imaging (e.g., Interventional Radiology)

• Diagnostic Imaging (CT, MRI, etc.)

• Virtual Wards as a solution for transition from inpatient to outpatient – Telemonitoring/Telemedicine

• COVID@HOME launched in Jan. 2022

• Pilot project by CIUSSS West-Central Montreal allowing COVID-19 patients at JGH to complete their recovery at home with ongoing telemonitoring

• Smart Wearables (Apple Watch, Fitbit, Pixel Watch, Withings BPM Connect, etc.)

• Smartwatches• Smart BP Monitors• Continuous Glucose Monitors (CGMs)

• Non-Smart Wearables

• Pulse Oximeters• BP Cuffs• Glucometers

• Hardware can be portable or fixed• Software can enable integration within EHR systems (internet-connected) or standalone

• Examples

• Abbott i-STAT wireless blood analysis• NeurOptics Pupillometer• Nova Biomedical Glucometers• Edwards HemoSphere Hemodynamic Monitor

• Philips B|Braun Smart IV Pumps• AcuDose-Rx Automated Dispensing Cabinets (ADC)

Pt now have access to more health-related data and information than ever before; increased engagement in managing their health with the tools and information to do so leads to improved health outcomes

Pt now have better access to their healthcare provider through tools such as telemonitoring or telehealth (virtual care modalities such as video conferencing)

• Accelerated by the COVID-19 pandemic

Pt can now connect more easily through virtual support networks

People are taking their health into their own hands & onto their own wrists

• The Digital Divide• Reliable internet access and availability of certain devices is imperative to ensure that the benefits of DH are experienced by all

• Unconscious Bias

• Technology can address issues of bias in health care, as machines are ‘blind’ to colour, ethnicity and other potential forms of bias. However, biases may be programmed into the technology that sought to solve the problem, as seen with the recent interest in developing AI oversight

• Digital Health Literacy (Learning, Readiness & Timing)

• “Digital Health Literacy is the ability to seek, find, understand and appraise health information using information and communication technologies (ICTs) to address or solve a healthcare problem.”

Clinicians now have access to more health-related data and information than ever before and have the tools to analyze and act on the information more effectively

The quality of patient data & ability to communicate effectively have been vastly improved

Devices can streamline practice activities, allowing nurses to focus more of their time on the care itself

• Digital Health Technologies are only tools that complement & support a nurse’s clinical reasoning & actions

• Professional judgement must prevail in the presence of technologies designed to support clinical assessments, interventions, and evaluation (e.g., monitoring, devices, decision support tools, etc.)

1. info and knowledge management - Uses relevant information and knowledge to support the delivery of evidence informed patient care

2.professional and regulatory accountability - Uses ICTs in accordance with professional and regulatory standards and workplace policies

3. info and communication technologies - Uses ICTs in in the delivery of patient/client care

• Obtaining informed consent requires:

Disclosure of information

Adequate understanding required from the healthcare provider

Difficult with rapidly evolving technological landscape

Competency of the patient (or surrogate) for decision-making

• Adequate understanding required from the patient or client

• Voluntary nature of the decision

Lack of control over data management & cybersecurity (see next section)

Healthcare institution signing terms & conditions on behalf of their patients; indirect responsibility

Is it possible to opt-out or withdraw consent?

• Requires Knowledge & Practice of Effective Cybersecurity Measures

Access & authentication

VPN access vs. institutional access points

Passwords & two-factor authentication vs. biometric authentication (fingerprints on AcuDose ADCs)

Organizational Policies

Hardware maintenance & software update distribution

Network management & firewall implementation

Audit logs of all user access data

Backup & cloud storage

Physical or virtual location of sensitive patient data

Outsourcing to private companies

Provisions to preserve the secrecy of confidential information 31. A nurse shall abide by the rules set forth in the Professional Code (chapter C-26) in regard to the obligation to preserve the secrecy of confidential information that becomes known to her or him in the practice of her or his profession and the cases where she or he may be released from the obligation of secrecy.

• Cost of implementation

• Government funding & political challenges

• Interoperability• Lack of universal integration between institutions

• Training & development of technical skills

• Use of hardware

• Use of VPN, user interface (UI) navigation, video conferencing

• Cybersecurity• Constant threats to sensitive pt info

• Tech support & contingency plans

• Oacis update causing outages across MUHC

• Errors/malfunctions & analogue alternatives

• Artificial Intelligence (AI)

• Large Language Models (LLMs) (ChatGPT, Bard, etc.)

• Machine Learning• Examples

Direct-to-consumer genetics/genomics (23andme) & personalized medicine

PredictivealertswithinClinical Decision Support Systems (CDSS)

Falldetection(e.g.,AppleWatch)

• New modalities for noninvasive biometrics

• Robotics

• Already implemented in surgery, will soon be involved in basic care