Future of Patient Care

Internet Today

            We are living in a time of “Web Revolution” which affects many aspects of our lives. These changes can be seen everywhere:  banking, schooling, shopping, traveling, working and healthcare. Most people pay bills, shop, make travel arrangements and go to school on-line.  Many people do not ravel to work but simply walk into a home office to start their day.

Ones basic healthcare may be accessed through the internet, such as checking labs, scheduling appointments, and even contacting primary care physicians.

 To generalize these changes, many things that were fiction yesterday have become a reality today. As the Internet continues to evolve there will be more healthcare services available such as e-group therapy, personalized health education, and support groups. The goal of this paper is to discuss the role of the internet in the management of chronic diseases (e-Clinics) and internet urgent care centers as the future of health care.

Chronic Care “e-Clinics”

            According to Health Policy Studies Division of the National Governors Association, approximately 78% of total U.S. health care cost accounts for managing chronic conditions.  Patients with chronic diseases represent 76% of all hospital admissions, 88 percent of all drug prescriptions and 72 present of all physician visits (Johnson, 2003).  Major challenges exist in the management of chronic diseases and their inherent complexity.   However, the use of technology may decrease complications avoid hospitalizations, and prolong life.  Piloted programs at Queens and Elmhurst Hospitals Centers showed that a web-based electronic diabetic registry aided physicians in providing more informed and personalized treatment.   These improvements resulted in better health care outcomes (Health and Hospitals Corporations [HHC], 2009).

            While analyzing the online management of chronic conditions, of one of my family members, I concluded that our healthcare system is moving in the direction of “e-Clinics” for chronic disease management.  My cousin N. T. has a problem with hypothyroidism as result of radiation exposure in Chernobyl. In a majority of cases, the management of hypothyroidism is straight forward procedure.  Thyroid medication like levothyroxine is prescribed to the patient and blood levels of TSH hormone are checked to make sure the patient is taking the right dose of medication.  In my cousin’s case, it was different.  She required micromanagement of her condition because of the side effects of taking required higher doses of thyroid medications or suffer symptoms of hypothyroidism as a result of not taking sufficient dose of the medication.  As a result she had frequent doctors office visits with blood draws.  She told me that it was very frustrating to her as she had to spend almost half of the day at doctor’s visits just to get one question answered. In addition to the time spent for the visit she had to pay a co-pay every time she was seen in the clinic.  However, two years ago her health care system transitioned to Electronic Medical Records (EMR).  With EMR other changes came.  Personal Health Records are available to patients via a secure web site and e-mail communication with a doctor becomes part of health care system EMR.  My cousin told me that for the last two years she had only one doctors visit and the rest of her communication with a doctor occurred via e-mail.  She became satisfied with her care.  She does not have to wait any more until her next clinic visit to get her questions answered, she just simply e-mails him.  In addition, she saves about $200 per year for co-pays and many hours travelling and waiting in clinics (N. T., personal communication, November 25, 2010).

 “E-Clinics” for chronic disease management are promising.  Some studies showed implementing telecare in chronic management decreased readmissions by 83% and health care costs by 86%.  Developments of new technologies like Home Telecare System are even more promising for chronic diseases management.  The system includes vital-signs, electrocardiogram monitoring devices, automated scheduling and medication reminders, as well as access to health education.  This system is connected through the internet to the server in the clinic, so data collected about a patient’s condition is automatically synchronized and immediately available to a healthcare provider for review. Case studies have shown that early identification of adverse signs helped prevent admission to a hospital or reduced length of stay.  Also, it was noted that using this system improved patient involvement in self care and improved medication compliance (Celler, 2003).

Internet Urgent Care Centers

            Working as an admission nurse at a large medical center, I estimated that about 60-70% of patients that I have admitted to the hospital used the Emergency Room (ER) as the mode of entry to health care.  Most of my patients came to the ER because of emergency healthcare needs.  However, many of these emergencies were related to delayed care as result of barriers to access in the health care system.  The following case study is an example of this situation:

Mr. B presented to the ER with right forearm swelling, redness, draining wound, sharp pain and fever.  Two weeks prior to the ER visit, Mr. B injured his forearm with garden scissors while working in his garden.  In the beginning it looked like a minor injury. The next day, his right forearm became red, painful and swollen.  He understood that it was infected and he needed medical help.  Mr. B. had recently become unemployed and uninsured.  Having a difficult financial situation, he decided not to go to a doctor’s office.  Instead, he called his friend who was returning from Mexico to stop by at a Mexican drug store and purchase some antibiotics.  Mr. B was taking antibiotics from Mexico for two weeks until the pain in his forearm became unbearable and he started to have fever and chills.  Mr. B spent two days in the ICU because he became septic as result of taking the wrong antibiotics.  Now let’s picture this situation in the future.  Mr. B has been infected and has financial constraints.  He knows that there is an on-line urgent care center based in his home town.  The on-line urgent care center charges five times less than traditional medical office.  Mr. B. takes a picture of his wound, goes on-line and through live chat he presents his case with pictures and Google personal health records to the healthcare provider. The On-line urgent clinic doctor prescribes appropriate antibiotics and sends an e-prescription to Mr. B.’s local Wall Mart where Mr.B. purchases the antibiotic for $1.  Taking correct antibiotics, Mr. B avoids a life threatening infection and hospitalization and spends only twenty one dollars (Mr. B., personal communication, September6, 2010). 

            When I tried to goggle “eHealth Urgent Clinic”, the only urgent clinic I was able to find was for computers.  On line Urgent Care sounds like a dream today, but it can become a reality tomorrow.

Conclusion

            It is clear that computer technologies and the internet are helpful tools for doctors and patients.  It saves time, money and facilitates improved communication and care.  90% of people who used online therapist were satisfied.  However, face to face care is still better.  Online healthcare providers will never replace the traditional doctor patient relationship (Yellowlees, 2008, pg 98).  I believe that a combination of traditional face- to- face treatment in combination with the use of the internet and computer technologies will make healthcare more efficient, personalized, cost effective and safer.  

References

Celler, B. G., Lovell, N. H. & Basilakis. J.  (September, 2003).  Using Information

Technology to Improve the Management of Chronic Disease.  MJA, 179(5), 242-246.

Health and Hospitals Corporations. (2009).  Chronic Disease Management.   Retrieved

December1, 2010 from http://www.nyc.gov/html/hhc/html/services/chronic-disease.shtml

Johnson, A.  (June, 2003).  Measuring DM’s Net Effect is Harder Than You Might Think.  Managed Care.  Retrieved December 2, 2010 from www.managedcaremag.com

.Yellowlees, P.  (2008).  Your Health In The Information Age-How You And Your Doctor

Can Use The Internet To Work Together.  Bloomington, IN: iUniverse

Use of Second Life in the Health Care Industry.

            I was always negative about Second Life because I have a friend who had a Second Life addiction.  I do not know what happened in his life that led him to this condition, but this dependence almost ruined his family and business.  He is a very successful businessman with a wife and two beautiful children.  At one point he neglected his family and completely sacrificed himself into Second Life.  He continued working, but as soon as he got home, he would close his office door and spend hours, sometimes nights in Second Life.  Because of sleepless nights he was poorly managing his business. As a result, his wife could not take it anymore and started the divorce process.  Eventually his relatives and friends had to intervene and were able to get my friend into professional psychiatric treatment.  It took many hours of counseling sessions and many days to bring my friend back to a normal productive life.  His wife did not divorce him and he is successfully managing his business despite economical crisis.

            When I was asked by my professor at UC Davis to join Second Life and create an avatar I was somewhat anxious.  But it was a graded assignment, so I joined Second Life and adopted an avatar that I named Larry Seubert.  I watched videos created by UC Davis staff and took an orientation session offered by Second Life.  When I was orienting on the welcome island, a couple of avatars came to me and asked about me.  Then I realized that Second Life is very power social tool that it can be used for both, good and bad causes.  It is like a knife that can be used to cut bread and can be used to kill. 

            So, what is the potential of Second Life for the healthcare industry?  I was amazed when I watched the Second Life seminar in “Davis Island” organized by UC Davis. On-line education becomes more and more popular and this element takes it to a new level.  However, all on-line courses I taken have had deficient interaction between professor and students.  These interactions are usually limited to e-mails and occasional chats.  But having a class session on the Second Life is like having a real classroom education.  The only difference is that professor and students have to create an avatar, have speakers and microphone and teleport to the classroom on time.  This is very convenient.  Second Life makes it possible to have real classroom experience from your home.   This real time class experience can be used for patient education as well.  For example, some medical institutions can create a diabetic class where the patient can come, interact with the educator, look at some cartoon-like model and so on. I think that there is a big potential in Second Life for patient education.  The only question is, who is going to do it and how to make it reliable and have ease of use. Second Life has a significant learning curve which may be difficult for current patients.

Why I have this blog?

I created this blog as an assignment for my class at UC Davis Extension “The Internet and the Future of Patient Care."  For some reason I was never thought of blogging before.  By taking the healthcare informatics class I learned that blogging is very easy and convenient way to share information and ideas.  Currently I am wound care nurse at UCDMC and MS student at Betty Irene Moore School of Nursing.  Working as a nurse I realized that we have dissent healthcare system comparing to the third world countries, but we have a lot of areas in our system where we need to improve.  In these blog I would like to share my thoughts and some information in regards what we need to do to make our healthcare system the best in the world.

Is a hospital a safe place to be?

Is a hospital a safe place to be?

Many people consider a hospital as a lifesaving and safe place.  Before I became a nurse,  I believed that no matter what happened to my body, the hospital is lifesaving, safe place-a hospital where doctors and nurses will use all the technology to save my life. The only thing I had to do was to get there soon enough. After I received my nursing degree, my view of hospitals as safe place changed.  Looking at statistics I learned from my Healthcare Informatics class at UC Davis, according to Institute of Medicine Report, about 90,000 to 100,000 patients per year die as a result of medical error and 50% of these errors are preventable.  To better understand this number, imagine one big airplane crashing every day. This is how many people are dying because of medical errors.  The interesting thing is that when one airplane crashes somewhere, this becomes breaking news, but there is no news when a medical error airplane crashes everyday.  I guess we got used to it or just simply do not want to hear this.  This is the huge civic problem and we have to deal with it.  Personally, I made one medication error myself.  At that time I worked as a dialysis nurse.  My dialysis acute unit received new dialysis machines.  During a dialysis procedure we give heparin to prevent the system from clotting.  The new machines had touch screens.  When I was programming the machine, I accidentally touched an extra zero, so the dose of heparin was 10 ml per hour instead of 1ml per hour.  Luckily, I caught this in time. The patient did receive more heparin then was ordered, but not a toxic dose. 
            Yes, I still believe that hospital is a lifesaving place, but is it a safe place? Looking at the statistics I mentioned, it seems that it is not as safe as some people think.  My next question is what should we do to make a hospital a safe place?  From the patient and family stand point, I always encourage my patients and their family members to be actively involved in the patient care.  I ask them to question me about what I am doing, what medication I am giving and why.  When my family members stay in a hospital, I always try to be with them and actively involved in their care.  Last October my mother-in-law was in a hospital because of complications from chemotherapy.  One of the complications she had was Deep Vein Thrombosis which required heparin for treatment.  Remembering my mistake with Heparin, I looked at the pump to see how much of medication she was getting. I suspected it was a higher dose than usual from my practice so I double checked. Sure enough, she had an extra 0 in her hourly dose.  Because of my active involvement is my mother-in-low care, I was able to prevent complication from Heparin treatment.  I was able to prevent problems associated with medication dose error, but how about those families that have no healthcare education?  So, what can we, as healthcare professionals can do it to make the hospital a safer place?  Many people believe that technology is the answer. I agree that computer technology like bar-coding medications will help to reduce big numbers of errors.  When I look at the technical aspect of the banking system, I believe that these guys are doing a very good job with my accounts.  With the help of computers, their error rate is very small.  I think, we as healthcare professionals can do the same thing in using technology for safe care. Finally, in some hospitals I see progress.  They implemented EMR with bar-coding medication administration system.  But in the healthcare field, we are so behind in technology implementation compared to other industries like banking.  So my concern is why healthcare industry is so slow.  I believe hospital safety is not of lesser importance than accurate banking.  I would like to open a discussion, what can we as nurses can do to speed up the process of computer technology implementation to make a hospital a safer place?