Final 20231116_NUR1 222_Digital Health[88].pdf

Introduction to Digital Health for NUR1 222 – Strengths-Based Nursing & Professional Practice Guest lecture by Daniel da Costa, BSc, MSc(A) WHO AM I? Daniel da Costa, BSc, MSc(A) LEARNING OBJECTIVES ü Become familiarized with the key terminology and plurality of definitions of Digital Health ü I...

Introduction to Digital Health for NUR1 222 – Strengths-Based Nursing & Professional Practice Guest lecture by Daniel da Costa, BSc, MSc(A) WHO AM I? Daniel da Costa, BSc, MSc(A) LEARNING OBJECTIVES ü Become familiarized with the key terminology and plurality of definitions of Digital Health ü Identify some of the practical applications of Digital Health and recognize key examples ü Understand some of the implications of this paradigm shift in healthcare for nurses and for patients, making connections to SBNH ü Consider the legal and ethical implications of Digital Health for nursing practice ü Recognize some of the main challenges & drawbacks of Digital Health and its inevitable limitations ü Establish awareness about emerging technologies and their integration within the Digital Health landscape OUTLINE Te r m i n o l o g y History & Implementation Practical Applications Implications for Strengths-Based Nursing Legal & Ethical Considerations Challenges & Drawbacks Future Advancements Conclusions Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions Join at slido.com #3895 686 Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions COMPETING CONCEPTS Information & Communication Technologies (ICT) Robotics Telemedicine Health Informatics eHealth Wearables Artificial Intelligence (AI) Electronic Health Records (EHR) Digital Health Telenursing Nursing Informatics Telehealth Telemonitoring Point-of-Care Testing (POCT) Internet of Things (IoT) Virtual Care mHealth Electronic Medical Records (EMR) Information Technology (IT) Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions WHAT IS DIGITAL HEALTH (DH)? [dij-i-tl helth] noun Nursing Informatics science and practice integrates nursing, its information and knowledge, and their management, with Information and Communication Technologies (ICT) to promote the health of people, families and communities worldwide”. (IMIA-NI, 2009) Side Note: Definition adopted (c. 2009) by Canadian Association of Schools of Nursing (CASN) • “CASN is the national voice for nursing education, research, and scholarship and represents baccalaureate and graduate nursing programs in Canada.” • Establishes and promotes national standards of excellence for nursing education. Digital Health, building from eHealth was motivated by the prevalence of advanced computing systems that transcend the internet alone, effectively broadening the scope of this concept. (Fatehi et al., 2020) The use of Information and Communication Technology (ICT) in support of health and health-related fields. (WHO, 2021) Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions WHAT IS DIGITAL HEALTH (DH)? [dij-i-tl helth] noun 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 lifethreatening diseases, and management of chronic conditions outside of traditional care settings. (FDA, 2023) Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions COMPETING INTERCONNECTED CONCEPTS Information Technology (IT) Medical Informatics e.g., Electronic Medical Records (EMR) Information & Communication Technologies (ICT) Health Informatics e.g., Electronic Health Records (EHR) Telenursing Telemedicine Wearables Point-of-Care Testing (POCT) Nursing Informatics eHealth Robotics Telemonitoring mHealth Telehealth Virtual Care & Teleconsultations Internet of Things (IoT) Digital Health Artificial Intelligence (AI) Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions DIGITAL HEALTH ACROSS TIME A Brief History… 1950s-1960s 1960s-2000s Health ICT ICT in Health • Mainframe computers • Practice management • Focus on corporate support (accounting, payroll) • Focus on the healthcare organization Industry agnostic (not health-specific) • • 2000s-2020 Corporate applications for logistics & performance management 2020 & Beyond eHealth • System-wide information workflows Digital Health • Decentralized • Patient-centred, empowering individuals • Focus on whole health system • Provider-centred • • Healthcare as a process, not an outcome Big Data, sources within & outside of healthcare • Sophisticated analytics & AI (Rowlands, 2020) DIGITAL HEALTH IN CANADA DR. ALEX SUMMERS’ STORY Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions PRACTICAL APPLICATIONS Documentation & Records • 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”. (CASN, 2012) Examples • Oacis & Vsign • MedUrge • InteleViewer • • • Picture Archiving Communication System (PACS) Medesync Dossier Santé Quebec (DSQ) & Carnet Santé Quebec Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions PRACTICAL APPLICATIONS Clinical Decision Support • • References for clinical practice • Examples Integrating & synthesizing research for evidence-based best practice guidelines (often combined with institutional policy) • • • UpToDate Lexicomp Epic Systems (EMR outside of Quebec) Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions PRACTICAL APPLICATIONS Patient Monitoring & Diagnostics (Inpatient) • Involves real-time data & analysis (filters & algorithms often applied), often also integrates with EHRs • Examples • • • Philips Continuous Patient Monitoring Surgical Imaging (e.g., Interventional Radiology) Diagnostic Imaging (CT, MRI, etc.) • Note the advancements in software-assisted visualization & analysis Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions PRACTICAL APPLICATIONS Patient Monitoring & Diagnostics (Transition) • Virtual Wards as a solution for transition from inpatient to outpatient – Telemonitoring/Telemedicine • Examples • 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 • Also at JGH, Goldman Herzl Family Practice Centre Virtual Ward (Gagnon et al., 2023) • “This is the way of the future. Prevention is becoming an even more crucial element of health care, whether it’s the prevention of illness or the prevention of hospitalization.” Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions PRACTICAL APPLICATIONS Patient Monitoring & mHealth (Outpatient) • Smart Wearables (Apple Watch, Fitbit, Pixel Watch, Withings BPM Connect, etc.) • • • Smartwatches Smart BP Monitors Continuous Glucose Monitors (CGMs) • vs. Non-Smart Wearables • • • Pulse Oximeters BP Cuffs Glucometers Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions PRACTICAL APPLICATIONS Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions PRACTICAL APPLICATIONS Point-of-Care Testing (POCT) • 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 Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions PRACTICAL APPLICATIONS Medication Administration (Pharmaco-informatics) • • Philips B|Braun Smart IV Pumps (see Shah & Jani, 2020) AcuDose-Rx Automated Dispensing Cabinets (ADC) Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions IMPLICATIONS FOR STRENGTHSBASED NURSING Patient Empowerment & Agency • Patients 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 (Norman & Skinner, 2006) • Patients 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 Patients can now connect more easily through virtual support networks People are taking their health into their own hands & onto their own wrists Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions IMPLICATIONS FOR STRENGTHSBASED NURSING Barriers to Patient Access • The Digital Divide • • Unconscious Bias • • Reliable internet access and availability of certain devices is imperative to ensure that the benefits of DH are experienced by all 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.” (Berkman et al., 2011) Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions IMPLICATIONS FOR STRENGTHSBASED NURSING Clinician Empowerment (Collaborative Partnership) • 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 Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions IMPLICATIONS FOR STRENGTHSBASED NURSING Not a substitute for Clinical Judgement or Nursing Practice • 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.) (CASN, 2012) Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions IMPLICATIONS FOR STRENGTHSBASED NURSING Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions IMPLICATIONS FOR STRENGTHSBASED NURSING Patient Engagement Learning Health System Interoperability Connected Care Interprofessional Team Digital Tools Clinical Transformations (Skiba et al., 2016) Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions LEGAL & ETHICAL CONSIDERATIONS Entry-to-Practice Nursing Informatics Competencies (CASN, 2012) 1. Information and Knowledge Management Uses relevant information and knowledge to support the delivery of evidence informed patient care • Searching and critically appraising of on-line literature and resources to support decisionmaking • Assists patients & families to access, review and evaluate information retrieved using ICTs. Canadian Association of Schools of Nursing. (2012). Nursing informatics entry-to-practice competencies for Registered Nurses. https://www.casn.ca/2014/12/nursing-informatics-entry-practice-competencies-registered-nurses-2/ Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions LEGAL & ETHICAL CONSIDERATIONS Entry-to-Practice Nursing Informatics Competencies (CASN, 2012) 2. Professional and Regulatory Accountability Uses ICTs in accordance with professional and regulatory standards and workplace policies • Complies with legal and regulatory requirements, ethical standards, and organizational policies and procedures (e.g. protection of health information, privacy, and security) • Demonstrates that 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.) Canadian Association of Schools of Nursing. (2012). Nursing informatics entry-to-practice competencies for Registered Nurses. https://www.casn.ca/2014/12/nursing-informatics-entry-practice-competencies-registered-nurses-2/ Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions LEGAL & ETHICAL CONSIDERATIONS Entry-to-Practice Nursing Informatics Competencies (CASN, 2012) 3. Information and Communication Technologies Uses ICTs in in the delivery of patient/client care • Identifies and demonstrates appropriate use of a variety of information and communication technologies (e.g., point of care systems, EHR, EMR, capillary blood glucose, hemodynamic monitoring, tele homecare, fetal heart monitoring devices, etc.) to deliver safe nursing care to diverse populations in a variety of settings. Canadian Association of Schools of Nursing. (2012). Nursing informatics entry-to-practice competencies for Registered Nurses. https://www.casn.ca/2014/12/nursing-informatics-entry-practice-competencies-registered-nurses-2/ Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions LEGAL & ETHICAL CONSIDERATIONS Informed Consent & Patient Autonomy • 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? Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions LEGAL & ETHICAL CONSIDERATIONS Privacy & Confidentiality • 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 Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions LEGAL & ETHICAL CONSIDERATIONS OIIQ Code of Ethics §2. 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. Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions CHALLENGES • Cost of implementation • • • Lack of universal integration between institutions Training & development of technical skills • • Use of hardware Use of VPN, user interface (UI) navigation, video conferencing Cybersecurity • Government funding & political challenges Interoperability • • • Constant threats to sensitive patient information Tech support & contingency plans • Oacis update causing outages across MUHC • Errors/malfunctions & analogue alternatives Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions FUTURE ADVANCEMENTS Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions FUTURE ADVANCEMENTS • Artificial Intelligence (AI) • Large Language Models (LLMs) (ChatGPT, Bard, etc.) • • Machine Learning Examples • Direct-to-consumer genetics/genomics (23andme) & personalized medicine • Predictive alerts within Clinical Decision Support Systems (CDSS) • Fall detection (e.g., Apple Watch) • New modalities for noninvasive biometrics • Robotics • Already implemented in surgery, will soon be involved in basic care Terminology | History | Applications | Implications | Legal & Ethical | Challenges | Future | Conclusions CONCLUSIONS • Stay Curious • • • • Nature Conferences Keep an eye out for new technologies entering the consumer space. Ultimately, they may play a role in new Digital Health solutions Be a Role Model • • The King’s Fund (UK) Stay Informed • • Canadian Nursing Informatics Association (CNIA) Spread the knowledge and become champions & pioneers to help bridge the intergenerational gap Get Involved • Nurses are key stakeholders at the center of the Digital Health revolution; make yourself heard! REFERENCES • Arnaert, A., Sumbly, P., da Costa, D., Liu, Y., Debe, Z., Charbonneau, S. (2023). Part 1: Using the UTAUT2 Model to Explore Acceptance of the Apple Watch Series 6 for Telemonitoring of Older Adults with COPD. JMIR Aging. (preprint) https://preprints.jmir.org/preprint/41549/accepted • Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., Viera, A., Crotty, K., Holland, A., Brasure, M., Lohr, K. N., Harden, E., Tant, E., Wallace, I., & Viswanathan, M. (2011). Health literacy interventions and outcomes: an updated systematic review. 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