The Role of Human Factors in Home Health Care Workshop Summary (2010) / Chapter Skim
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9 Information Technology and Systems in Home Health Care--George Demiris
9 Information Technology and Systems in Home Health Care--George Demiris
Pages 173-200
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can address these challenges and enhance home health care services. Advances in telecommunications, web solutions, and social networking tools have the potential to support health care delivery and education.
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TELEHEALTH APPLICATIONS FOR HOME BASED DISEASE MANAGEMENT Telehealth applications offer a platform to support disease management for home care patients diagnosed with chronic conditions and their families. This section is organized by the disease or condition addressed by the application.
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The TeleHomeCare project at the University of Minnesota included a system based on the use of low-cost commercially available monitoring devices and an Internet application designed for patients diagnosed with congestive heart failure or chronic obstructive pulmonary disease or requiring wound care. The system included web pages customized to address the information needs of individual patients and included an online diary with questionnaires to be filled out daily.
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or patient satisfaction. Although the average direct cost for home health services was $1,830 in the intervention group and $1,167 in the control group, the total mean costs of care, excluding home health care costs, were $1,948 in the intervention group and $2,674 in the control group.
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WEB-BASED COMMuNITIES FOR HOME CARE PATIENTS In addition to web-based applications that follow an institution-centric approach and link home care patients to health care providers, the Internet also supports a consumer-centric model and enables the creation of networks between home care patients diagnosed with the same condition, families or other informal caregivers, communities, and the general public. Such networks are often referred to as virtual communities.
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The emphasis in such virtual communities is on mutual problem solving, information sharing, expression of feelings, mutual support, and empathy. Technologies for virtual communities include, among others, online message boards and automatic mailing list servers for asynchronous communication, videoconferencing, Internet relay chat, group and private chat rooms for synchronous communication, and even social networking platforms, such as Facebook or Twitter.
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Such teams can be essential to successful disease management and to providing continuity of care for the patients. PERSONAL HEALTH RECORDS A concept emerging from the proliferation of web technologies in people's homes is the personal health record (PHR)
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. The PHR concept is expected to enable a shift from institution-centric to patient-centric models of care as personal health records can be used for sharing such health information as health finances, diagnoses (problem lists)
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With their potential to empower consumers and place the patient at the center of decision making and management of his or her own health, PHR tools may in the near future significantly affect home care. ROBOTIC APPLICATIONS Robotic applications using artificial intelligence principles and, in some cases, with anthropomorphic features have traditionally been used in the clinical setting, mostly in an experimental mode (e.g., robotic-assisted surgery, including robotic-assisted laparoscopic pyeloplasty, cystectomy, etc.)
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. The technology does not require training of or operation by the resident, thereby distinguishing smart home applications from standalone units that can be used in the home setting and need to be operated by the end-user (e.g., blood pressure cuffs, videophones)
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. HuMAN FACTORS CHALLENGES AND CONSIDERATIONS The use of technology applications and tools in home health care raises a number of issues that human factors expertise is called on to address.
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These standards refer to the security of all electronic health information and have a great impact on the design and operation of information technology applications in home care. The use of the Internet in disease management calls for a clarification and definition of the issues of ownership of and access to monitoring data.
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. Although information technology can play a great role in disease management, the fastest growing segment of the U.S.
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. Data Transmission and Interoperability Technology-based applications in home care require in many cases the secure exchange of clinical data between different systems or data sources to group together the wide range of data required for disease management.
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Policy Considerations The public policy issues related to the use of information technology in home health care are the same as those that arise for the use of IT in health care in general and involve several levels (state, federal) as well as numerous stakeholders.
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It is important in this context to assess FDA's evolving position on software that is used for medical purposes but is not intrinsically bound to a particular device, such as an electronic medical record system, a decision support system, or a web-based disease management program. While the FDA currently defines such systems as tools that provide assistance to health care professionals in the treatment of their patients (thus, these tools themselves have no direct patient impact)
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. The policy changes that are likely to lead to improved consumer adoption of personal health records include establishing standards for PHR information, facilitating secure exchange of health information, and improving consumers' access to the records and their understanding of their role and capabilities.
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. A systematic review of economic evaluations for home telehealth identified a total of 22 studies on home telehealth for chronic diseases published between 1998 and 2008 (Polisena et al., 2009)
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DISCuSSION This review highlights the diversity of technology applications and tools in home health care and the promising role they can play for a variety of stakeholders (including patients, families, health care providers, communities, and the general public) and for a multitude of clinical areas (covering physiological, functional, cognitive, social, and psychological parameters as well as holistic aspects of wellness and quality of life)
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. Nevertheless, the ethical need to respect autonomy and respond to home care patients' desire for more involvement in decision making is becoming widely recognized (Richards, 1998; Coulter, Entwistle, and Gilbert, 1999)
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Future Trends As technology advances, rapid developments in the areas of robotic applications and smart homes are anticipated. Currently, research is under way in Japan to explore the role of humanoids in home health care and nursing homes.
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. unintended Consequences As is the case with any IT implementation, when exploring options for new and innovative technologies in home health care, one has to predict or prepare for unintended consequences.
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ABOuT THE AuTHOR George Demiris is associate professor of biobehavioral nursing and health systems in the School of Nursing and Biomedical and Health Informatics, School of Medicine, at the University of Washington. His research interests include the design and evaluation of home-based technologies for older adults and patients with chronic conditions and disabilities, smart homes and ambient assisted living applications, and the use of telehealth in home care and hospice.
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. Care coordination/home telehealth: The systematic implementation of health infor matics, home telehealth, and disease management to support the care of veteran patients with chronic conditions.
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. Outcomes of the Kaiser Perma nente tele-home health research project.
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. Home telehealth for chronic disease management: A systematic review and an analysis of economic evaluations.
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. Standards for privacy of individually identifiable health information; proposed rule.
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