Youth and Transitional Care

I had a very interesting meeting last week with a clinical nurse manager based at one of our major children's hospitals about transitional care for youth.

In Western Australia, after a child reaches the age of 16, they must be transferred to an adult hospital. I must admit that the issue of transitional care has not even entered my mind, nor did I realize the impact it can have on the young person in question, their families and their long term management and outcomes. In fact, after spending a couple of hours discussing the issue in more detail, I was alarmed to learn that in extreme cases, some of our young people can face life threatening illness that can be traced back to their initial transition from a children's hospital to an adult hospital.

The problems faced are that in many cases, children spend a great deal of their youth at one facility. The very nature of children's hospitals is one of a vibrant, family focused facility. The staff try their hardest to make a kids stay at hospital as enjoyable as possible and you feel this from the moment you walk through the front doors. In fact, on the day I had this meeting, I couldn't help feel and notice just how warm and friendly the staff were. There were kids in a classroom doing school work and in one room I saw some kids just chilling out playing some video games. In the waiting area I watched a young boy, probably 9 or 10 sitting in a chair. I could tell straight away from just looking at him that he was very upset. I smiled and said hi but did not bother him any further. Shortly after that, a young nurse came bounding up to him and with a beaming smile told him to follow her to their fun room. With that the young boy began to cry and the nurse immediately sat down with him and comforted him. She didn't have to ask him what the problem was, she gave him a cuddle and put her arm around him and said she knew it was. She told him that it was okay to feel down and that he had every right to be angry and fed up with being in hospital. With that he smiled at her and after a few minutes, he got up and slowly walked with her to the fun room. You could tell he is a very unwell boy indeed. What struck me at the time was that the nurse knew enough about this boy to be able to really identify with him and his emotions. This sort of bond is more difficult to find in an adult facility. More on that later.

So with this in mind, I met with the clinical nurse manager who explained to me that quite often, once a child turns 16 they are so overwhelmed by the transfer to an adult hospital that they simply stop going for checkups or treatments. The whole process is traumatic. The hospitals are bigger, more clinical and often do not have the feel of a family orientated facility. All of a sudden they are meeting with new doctors and nurses who do not have the time to spend with them. This is not the fault of our medical staff, it's simply a reality now that they are working to provide help and support to an over-stretched health system. As for the parents of these young people, they are all of sudden dealing with a different set of medical staff, in some cases having to detail again their child's individual issues or medical anomalies that may not be on the various medical records. As the child begins to take more control of their own health condition, the process of transition can mean that they lose focus, confidence in their ability to self maintain and in extreme cases, stop visiting hospitals for their regular consults.

Enter technology, the meeting quickly got around to discussing what we could develop to help youth in the months, years before transition cope better with the process. We looked at a few areas, the easiest and most fun was looking at technical options, the second was partnering with various education institutions to have some of this technology available to students at school and the third was educating adult hospital medical staff on the issues facing kids in this situation.

I am very fortunate indeed to be able to work on this project for a couple of reasons, first, transitional care is quite new in terms of how it's seen in medical circles in Australia. The second is that our target audience just happens to be in the age group that takes to technology likes ducks to water. It's almost natural for kids to just know how to use gadgets. I don't quite know how they have this ability, but they do.

We are now investigating the types of technology we can use to empower kids to manage their conditions and make them more aware of their patient rights and just exactly what to expect when they visit an adult hospital. Some obvious technology types will be podcasts and website access but we have a few other ideas which for the time being, I am unable to disclose. They are however, very exciting and I believe we can make a big difference to these kids. I would be very interested to hear from anyone who has worked in this area of transitional care or has an interest in learning more about it. I got the feeling from the clinical nurse manager that she has really struggled to gain acceptance of the issue. As part of her Masters thesis, she investigated this area and this would seem to have given more prominence to the issue.

I hope this entry has got some of you thinking and when I have finalized my thoughts on other technology opportunities I will post a new entry.

Sally

tags technorati : transitional care adult hospital childrens hospital chronic disease management health podcast

Telehealth - cost effective health care

This article from news10now.com showcases how using telehealth for seniors is cutting costs. By giving people access to telecommunication devices, physicians can consistently monitor patients which long terms means they have better care and hopefully less trips to ER's. Read article

There is a video which showcases one such patient using her telehealth monitor. The great thing is that it all seems so easy which is very important especially when you are dealing with seniors who sometimes can be quite scared of technology. Watch video

tags technorati : telehealth, emergency room

Health Podcasts on the rise

This article from WashingtonPost.com talks about the rise of health related podcasts. There are now over 2,000 which supports what I think most of us are seeing as a trend. Read article here.

I am very interested to see that many of these podcasts are being produced by leading health organisations which I believe is important in establishing strong and reliable content on the web. It's great to see that the health industry is picking up on new technologies so quickly and adapting them to suit the needs of patients. I would like to see more podcasts out there that are not necessarily focused solely on disease but on preventative and education for the community. We are now in a unique position of having access to some really amazing and cool technology that youth are using. For many in population or community health, targeting youth is a strong focus so it seems sensible to develop podcasts for this particular group.
Related articles:
New patient support program using iPod Technology

tags technorati : health podcast

EMR - The Mac way

This is a great example of how sometimes going for simplicity can be the best option and cheaper! Read Now

It details a low cost EMR solution that will be of interest to many of you. EMR’s can cost between $50,000 and $200,000, but an occupational therapy center in Cincinnati, Ohio set theirs up for around $6,000.

tags technorati : EMR, Apple, Mac

WiFi access in the cities

I came across this article today in the SMH. Adelaide poised to lead WiFi pack. It talks about Adelaide (South Australia for those of you not from Downunder) is planning on rolling out the largest metropolitan WiFi network in Australia. This is part of an on-going bid to get more people into our cities. As we are now becoming so dependant on our gadgets, having free broadband access is a plus for many of us to visit our cities.

This is all good news for people working in ehealth. The more accessible broadband access is, the better the coverage of ehealth solutions including chronic disease management tools and online video education.

I am now thinking more and more about developing strategic partnerships, something I mentioned in an earlier entry (Read Now - Remote crash scene videos may speed treatment of victims). Perhaps we should be also working closer with city councils and community groups to look at ways of providing the public with access to technology. The more we can offer, the better our odds are of really getting to those who don't currently have access. We also need to consider our homeless and look at developing solutions that they can benefit from as well. I don't know the statistics but it is fairly clear that homeless people in particular are at high risk of developing serious health issues. Many suffer from mental illness and we should not forget them in our push to develop ehealth strategies and solutions.

wifi ehealth

Internet Tablets

I am really interested to see how quickly these nifty little devices from Nokia and other providers get picked up by health providers. They need to make them phone capable though but it's still a step in the right direction. A lot of us use Blackberries and they are great but for the majority, they are used more by corporations and execs than for private use. The great thing about what Nokia and others are doing is that they are making this technology available to everyone. It means that we can develop some really exciting solutions for the public that they can access via their phone and it makes it completely mobile. That is even better because people are so busy these days, they need access to education, information and management applications on the fly.
You can read a recent article here: Nokia to announce upgraded 770 Tablet

Listen to the Interactive Health Podcast

Interactive Health Podcast - Show 5

This week we continue our discussions on how to establish online video education in health, utilising technology for aged care, a new product called the Nike + iPod Sport Kit, throw a challenge to fast food chains, discuss saving whales and a little beagle called Rose. And most importantly, we finally get hold of our roving reporter, Regan! It’s a great show with lots of information for anyone in health with a genuine interest in helping to make health more user friendly utilising technology!
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Interactive Health Podcast - Show 4

This week we discuss the H.264 video format which provides excellent image quality at very low data rates and is perfect for health professionals to deliver video across the internet, 3G Mobile and video conferencing.
We also discuss how health services can start the process of implementing video for clients or for the population.
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Interactive Health Podcast - Show 3

Download our third Interactive Health Podcast
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Interactive Health Podcast - Show 2

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Download our second podcast!
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Interactive Health Podcast - Show 1

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Download our first podcast!
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TV doc treats outside the box

I was pleased to read this article this morning. Read Story In short, telemedicine is now available in the suburbs. I eagerly read this story which explains that in Peachtree City, anyone can walk in, get a username and password and speak to a doctor who is somewhere else and get a regular consultation. How it works is that after a patient receives their logon and password, they go to a computer and answer medical history questions. A medical assistant then checks the patient's vitals and then both meet with the doctor who is on a TV screen in another room. Via the Doctor's instructions, the medical assistant puts a otoscope in the patient's ear or points a camera down the throat or uses an electric stethoscope against the chest. By computer, the sensations from these devices are trasmitted back to the doctor who can then prescribe the necessary medication.

Now, I think this is brilliant and will certainly fill a niche market, especially for people who are in a hurry or just generally don't have time to sit and wait in a doctor's clinic. But what disappointed me was that the cost for this is $65.00 or if you just want to talk to a Doctor, $25 per 5 minutes. I realise that in the US especially, the cost of visiting a doctor or any medical professional is usually ridiculously high, it's something I cannot understand and am so thankful that I live in a country that does offer reasonable rebates. For instance, I can see my doctor and I pay $40 Australian dollars and will receive $32 back from Medicare which is available to every Australian. Whilst I don't wish to get into why some governments offer better medical services to their population than others I do think that offering a technical option like this should definitely be more cost effective. Let's face it, you are paying to get a medical professionals opinion. This often involves prodding and poking of various body parts, and if I am going to pay out $65 big ones, I want the actual doctor to be doing this. Instead, I get a medical assistant using devices that transmit back to a doctor in a remote location. I just feel that we are really missing a golden opportunity here. Finally, we can offer citizens who are not fortunate enough to have medical services offered at a reasonable rate an alternative. It should be cheaper, a lot cheaper. People go without seeing a doctor in the US because they simply cannot afford it. Some get so sick that by the time they go to a hospital they are facing a very long and expensive recouperation and in some cases, no help can be given. This is a tragedy and telemedicine should be able to offer a good altenative. If we can give people in remote regions of India who are dirt poor access to telemedicine, then why can't people living in the US have the same access? I realise that business is in the business of making money and I appreciate the need for these companies to make a profit but is there anyone out there that just genuinly wants to help their fellow man? I just don't get it, and it disappoints me to think that we can produce some great technical options that do not cost as much as setting up a practice, staffing and insurance considerations and still, it's damn expensive!

Consumers or as I like to call them, people, have the right to health at an affordable rate. Rich nations should be ashamed of themselves for not doing more to encourage IT and medical corporations to develop solutions for average folk. Why not offer tax subsidies? I just hope that we can get past the almighty dollar and really help people in need. It's not right.

HITSphere

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Telemedicine - Not just for affluent countries

A read this story over the weekend and it really does emphasize a very important point I like to make in my role at work that using technology to help deliver health is not simply just for affluent countries or people. Read this story

One of the great aspects to utilizing technology is that it can have a huge impact for third world countries and those that are slowly emerging with better economies, technology and health. Take India for instance, 10 years ago most would have considered the delivery of telemedicine to remote regions in India as being almost impossible due to infrastructure short-comings. But with a Information Technology boom has come some very interesting advances that will help people in poorer regions throughout the country. Right now, bicycle rickshaws are being used to help physicians in Uttar Pradesh deliver video conferencing to nearby villages. They provide a variety of education resources and access to healthcare. They have the computers on board with special casing and cushioning to ensure no damage whilst transported over rough terrain. I just love the fact that you have two extremes here, one, a rickshaw, probably one of the most basic and necessary forms of transport in India and the other, computers and wireless hi-fi access providing leading edge technical solutions.

Developed Countries could learn a lot from emerging countries about providing health care solutions. I sometimes think we over complicate things resulting in lengthy delays in providing solutions to people. Here, you have an example of necessity bringing a terrific solution using old and new to great affect.

Read the story, well worth it: http://www.ihealthbeat.org/index.cfm?action=dspItem&itemID=104982

New patient support program using iPod Technology

To say that I found this article very exciting is an understatement. Clarian Health Partners are now doing something that I have been trying for about 12 months now to do, providing patients with access to education and support information via iPods. They have gone one step further and given patients in the HealthPod program an iPod! Health related video and audio segments are loaded onto their iPod during the entire Program, which in this case is the Bariatric Program. It is very refreshing to see medical practitioners taking advantage and utilizing technology in a positive way to help their patients.
To the staff at Clarian Health Partners who have implemented and supported this, congratulations!

Tomorrow I am presenting my e-health Network to an Executive group for one of the Hospitals we are now rolling our programs out to. I will be mentioning what Clarian Health Partners are doing as it all helps to add weight to our argument. One thing I must say is that I rarely get negative feedback from the many Specialists, CEO's and Executive Directors of the various Health Agencies I deal with but having a real example to showcase will hopefully help them to see it's potential for use.

Check out the article, definitely worth a read! Clarian Health Partners

Outpatient Care - Can technology help and is there a better way?

I read with great interest an article from the Sydney Morning Herald regarding outpatient delays in Victoria. The story covers claims that patients are dying waiting to be seen by specialists. Read Article
Apparently, a survey has found that 15% of Doctors have lost at least one patient due to delays accessing hosptial specialists and 83% feel that access to outpatient care has become worse in 3 years. 79% believe access to outpatient care was poor or very poor for surgical patients.

Can technology made accessible to outpatients provide interim measures or possibly help prevent some from returning back to Emergency Departments? I’m not sure that if a person requires a knee replacement for instance, that they are going to be able to benefit from technical resource. Yes, we could provide them with information on managing their pain or details on minimizing further injury whilst waiting to be seen by a specalist. But I doubt that we could ever really claim to be able to reduce the burden in this instance. We can, however, provide valuable information and education to people waiting to see a specialist. This can assist them in managing their condition until they are seen. Hopefully, we can help to minimize the chance that they may need to visit an Emergency Department.

We could, for instance, video specialists talking about various conditions and get them to talk about some practical and important preventative measures they can take. It could be really basic information, like resting, not lifting heavy equipment, etc. We can take it even further though. A specialist could go into detail about certain procedures, explain the process before and after surgery. Talk about what they need to be doing now and what should be done when they return home. Information for carers is also critical. Also, detail what happens when they come to hospital and what outcomes to expect. These types of technical solutions can help reduce numbers of patients going to their doctor to ask the very questions that we could potentially cover.

Again, this all focuses on the end result. The band-aid approach. I see this everyday and I find it frustrating. I realise that there is an immediate need for Health agencies to be seen to be doing something. Votes for political parties are won and lost on health policy. Providing more beds, employing more staff seem to be familiar promises. But no where near the amount invested in hospital care is spent on prevention and education. I know that in some cases preventative education is not going to help. I understand that some people are just going to develop disease due to genes or other factors. But, can someone please explain to me why Government officials and those employed to run our Health Care systems don’t invest in prevention? It doesn’t make good practical business sense to me. We will never be able to get ahead of the game because more people are becoming ill and we simply can’t employ enough people to support their needs. We need to be positioned at the beginning the game, educate and support people to be healthy. I’m not talking about printing brochures that tell someone to keep active. It’s boring and clearly, not working. Our rates of childhood and adult obesity are rising, across the board. Diseases are also going up. People still smoke, drink, do drugs. Many, will end up in an ED somewhere, sometime in the future.

We should be investing in support services, putting people on the ground, the front-line. Developing programmes and initiatives for communities, schools, pre-school and so on. And, investing in technology. We all know that the adults of tomorrow are incredibly tech savvy. They want to use technology and we have the opportunity and ability to provide them with some brilliant, innovative initiatives that help them to learn about keeping fit, healthy and happy.

An Ounce of Prevention is Worth A Pound of Cure. We all know this saying and I would challenge anyone out there who doesn’t agree with it.

We need to start practicing what we preach.

Too much tech talk by tech folk in Health

I had an interesting dicussion yesterday with a work colleague regarding how best to implement video education to the community. After spending about 2 hours coming up with different concepts, I pondered later that night on just how much I had changed, professionally. In my role, I am responsible for delivering the technical infrastructure to the e-health Network but have been very fortunate to learn a great deal about Population Health and Health Promotion in particular. If you had asked me 4 years ago, I would given you a very technical overview of how I would implement video education with little thought about the end user, their needs or their problems. But with the benefit of spending 4 years learning about preventative education in the community, I now think more along the lines of developing programmes and initiatives that utilise video education rather than just a technical solution to the question.

In many health organisations throughout the world, Information Technology Departments maintain a clear separation to the clients they support. This has been the case in most of the positions I have held in IT Departments. We provide a service to clients and rarely take off our technical hats to really learn about the Departments and clients we support. With the benefit of hind sight, I wonder how many opportunities I may have missed to develop solutions for my clients that could have really impacted and improved how they went about their business. I would urge anyone in IT who works in health to really take up the challenge to learn as much as possible about the core functions of your workplace. In my case, I have a greater understanding and appreciation of the challenges and rewards that come with working in Health and now see my role as much more than just a tech person. Indeed, I believe now that I have found my vocation, I genuinely want to help people in my community to be healthy. I want to provide tools and education to help them manage their conditions and hopefully minimise or eliminate the risks they face. This greater appreciation and knowledge of my workplace has helped me to build along with a great team, an e-health Network that I am very proud of and I feel will provide great benefits to our community. For me, not focusing so much on how I will build something but how we might help someone is far more rewarding.

If you are a health professional, I think it would be very beneficial to really try and educate your fellow IT professional about what you do and what your organisations core functions are. Most tech folk are always keen to develop solutions for you but if they don’t know what your core function is, they can’t really get an understanding of your requirements. It can be challenging and a bit daunting trying to communicate with different professions within a health organisation. And I know that many people have a pre-conceived idea of what a tech person is, the word nerd is often used. True, I have my nerd moments and my work colleagues, at first, weren’t quite sure how to really work with me but after 4 years, we have a mutual respect for each others profession and have very clear vision and goals for what we want to achieve.

So my message is, if you're in IT try and learn as much as you can from the clients you support in Health. I guarantee that you will find your work more rewarding and your skills will improve in all areas. It’s a win, win situation.