Home TeleHealth Nursing:
From Silence to Reality
Dr. Antonia ArnaertAssociate Professor, McGill School of Nursing#514-398-5624 / [email protected]
Why Bother with the Future?"If you think that you can run
an organisation in the next 10 years as you've run it in the past 10 years you're out
of your mind."
CEO, Coca Cola
The future belongs to the unreasonable ones, the ones who look forward not
backward, who are certain only of uncertainty, and who have the ability
and the confidence to think completely differently.
Why Bother with the Future?
Charles Handy quoting Bernard ShawAmerican Journalist
The point is not to predict the future but to prepare for it
and to shape it
Why Bother with the Future?
How Best to Think about the Future?
FORESIGHTForesight is a method of thinking about the future in order to think about what should be done nowThink of the DRIVERS of CHANGEGather a DIVERSE GROUP together Ask them to think OUTSIDE THE BOXAsk them to make recommendations on what should happen NOW to prepare for the future
FACTS: CanadaCanada's wireless phone industry made huge progress.End of March 2008: subscribers 20.1 million63.7 million text messages per day2007: Total wireless revenues in Canada $12.5 billion
Source: Maravedas. The Canadian Internet Database
20172000
WIRELESS
Increase Prevalence of Chronic Illnesses
Increase Prevalence of Chronic Illnesses
Aging Population
Aging Population
Rising Health Care
Expenditures
Rising Health Care
Expenditures
Changes in Canadian
Healthcare System
Changes in Canadian
Healthcare System
Shortage of Medical
Professionals
Shortage of Medical
Professionals
Environmental Factors
Environmental Factors
Waiting Lists / Overcrowded ERWaiting Lists /
Overcrowded ERIncreased Political
Importance of Healthcare
Increased Political
Importance of Healthcare
Movement of Services to the
Community
Movement of Services to the
Community
New Technologies
E-Health
New Technologies
E-Health
Healthcare Consumerism
Healthcare Consumerism
Forces Changing the Healthcare Landscape
“e-health is an emerging field in the intersection of medical informatics, public health and business,
referring to health services and information delivered or enhanced through the Internet and
related technologies.
In a broader sense, the term characterizes not only a technical development, but also a state-of-
mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to
improve health care locally, regionally, and worldwide by using information and communication
technology.”
What is eWhat is e--Healthcare? ...Healthcare? ...
Source: Eysenbach, G. (2001). What is e-Health? Editorial. Journal of Medical Internet Research, 3(2), e20.
TELEHEALTH & NURSING
Where are we in Canada?
Telehealth Nursing (CNA) = includes all client-centered forms of nursing
practice as well as the provision of information and education for healthcare providers occurring
through, or facilitated by, the use of telecommunications or electronic means.
(1) Telephone Nursing= Provinces and territories have 24/7 telephone
nursing lines.
(2) Telemedicine Encounters
(3) Home Telehealth
Today’s Telehealth Nursing Delivery Models
(2) Telemedicine Encounters• Nurses: a key role in effective integration of telemedicine services• Prior to the tele-consultation, the nurse will make sure to have all
information ready for the consultation, e.g., vital sign measurement, medications and completed lab work.
• During the tele-consultation they assist the physician specialist with the assessments, communicating key information, and serve as patient’s advocate.
• After the tele-consultation, the nurse does the follow-up care and communicates these to the patient, and other healthcare providers.
Research Projects
Nursing Home Tele-Health
Depression
Hypertension
Diabetes
COPD
Palliative Care
Cancer
ISDN
Wireless
Telephone
ISDN
Wireless
Telephone
Cancer
“Any formalized patient education program aimed at teaching skills needed to carry out specific medical regimens and guide health behavior change for patients to control their
disease and improve their well-being”
Knowledge Acquisition↑ Self-Efficacy (Self-Confidence)Adoption and Maintenance of Skills
Behavior ChangesSource: Bourbeau & Nault (2007). Self-Management Strategies in COPD. Clin Chest Med, 28, 617-628.
Self-Management
Using a Chronic DiseaseManagement (CDM) Approach
Expert Managers
Home Telehealth PlatformTelehealth
NursesPatient HOME
High-Speed
InternetCase Managers
Home Telehealth Nursing Services
COPD Patients
Home Telehealth Patients with a New Stoma
“I feel much safer with it [videoconferencing system] there now. I feel more confident”
“ I’m totally at ease and the nurses understandyou and they can talk to you from human to
human, you know?”
“I see her [the nurse] on the T.V., an I’m talking to her expressions, I see her quite a bit. So yes I feel totally at ease with that
[videoconferencing system]
“The advantages is that I’m more comfortable in my own home, you know? And for me to get at SMHC, for example, for my chemo day.
We leave her at 5:30am …, because he [her husband] has to drop me at SMHC at 7:00am, … So I’m there from 7:00am in the morning and I’m not seen till 9 or 10 o’clock. So I’m there for a long time, whereas
sitting here I’ll be fine.”
Home Telehealth NursingDiabetes - Hypertension
“I think it will help people take control, or at least feel that they have more control… over their health, and, and
where their going. And, I believe that …if their doing this constantly and they
have direct feedback from either the machine or from the nurses or a doctor, I think it empowers people
to really take charge of their situation”
“it’s an amazing apparatus”“This should be widespread”
“It’s exceptional, exceptional … And I was so fortunate being on it” “I say it’s
very beneficial”
Home Telehealth Palliative -Oncology Patients
Messaging Device System
Pain & Symptom Management
Telehealth-BELTTM
ARNAERT
Successful Telehealth ServicesWhat do you need?
BELT
Bandwidth Education/
Equipment
Leader Team
TELEHEALTH
WAGNER’S CHRONIC CARE MODEL
Ca
Inter-Professional Collaboration
ChronicDisease
Management
Case Management
TELEHEALTH
PATIENT-CENTRIC CARE
WIN WIN WIN
Telehealth is a TOOL that allows all concerned to WIN!
Home TeleHealth Model
THANK YOU