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604-How to Enhance Self-Management th h N T h l f P ti t through New Technology for Patients and Their Families: Not Your Mother's Telehealth

MERRILY EVDOKIMOFF RN, PHDM & J ASSOCIATES

ObjectivesAt the conclusion of Presentation, participant will be able to:

1 Identify 5 new IT products that may be used to 1. Identify 5 new IT products that may be used to ease patient transition from hospital to home.2. Implement IT product usage into organizational work flow with minimal disruption.3. Measure outcomes that have demonstrated i i fimprovement with use of above programs.

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Class goal

During this presentation the participants g p p pwill have an opportunity to:1. Visualize the typical patient in 2020.2. Think outside the box about ways to

use technology.

Why do we care?

Changing patient expectations ”the Changing patient expectations-”the quantified self”Continued focus on care transitionsCommunication, Communication, CommunicationCommunicationRapidly developing technologyLack of experience in implementation

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4 Pillars of Coleman’s Care Transitions Model

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1. Medication Self-Management

2. Patient Centered Health Record3. Early, consistent communication with PCP/Specialists

4. Red Flags

What do patients and their families say?

Hospital discharges did not provide for:

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Hospital discharges did not provide for:

information transferpatient/caregiver preparationsupport for self managementsupport for self-managementempowerment skills to assert preferences.

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What's out there?

Personal pedometersPersonal pedometersApple health bookGoogle glassApple watchPHR

Personal pedometers

Fitbit, Nike Fuelband, Move,Jawbone UP Basis OmronJawbone UP ,Basis, Omron

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Healthcare research

Decreased LOS post-opDecreased LOS post opDemonstrated accuracy in sleep/wake studiesIncreased activity w COPD patients

Next Step:-under mattress sensors for sleep

Red Brick Health-personalized coaching plans

Additions Quantified Self Apps

MyFitnessPal Tracking your food intake Searching for happiness? MyFitnessPal,. Tracking your food intake Searching for happiness? Track your mood.AskMeEvery: track mood for 3 months. Example: it proved was unhappy with job. Soon after, I quit. Other good apps includeMercuryApp and TrackYourHappiness. Being mindful of our changing moods keeps us self-aware.

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Apple’s Healthbook

Fitness functionality: activity, weight, nutritionHeat Rate and BP MonitoringBlood work, O2 Sat, BS

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Hydration and respiratory rate monitoring

Sleep tracking

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Emergency card

Apple Watch

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Apple Watch in Health Care

Data ConsolidationData ConsolidationQuantified SelfEasier complianceMinimally Disruptive MedicineSocial AspectsReal Time Data Tranmission

Minimally Disruptive Medicine

Shared decision making enables patients and clinicians to share the

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Shared decision making enables patients and clinicians to share the best available research evidence and make decisions that better reflect the patient's values and preferences. Minimally disruptive medicine focuses on pursuing the patient's goals (preventing premature death, feeling better, and living without hindrance from complications of disease or treatment) while reducing the treatment burden.

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Google Glass

Able to pull information from large data banksAble to pull information from large data banksRecord interactionsImmediate access to medical recordOthers cannot hear audio

Google Glass In healthcare

Clinical documentationClinical documentationEmergency department dashboardsDecision supportAlarms and notification system

Think what you could use it for!

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Lower tech personal health recordshttp://www.myphr.com/startaphr/what_is_a_phr.aspx

My Kinergy

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Medications

Barriers to Overcome

Imbedding in workflowImbedding in workflowPerception of time to implementConcerns regarding patient/family maintaining record.Legal documents: new category

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Barriers to Implementation

Pt/Staff Responses

InclusionInclusionImportanceJob PerformanceInsecure?

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Evaluating new technology

What problem will it solve?What problem will it solve?Can I objectively measure its impactwhat population will best serve?Do I have champions in my agency who will helpHow easy is it to usehow versatile is it

Data Consolidation

Getting to know what to collectGetting to know what to collectDeveloping minimally invasive ways to collect.Barriers:

How to share

How to analyse

How impacts practice

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Embedding new technology in your Workflow

Use of P D SAUse of P D SAstart small: one clinician one patient

PDSA

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Plan• ASSEMBLE YOUR TEAM• STATE AIM OF YOUR TEST.• PREDICT WHAT YOU EXPECT TO HAPPEN.• DEVELOP CHANGE ACTION.

Flow Map Process

1. Determine the Boundaries2. List the steps3. Sequence the steps4. Draw appropriate symbols5. Check for completeness6. Finalize the current process map7. Complete the “Quality Audit”8. Apply waste analysis to identify bottlenecks, waste and improvements9. Test your changes10. Redesign new system and document in the form of policies and

procedures, Sevin, C & Taylor, J. HHQI/IHI, 2013

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Web Sites to Help w Process Map

Xmind comXmind.com

Do• CARRY OUT YOUR PLAN.• IDENTIFY BARRIERS, UNEXPECTED FINDINGS.• EVALUATE, ANALYZE DATA.• START SMALL, 1 CLINICIAN, 1 PATIENT

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StudySTUDY YOUR FINDINGS:• WERE THEY WHAT YOU EXPECTED?• WHAT DID YOU LEARN?• WHAT FINDINGS SURPRISED YOU?

Charts, stories, diagrams

Successes and failures

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Act• MAKE CHANGE PLANS BASED ON WHAT YOU

LEARNEDLEARNED• PLAN NEXT “DO”: INCREASE NUMBERS

INVOLVED.

Change 38

Small tests of change-revise (PDSA)

Kaizen (teams)

Look at variations/unexpected findings

Measure success-tell the story

Revise

Try again!

Slowly “spread”

Accept variations

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Implementing the Change

Develop processes to reinforce changeDevelop processes to reinforce change

“Make it easy to do the right thing”Report outcomes

Tell success stories

Look for cultural paradigm shift

Leverage successes in marketing, recruiting, other community groups, providersproviders

Examine effect on other departments

Build into infrastructure i.e. orientatin

Desired Outcomes/Measurement Tools

Increased patient/caregiver satisfactionIncreased patient/caregiver satisfactionHCAPS

Improved patient engagementTool: Patient Activation Measure (PAM)

(How will this impact practice)

Improved adherence to plan of care

Improved medication adherenceMorisky Medication Adherence Tool

Adherence with scheduled appointments

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Financial Considerations

ProductivityProductivitynumber of visitsstaffinglength of staybrand loyaltypatient/familyreferral sources

Just Imagine…….

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ReferencesColeman, E., Parry, C., Chalmers, S. & Min, S. (2006). The Care Transitions

Intervention: Results of a randomized controlled trial. Archives of Internal Medicine, 166(25), 1822-1828, ( ),

Hibbard, J., Stockard, J., Mahoney, E. & Tusler, M. (2004) Development of the patient activation measure (pam): conceptualizing and measuring activation in patients and consumers. Health Services Research, 39(4), 1005–1026

Montgomery-Downs HE1, Insana SP, Bond JA.(2012). 6.Movement toward a novel activity monitoring devise.Sleep Breath.,16(3):913-7. doi: 10.1007/s11325-011-0585-y.

Sevin C, Evdokimoff M, Sobolewski S, Taylor J, Rutherford P, Coleman EA. How-to Guide: Improving Transitions from the Hospital to Home Health Care to Reduce Avoidable Rehospitalizations. Cambridge,MA: Institute for Healthcare Improvement; June 2012. Available at www.IHI.org.

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604-How to Enhance Self Management through New Technology for Patients

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oug e ec o ogy o a e s and Their Families:

Not Your Mother's TelehealthMERRILY EVDOKIMOFF RN, PHD

M & J ASSOCIATESmerrilyevd@gmail.com

508-560-3801

mjhomehealthassociates.com