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Factors that influnce older peoples engagement with tech

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Abstract

Shared electronic health and social care records in some service systems are already showing some of the benefits of digital technology and digital data for integrating health and social care. These records are one example of the beginning "digitalisation" of services that gives a glimpse of the potential of digital technology and systems for building coordinated and individualized integrated care. Yet the promise has been greater than the benefits, and progress has been slow compared to other industries. This paper describes for non-technical readers how information technology was used to support integrated care schemes in six EU services, and suggests practical ways forward to use the new opportunities to build person-centered integrated care.

Keywords: Health information technology, integrated care, clinical care coordination, communication, quality

Introduction

This paper uses the non-technical term "digitalisation" to describe the introduction of digital devices and systems for collecting and using data for many purposes. It concentrates how we can best use such data and systems to enable coordination of clinical activities between beneficiaries and providers and between providers. It also considers how these data, generated in the course of clinical care and of beneficiaries lives, can be used to inform planning and management decisions about integrated care and used for research. The author's perspectives and values are those of a technology enthusiast, a former clinician and now researcher, but also with a concern about the possible harm to personal care and relationships that could come from unskillful design and inappropriate use of the data and of these powerful technologies.

The potential and the progress

Most clinicians, leaders and researchers have some awareness of the potential of IT for enhancing health and social care and its coordination, but also of the dangers and time distractions of under-designed systems. Many note the slow progress in using IT effectively to enable coordination for of care for service beneficiaries (patients/clients). Care providers need information about a beneficiary's wants and needs, and about what other providers are doing if they are to adjust their help to compliment the help of others: the "help of others" includes a beneficiary's self-help and help of their close-carers. Beneficiaries often assume clinicians and care workers have access to all the necessary information about and for their care. Often it is beneficiary's or close-carers who are the integrators of care, and can gain from knowing who else is involved, what they are doing, and from using IT tools to articulate their need and to follow their progress. In short, efficient integrated care is not possible without communication and information, and IT holds great promise for improving the quality of integrated care, for reducing costs and also making possible innovative models of IC.

As regards structures for integrated care, rather than by forming one fully integrated delivery system, more services are combining to build networks of independent organisations [ 1]. In other industries the "one organisation model" of integrated production is being replaced or "disrupted" with integrated supply chain approaches because the lower cost and sophistication of IT now makes this possible and because of the focus but coordination allowed by this network form [ 2, 3]. This experience and the research from other industries shows ways to build new models of integrated care that IT and the internet makes possible which allow coordination but also a degree of autonomy for the networked units.

Another use of IT by industry that is relevant to integrated care is to create new and more efficient ways to interact with customers. This includes facilitating customer-customer interaction (peer to peer support), as well as gathering and using customer data for better customer management, prediction and planning [ 4]. In health and social care, modern person-centered integrated care ("PCIC") recognises that most care is self-care and by close-carer family members and friends, and that the person must be at the center of the integration model, with providers supporting them and their close-carers [ 5, 6]. IT enables services to transition to this model, as well as to bring new and more innovative ways of providing care: the principle of "move data not the patient" is useful for considering ways for reducing unnecessary and unwanted visits.

IT to support integrated care in Europe: six cases

IT is increasingly used as one component of integrated care models for different patient groups: for example adding a smart phone app for beneficiaries to communicate with their care manager or a remote monitoring device. A second way is to use IT as the basis for a completely new way of providing integrated care - this is less common. To date, most published empirical reports are of IT systems that enable integration but involve considerable investment and long term development, and are mostly from the USA and possibly not relevant to many parts of Europe.

As part of the European Integrate project [ 7] a comparative case study was performed in 2015-2016 of the use of IT to support six different integrated care schemes: two in Sweden, two in the Netherlands, one in Spain and one in Germany [ 8]. The six schemes were for different beneficiary groups: people with mental health challenges, diabetes, and frail older people. The case studies gave an empirical "snapshot" of the IT systems supporting the integration, as well as of staff perceptions of the strengths, weaknesses and needed improvements.

The IT systems described in these cases studies reflected the professional and organisational fragmentation of the larger care systems of which they were part. The schemes sought to build integrated care for specific beneficiary groups, one connection at a time, and without radical restructuring and change. Information systems had been designed to serve individual professionals and separate services and were not very effective for supporting person-centered integrated care. The integrated care schemes had to work with the inherited buildings- and profession- based information systems and try to use digital technologies to improve communications.

Overall, the study found a limited use of IT to help integration in the six cases. The main technology used was electronic medical records that gave providers a way to collect, store, and retrieve their own beneficiary records, as well as some limited electronic access to other information about the beneficiary. In four of the six cases, providers could not securely exchange beneficiary's information with providers working for other organisations, and most relied on fax, telephone and face to face meetings to communicate and coordinate care. The improvement that all providers wanted was for their organisation's system to be able to connect with other organisation's systems so as to be able to communicate and share information. Beneficiaries in five of the six cases studied did not have access to, and could not contribute to the health or social care information held about them [ 8].

Ways forward for developing IT for integrated care

Recognising that the above study, there are still tentative lessons that can be drawn about how to make more and better use of IT to build integrated care. These are discussed as ten recommendations in the full study report and summarised below to help others to consider their role in shaping the development of IT for integrated care [ 8].

Enabling data exchange

To support integrated care, a necessary requirement of any IT system is to be able to receive and send data, and in a way which the data cannot be accessed by unauthorized parties. In the USA, changes to ensure "interoperability" between systems are being driven by government requirements for electronic medical records (EMRs) and by health information exchanges, but the influences in Europe are not as strong to ensure interoperability [ 9, 10]. New technologies and software are reducing the costs and security risks which arise from ensuring system inter-operability for integrated care [ 11]. With more providers recording personal data about the beneficiaries in the same system, more attention needs to be given to designs which allows fast access to, or presentation of, information at the time and place it is needed, for example by records structured in a way that enable integrated care.

Engaging beneficiaries and close-carers

For future integrated care to be more person-centered, IT systems will need to enable beneficiaries and close-carers to specify their needs and goals and to allow them and providers easily to monitor and review their care plans. A structured approach to care needs assessment and planning can be led by one care coordinator, but there are different models for how other care providers are to be involved. IT does not replace the need for agreement about the social and organisational arrangements for their involvement: making data accessible does not mean it is accessed or acted on. Beneficiary access to their records can be facilitated by IT, but ways to ensure the privacy of data about third parties recorded in the records will be needed as will careful design and testing to ensure that beneficiaries who are not technically competent can use of benefit [ 12].

Co-Design

In the European case study above, many providers reported that their IT systems were general purpose systems and not designed to support their integrated care work. The systems tended to reinforce old models of care rather that "nudge" providers towards more beneficiary-centered and multidisciplinary working models. To be effective, future systems will need to involve users in their design and implementation and will need to balance standardization with local tailoring to advance the model of integrated care that is envisioned. This means selecting users carefully for the co-design work, and choosing skilled designers who understand clinical and social care practice and can lead a co-design process.

Data for planning and management

The key to cost control is a tiered coordinating care system, giving different levels of care intensity for different beneficiaries, and selecting beneficiaries for each level, based on accurate data [ 13, 14, 15]. Many current information systems need to be developed to provide the managers who are planning coordinated care with information on which they can base proposals or plans for such services. In addition, information for operational management of coordinated care schemes can be presented in actionable ways, such as by "dash board" visual presentations [ 16]. These systems need to be able to predict beneficiaries at high risk of deterioration and to obtain timely data about those beneficiaries making frequent avoidable use of emergency rooms or experiencing avoidable admissions [ 17, 13, 14].

Research into IT to support IC

Our case study came to a conclusion similar to that of another study that, "the pace of eHealth research has generally not kept up with technological advances, and many of the current designs, methods and funding mechanisms are incapable of providing the types of rapid and relevant information needed for successful ehealth implementation" [ 18]. More research is needed independently to assess the claims and promises of the IT industry: is new hardware and software reducing costs and enabling local tailoring of systems to specific integrated care schemes, as well as improving security with biometric authentication?

Perhaps the greatest limiting factors to developing systems to support integrated care are the lack of skills and investment to co-design the systems to advance the visions of person-centered integrated care which are emerging [ 6]. Researchers have a role to play in these developments and can also help to make the systems usable for research which is lower-cost and more timely [ 19].

Conclusion

"It is too technical for me - leave it to the experts" is a common and understandable response. Yet researchers and practitioners are able to, and have a responsibility to shape the systems to support the individualised person-centered and coordinated care we are trying to build. Not by asking permission to be involved, but by making it a requirement that systems are co-designed with users who are enabled to take part in the development. More humane, person-centered and less wasteful care is possible with these technologies. Equally possible are costly and cumbersome systems that take time from patient care and are difficult to access, that misuse data, and that turn necessary person-to-person physical visits into a luxury for the wealthy. The future of integrated care is too important to be left to technicians and the IT industry.

Acknowledgement

This perspectives paper was written in response to the editor's request for a personal perspective paper that drew in part on the EU WP10 Integrate project. This perspectives paper does not necessarily represent the views of other key contributors to the EU integrate project: However, I would like to acknowledge the work of the following colleagues to EU integrate project that is described in the full report referenced in the text: Alberto Alonso, and Nadine Kubesch of the Barcelona FUNDACIO PRIVADA CLINIC PER A LA RECERCA BIOMEDICA, and Mats Brommels of the Karolinska Institute, Department LIME, MMC.

Competing Interests

The author has no competing interests to declare.

References

1. Enthoven AC. What is an Integrated Health Care Financing and Delivery System (IDS)? and What must would-be IDS Accomplish to Become Competitive with them? Health Econ Outcome Res Open Access. 2016;2:115. [ Google Scholar]

2. Evans P, Wurster T. Cambridge, Mass: Harvard Business School press; 1999. Blown to Bits: How the New Economics of Information Transforms Strategy. [ Google Scholar]

3. Meijboom B, Schmidt-Bakx S, Westert G. Supply chain management practices for improving patient-oriented care. Supply Chain Management: An International Journal. 2011;16(3):166-175. (2011) [ Google Scholar]

4. Van Belleghem S. London: Kogan Page; 2015. When Digital Becomes Human: The Transformation of Customer Relationships. [ Google Scholar]

5. Redding D. "The narrative for person-centred coordinated care" Journal of Integrated Care. 2013;21(6):315-325. doi: 10.1108/JICA-06-2013-0018. [[ CrossRef] Google Scholar]

6. Goodwin N. Towards People-Centred Integrated Care: From Passive Recognition to Active Co-production? International Journal of Integrated Care. 2016;16(2):15. doi: 10.5334/ijic.2492. 1-2. [[ PMC free article] [ PubMed] [ CrossRef] Google Scholar]

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8. Ovretveit J, Alonso A, Kubesch N, Brommels B. Digital Health Technology to enable service coordination, care integration and self-care, WP10 Report of the EUProject Integrate. 2015. available from: www.projectintegrate.eu. or from LIME/MMC, Karolinska Institutet, Sweden.

13. Rea H, Kenealy T, Horwood F, Sheridan N, Parsons M, Wemekamp B, Winter F, Maingay G, Degeling P. Integrated systems to improve care for very high intensity users of hospital emergency department and for long-term conditions in the community. New Zealand Medical Journal. 2010;123(1320):76-85. [[ PubMed] Google Scholar]

14. Billings J, Georghiou T, Blunt I, Bardsley M. "Choosing a Model to Predict Hospital Admission: An Observational Study of New Variants of Predictive Models for Case Finding." BMJ Open. 2013;3:e003352. doi: 10.1136/bmjopen-2013-003352. [[ PMC free article] [ PubMed] [ CrossRef] Google Scholar]

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17. Rais S1, Nazerian A, Ardal S, Chechulin Y, Bains N, Malikov K. High-cost users of Ontario's healthcare services. Healthcare Policy. 2013 Aug;9(1):44-51. [[ PMC free article] [ PubMed] Google Scholar]

Articles from International Journal of Integrated Care are provided here courtesy of Ubiquity Press

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Digital Technologies Supporting Person-Centered Integrated Care - A Perspective

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Shared electronic health and social care records in some service systems are already showing some of the benefits of digital technology and digital data for integrating health and social care. These records are one example of the beginning "digitalisation" ...

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Right before her afternoon run, Rita pairs her smart preventer inhaler with her smartphone and takes two puffs. Checking the companion app, she finds that she took the right dose and waited for the recommended 30 seconds between inhalations. Relieved that her workout will not trigger her asthma symptoms, she begins tracking it on her smartwatch.

Following the 40 minute run, Rita checks her peak flow reading - or how well she exhales - with her smart, handheld peak flow monitor. This enables her to determine whether her workout caused any narrowing of her airways, which could lead to an asthma flare-up well before symptoms show. The reading she gets is within the normal range, indicating that her preventive corticosteroid puffs helped her stay on track with her fitness goals.

Source: www.medcitynews.com

Rita's fictional example sounds seamless and contemporary, but it is still fictional, while the technologies depicted are contemporary. It is well-documented that asthmatic patients experience difficulties adhering to proper inhaler techniques. Researchers found that among this patient group, nearly half use their inhalers incorrectly. The Asthma UK organisation for its part reports that the inhaler technique of around 1 in 5 patients hasn't been checked by a GP or an asthma nurse in the last year.

Such inadequate use of their inhaler leads to poor disease control as well as increased associated healthcare costs. If we consider that asthma affects over 25 million people in the U.S. and 5.4 million people in the U.K., where the condition also leads to some 70,000 hospital admissions and 1100 deaths, we can better understand the importance of proper preventive measures.

To control asthma, one needs data and quantifiable feedback about how they are doing; and this is possible through technologies patients can use. As such, asthma is well-suited for a digital health overhaul and here we'll see how this is the case.

No room for breathing: a field tight on digital health innovation

As a field that deals with respiratory difficulties, research and innovation relevant to asthma similarly suffer from sufficient breathing room. The Asthma UK organisation reports that in the U.K. only 2% of all medical research funding is channelled into studying respiratory diseases like asthma.

In its 2016 Connected Asthma report, the organisation further highlighted the advantages that technologies like smart inhalers, health apps and remote monitoring could bring to address asthma attacks and associated symptoms. In 2020, four years after the report, Asthma UK noted the limited availability of technology in this space.

Source: https://www.digitalhealth.net/

Studies have shown that asthma management proportionally influences patients' lives. They link poorly controlled asthma to lower general health-related quality of life, as it affects various aspects from daily activities to sleep quality.

As such, properly controlling the condition can drastically improve patients' lives. Luckily, there are efforts to bring new technologies to assist asthmatic patients with their ailment.

Renewed breathing space with recent digital health endeavours

" New and emerging technologies, such as smart inhalers that link to personal devices, have the potential to revolutionise the way we diagnose, manage and treat asthma," said Dr. Kedar Pandya, director for cross-council programmes at Engineering and Physical Sciences Research Council (EPSRC).

To fund such endeavours that bring innovative, patient-centric solutions to asthma care, the EPSRC, along with Asthma UK and a couple of other organisations launched a £3 million fund in late 2020. " We believe technology could play a vital role in this and are excited to see the novel solutions to preventing asthma attacks and improving the lives of people with asthma that are created as a result of this funding," said Dr. Samantha Walker, director of research and innovation at Asthma UK and British Lung Foundation partnership.

It's encouraging to see such efforts towards bringing promising technologies in asthma management; more so, when studies are backing their contribution. A recent one conducted by Northwestern University provided asthmatic patients with smart inhalers to use. The latter feature a Bluetooth sensor add-on that detects when patients use their medication and thereby share the data with physicians.

The researchers found that such smart inhalers can help improve medication adherence; as well as better assist asthmatic children in managing their condition.

Inspirational tech

Smart inhalers like the one in the study or as depicted in Rita's case do exist commercially like the FDA-approved Hallie sensor. It fits a range of existing inhalers and monitors the user's medication use. It also allows them to share the data with their doctor. A similar alternative is the Propeller sensor. However, there are only a few of such options available for now. However, more are under tests in clinical trials, and have given promising results like the one from the recent study, we could soon see more on the market. Even those suffering from asthma are showing interest in such options. Asthma UK's own research found that around 9 in 10 asthmatic patients would think of adopting a smart inhaler if the NHS made them available.

Another solution depicted in the introduction, Rita's handheld smart peak flow monitor, is also an option right now. We reviewed two such devices before, the Smart PeakFlow and the AioCare. During our tests, we found them both to be accurate, feature-rich and great options for remote monitoring.

A more widely available option is smartphone asthma logging apps. A number of these are available like AsthmaMD and asthmaTrack that enable users to log details about their asthma activity, triggers and medication use, which they can then share with their physician. Others like DailyBreath take into consideration how weather and environmental conditions can influence the user's condition, and thereby recommend preventive actions.

In the future, those with asthma can expect to have dedicated wearables as an option as well. The ADAMM smart patch is one such wearable that monitors symptoms like cough, respiration rate and presence of wheeze. Whenever these deviate from the individual norm, the wearable vibrates to indicate the user of the deviation; and it even sends a text notification to a designated person. The device is said to be "coming soon", but we can see its potential for adoption.

Until recently, asthma care was rather lacking in digital health options. But with such options on the horizon, this trend seems to be on track to change for the better. And indeed, asthma care is a field ripe for digital health adoption.

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Dr. Bertalan Mesko, PhD is Get access to exclusive content and analyses about the future of digital health on Patreon.com! The Medical Futurist and Director of The Medical Futurist Institute analyzing how science fiction technologies can become reality in medicine and healthcare. As a geek physician with a PhD in genomics, he is a keynote speaker and an Amazon Top 100 author.

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How Digital Health Technology Can Contribute To Asthma Care

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Right before her afternoon run, Rita pairs her smart preventer inhaler with her smartphone and takes two puffs. Checking the companion app, she finds that she took the right dose and waited for the recommended 30 seconds between inhalations.

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Connecting patients, practitioners and regulators in supporting positive experiences and processes of shared decision making: A progress report
This paper describes a novel approach to explore how regulators, working with patients and practitioners, may contribute to supporting person-centred care and processes of shared decision making in implementing professional standards and reducing harms.

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Connecting patients, practitioners and regulators in supporting positive experiences and processes of shared decision making: A progress report This paper describes a novel approach to explore how regulators, working with patients and practitioners, may contribute to supporting person-centred care and processes of shared decision making in implementing professional standards and reducing harms.

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Health Expectations - 2021 - Lockyer - Understanding COVID‐19 misinformation and vaccine hesitancy in context  Findings

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Member States have recognized the importance and need of an infodemic response through recent resolutions, coming together in solidarity and responding to calls for actions. Therefore, WHO is building partnerships across all societies to respond to the COVID-19 infodemic and is developing country tools for infodemic management that can be used now and for future infodemics.

During the COVID-19 pandemic, WHO has worked with the UN family, tech sector, media, civil society and other amplifying communities to understand concerns, co-develop messages, extend the reach of health information, and to respond to the information needs of communities. WHO has also worked with academia to develop a public health research agenda for infodemic management, and with a diverse group of experts to develop a competency framework and trainings in infodemic management.

WHO is championing universal access to credible health information, and building resilience to misinformation for people worldwide. At the same time, more efforts are needed to better understand the scale of the infodemic, and impact of strategies used to manage it, in order to develop new toolkits for countries.

Through regional networks, such as the Africa Infodemic Response Alliance, WHO is fostering new approaches to meet changing needs for an evolving health emergency infodemic response. This is providing a foundation for further collaborations to also improve preparedness and early detection of emerging and resurgent health threats.

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An infodemic is too much information including false or misleading information in digital and physical environments during a disease outbreak. It causes confusion and risk-taking behaviours that can harm health. It also leads to mistrust in health authorities and undermines the public health response.

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Article on patient centred care in a multicultural world

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Patient Experience Radio podcast - Patient Experience Network

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The Patient Experience Network presents "Patient Experience Radio", a new platform to spread the word on best practice in patient experience. These podcasts focus on case studies and examples of work that have enhanced the patient experience and we hope to either inspire you to strive for improvement in your own work, or to reassure you that the things you are already doing are brilliant.

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How digital technology is transforming health and social care 

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How digital technology is transforming health and social care 

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Digital Literacy Capability Framework 2018

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Universal access to the NHS - but only if you have a smartphone

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Universal access to the NHS - but only if you have a smartphone

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Information and communication technologies (ICTs) are technologies that help gather, store, process and share information electronically. Examples of ICTs are electronic medical records, medical journals and databases on the internet, videoconferencing for doctor appointments, or systems on the internet to give feedback to doctors so they can improve the care they provide. ICTs have the potential to improve health care and the health of patients. But even though computers are being used more and more in hospitals, not all health care professionals use ICTs. For this reason, there are many strategies to try and promote the use of ICTs. Strategies can include training groups of health care professionals to use a specific ICT, or teaching someone one-on-one to use an ICT, or simply providing training materials.

A review of the effects of different strategies to promote the use of ICTs was conducted. After searching for all relevant studies, 10 studies were found. The evidence shows that some ways, such as group training, or one-on-one training sessions, or providing training materials, may improve the use of ICTs. But overall, it is still uncertain whether some strategies are effective. More research is needed.

There is very limited evidence on effective interventions promoting the adoption of ICTs by healthcare professionals. Small effects have been reported for interventions targeting the use of electronic databases and digital libraries. The effectiveness of interventions to promote ICT adoption in healthcare settings remains uncertain, and more well designed trials are needed.

Read the full abstract...

Information and communication technologies (ICT) are defined as digital and analogue technologies that facilitate the capturing, processing, storage and exchange of information via electronic communication. ICTs have the potential to improve information management, access to health services, quality of care, continuity of services, and cost containment. Knowledge is lacking on conditions for successful ICT integration into practice.

To carry out a systematic review of the effectiveness of interventions to promote the adoption of ICT by healthcare professionals.

Specific strategies, defined with the help of an information specialist, were used to search the Cochrane Effective Practice and Organisation of Care Group (EPOC) register and additional relevant databases. We considered studies published from January 1990 until October 2007.

Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before/after studies (CBAs), and interrupted time series (ITS) that reported objectively measured outcomes concerning the effect of interventions to promote adoption of ICT in healthcare professionals' practices.

Data collection and analysis:

Two reviewers independently assessed each potentially relevant study for inclusion. We resolved discrepancies by discussion or a third reviewer. Two teams of two reviewers independently extracted data and assessed the quality of included studies. A meta-analysis of study outcomes was not possible, given the small number of included studies and the heterogeneity of intervention and outcomes measures. We conducted qualitative analyses, and have presented the results in a narrative format.

Ten studies met the inclusion criteria. Nine of them were RCTs. All studies involved physicians as participants (including postgraduate trainees), and one study also included other participants. Only two studies measured patient outcomes. Searching skills and/or frequency of use of electronic databases, mainly MEDLINE, were targeted in eight studies. Use of Internet for audit and feedback, and email for provider-patient communication, were targeted in two studies. Four studies showed small to moderate positive effects of the intervention on ICT adoption. Four studies were unable to demonstrate significant positive effects, and the two others showed mixed effects. No studies looked at the long-term effect or sustainability of the intervention.

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Promoting the use of information and communication technologies (ICTs) by health care professionals

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Information and communication technologies (ICTs) are technologies that help gather, store, process and share information electronically. Examples of ICTs are electronic medical records, medical journals and databases on the internet, videoconferencing for doctor appointments, or systems on the internet to give feedback to doctors so they can improve the care they provide.

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