Case study: Electronic records supporting remote care

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Из курса от партнера The University of Sydney

eHealth: More than just an electronic record

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The University of Sydney

eHealth: More than just an electronic record

81 оценки

The MOOC, "eHealth: More than just an electronic record!", is multidisciplinary in nature, and aims to equip the global audience of health clinicians, students, managers, administrators, and researchers to reflect on the overall impact of eHealth on the integration of care. It explores the breadth of technology application, current and emerging trends, and showcases both local and international eHealth practice and research. The entire eHealth Course consists of 5 modules and takes about 5 weeks to complete. Completion certificates are issued on the basis of participation in all 5 modules. Completing the health practice assignment in Module 5 entitles you to advanced standing in some of the eHealth courses run by the Faculty of Health Sciences, University of Sydney. What you'll learn - The fundamentals of eHealth and where it is heading - What kind of health data we are currently collecting and how it will transform healthcare in the future - How new technologies are helping health consumers participate in their own healthcare - How eHealth can improve the coordination and efficiency of healthcare and what the barriers might be Length: Self-paced 5 week course Study time commitment: 3 hours per week Assessable components: Assignment 1 in Module 2 (40%) and Assignment 2 in Module 5 (60%). Guest presenters (listed in alphabetical order): * Jordan Andersen | The University of Sydney * Dr Teresa Andersen | Sydney Local Health District * Dr Robert Birnbaum | Harvard Medical School / Partners Healthcare * Melissa Brunner | The University of Newcastle & The University of Sydney * Professor Jane Burns | Young and Well Cooperative Research Centre & The University of Sydney * Professor Rafael A. Calvo | The University of Sydney * Dr Andrew Campbell | The University of Sydney * Dr Jelle Demeestere | John Hunter Hospital, Newcastle NSW * Professor Hugh Durrant-Whyte | The University of Sydney * Karen Finnin | Physios Online * Professor Afaf Girgis | UNSW Medicine * Anna Janssen | The University of Sydney * Professor Judy Kay | The University of Sydney * Dr Melanie Keep | The University of Sydney * A/Professor Jinman Kim | The University of Sydney * Dr John Lambert | eHealth NSW * Dr Melanie Keep | The University of Sydney * Dr Karen Luxford | Clinical Excellence Committee NSW * Michael Marthick | Chris O’Brien Lifehouse & The University of Sydney * A/ Professor Mark McEntee | The University of Sydney * Professor Kathryn Refshauge | The University of Sydney * Dr Ursula Sansom-Daly | Sydney Children's Hospital, Prince of Wales Hospital & UNSW Medicine * Dr Arran Schlosberg | The University of Sydney * Professor Stephen Simpson | The University of Sydney * Professor Leanne Togher | The University of Sydney * Josh Zadro | The University of Sydney

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Module 5 - eHealth in Professional Practice

"How can eHealth principles and technologies be applied in my own professional practice?"

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Case study: Electronic records supporting remote care5:38

Case study: Physios Online3:20

Case study: The 'My Home Dialysis' program3:54

Case study: 'Synergy' online hub for mental health & wellbeing3:19

Case Study: Supporting wellness after cancer treatment3:47

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Pamela Branas
Professor in eHealth
Research in Implementation Science and eHealth Group (RISe)

[MUSIC]

Patient living in small country town.

She lives with a husband and they have a district hospital run by a general

practitioner who also works in the hospital.

She's brought into that hospital by her husband, incredibly short of breath.

She is gray and clammy, and really struggling, and

she can't even get out of the car.

So the hospital team get her out of the car.

Bring her into the hospital, do some basic observations.

Her blood pressure is within normal ranges, her heart rate is very high.

She doesn't have a fever.

But her oxygen levels are quite low and so they put some oxygen on and

do some immediate basic assessments of the patient.

So the first challenge facing the team out there is that the patient can't speak.

So she's too busy breathing, so

the husband can provide some husband level information.

But this time the husband was so concerned about his loved one that he didn't even

bother to pick up the bag of medications.

And her wallet's at home as well, so he doesn't have the list of medications.

So the GP, who is a locum,

who turned up a week ago, doesn't know anything about this lady's history.

Doesn't know what meds she's on.

What's previously been done to her.

Anything.

So the value of the electronic health record or electronic medical record is

that they can go to one of the nearby computers and find out all the care that

has been given to that patient in that facility and possibly beyond.

So, they'll usually get very basic information.

How many times has she been in hospital?

What was it for?

What was the diagnosis of that admission?

So, just knowing that she's had a range of admissions that have been for

a mixture of chest pain, which is thought to be acute coronary syndrome, but

without having had a heart attack in the past.

And the fact that she's been in a couple of times for chronic obstructive

pulmonary disease, and that she's had regular visits to a clinic for

management of her diabetes is incredibly valuable information.

So the GP and

the nursing staff at the regional center are clearly out of their depth.

This lady is very sick and they're worried about her.

And they really don't know the best way forward.

So they ring for help at their nearby tertiary referral center.

And they get an intensinist on the phone who is able to look at the electronic

record of this patient, so they might see the results of angiography reports.

They might see the results of previous x-rays and be able to look at those x-rays

and make their own interpretation of what was happening.

They will see multiple discharge summaries.

They might even see information that came from a tertiary hospital transfer that

happened in the past.

They will see laboratory results that extend back years and

can explain the various subtleties of deviation of this

patient's three different chronic diseases.

If the GP has X-ray capabilities in their sight, they'll be able to look

at that X-ray within a minute of it being taken of the patient and

be able to support the GP's interpretation of that X-ray.

They will see the results of the point-of-care testing.

So the GP might have taken some blood and run it through a blood gas machine.

And they'll be able to look at those results and

then look at the trend against all the previous results that were taken.

They'll be able to see the interpretations of this patient made by specialists of

single organ systems.

So cardiologists, respiratory physicians, and endocrinologists.

None of this information would have been available in a paper world because it

would take us three hours just to get a medical record out of the stool.

And through that review I can see that this patient has been in many,

many times for really what is end-stage disease.

They've seen that there've been some early discussions about possible end of life

care management.

But nobody's really made a definitive statement.

And there certainly is, they've checked with the GP,

the patient hasn't brought in an advanced care directive.

And there isn't anything on record in the systems.

So general option is the recommendation of the specialist is that the patient have

the discussion with the family of the patient because the patient is

really to sick to participate in this.

About offering comfort care because curative care is unlikely to

offer any benefit, this is not a curable disease.

And the GP says well actually that's what I wanted to do but

I just didn't feel comfortable doing that and so he says but

what do I need to say and what do I need to do.

The specialist is, decides to very much support this and

has some conversations with the GP.

He offers the service of offering a remote video conference to talk directly to

the patient with the GP.

The GP actually feels so confident based on the discussion with the specialist that

they said this is not required actually.

I'm very comfortable talking to the family.

I don't treat the patient, but I do actually treat a husband and

I know him quite well and I think we can manage this.

Can I give you a call back if things don't go well?

And they conducted that conversation and that lady passed away peacefully.

With her own family around her in a community that loved her and

knew her well.

So when you enable a remote specialist to assist the local,

generalist team in this way.

Two different things can happen.

One, we make better choices about whether the patient should be transported or not,

or if they need transport.

It's amazing how often when you rely on the information, you have to err on

the side of, we'll bring them here and we'll have a closer look.

Whereas, when you've got much more information at your disposal, and

you actually see the quantum response of the patient to your care.

It allows you to triage much better and there are patients you won't bring to

a central facility that could be 500 kilometers travel away, unnecessarily.

So that's the first thing.

The second thing, of course,

is that you can start all the advanced treatments early.

It's amazing how much treatment is able to be delivered in these

what appear to be small sites.

The treatments that matter in the first few hours of the condition

are often quite simple treatments.

And with appropriate support and over-the-phone advice it's amazing how

well the GPs and their nurses in their small sites can deliver excellent care.

And what we've found, with experiences that when you do this,

the patients arrive in better condition.

And not only that.

They can be transferred with lower levels of support.

[MUSIC]

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