The vision - renal care in your hands
Health Information Technology to enable patient-centered management of Chronic Kidney Disease
Introduction
Patients taking ownership of their Chronic Kidney Disease (CKD) can allow for a cost-effective method of managing both progression of CKD and overall maintenance of patient well-being. However, as with medical practitioners, we need to adapt and use the advances made in Information Technology to deliver a platform to the patient through which the patient can share personalized healthcare information, enabling them to take ownership of their CKD. This platform should consist of automated information, advice, and guidance about the progress of their kidney disease and the associated organ-specific complications. Advances in information technology (IT) enable this redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can now support a transition from institution centric to patient-centric applications.
The use of mobile IT devices such as smartphones in health care is increasing. For health care practitioners, the use of mobile IT can bring additional resources to the point of care and can change the location of that point of care. This application can focus on serving the needs of the user by providing widespread access to relevant information and/or remote data capture, thus eliminating the need for the user to be physically linked to a network or restricted to a specific geographic location.
HealthCart mobile phone application can deliver patient-focused information and advice as demonstrated here. With user-friendly displays, patients can share in their own health care information with the appropriate advice delivered parallel to their own disease. With chronic kidney disease being a number-driven chronic disease, this application will be able to make clear cut decisions individualized for each patient, giving them the opportunity to take ownership of their chronic kidney disease.
- Patients taking ownership of Chronic Kidney Disease management
- The use of modern IT applications to bring efficiencies to the delivery of renal care
- Bringing home the care of renal disease to the hands of clinicians and patients
.jpeg "Service overview from the palm of your hands")
.jpeg "CKD management in your community")
The concepts
Conceptually RenalReality evolves around the principle that the patient-doctor interactions in the primary and secondary interfaces are complicated and multi-directional, allowing the patient and public to become shared and active participants in their own chronic disease. The secondary care delivery model is expensive and depends heavily on limited interactions between health practitioners and patients. Through the appropriate use of Health informatics and modern device platforms, we can change the location of service delivery to the patient’s home; which in turn allow the patient’s to be pro-active in their disease management versus the current reactive model of care, normally sustained only for the peri-consultative period. Additionally, patient ownership of disease completes the cycle of this multi-facet interface, connecting in return patient awareness of chronic diseases in the public, especially to those at risk of CKD.
- Public Awareness through Public and Primary Care interaction
- Screening of high-risk patients in primary care through the primary care interface
- Shared Care protocols from secondary care providers and specialists
- Patient ownership through mobile applications in public health
- Information technologies to bring these aspects together within one Concept
.png "Cycle of CKD management within primary-secondary care interface")
In the Public Sector CKD-all about AWARENESS as the primary interaction between potential patients and the primary health care provider.
Those at risk of CKD encourage to make contact with GP in primary care for the screening process that includes blood tests and urine analysis.
Those patients identified with probable CKD are referred to the Secondary care setting where they get to be seen by Renal Specialists.
The Secondary interface generates Shared Care Plans communicated to both primary care providers and patients.
Communication with patients using the latest IT channels allows for patients to complete the cycle of CKD management and awareness in Primary care.
Clinical integration and sharing of information
Patient Ownership of Chronic Kidney Disease
Most hospital IT settings accumulate fractions of patients’ data in chronological order. Previous data models included episodic patient encounters as one type of health care transaction but did not capture the life course of the individual patient or consistently take an approach to ensure continuity of care. The practitioner now needs to integrate volumes of data spread over different platforms into a clinically useful format. RENALREALITY software re-organizes data and auto-populate it in clinical useful screenshots to allow quick and to the point of decision making. These screenshots allow for “active surveillance”, auditing patient trends, KPI’s and becomes the main focus of patient management at the secondary care level. However, this is only useful for health care deliverer and not the patient. A Smartphone application can feed on the same RENALREALITY database in producing screenshots to patients, letting them share in both the information and clinical decision making. The patient takes ownership of their own chronic disease in this way
(See diagram 2 – Flow of health information – an area in Red = smartphone app HealthCart)
HealthCart Smartphone application
This concept of ownership consists out of 2 components, sharing information and actively participate in clinical decision making through well-designed patient pathways – tailor-made for each patient, in the context of the patient’s own set of clinical data.e your own text and edit me.
The use of mobile IT devices such as smartphones in health care is increasing. For health care practitioners, the use of mobile IT can bring additional resources to the point of care and can change the location of that point of care. This application can focus on serving the needs of the user by providing widespread access to relevant information and/or remote data capture, thus eliminating the need for the user to be physically linked to a network or restricted to a specific geographic location. HealthCart smartphone application can deliver patient-focused information and advice as demonstrated here. With user-friendly displays, patients can share in their own health care information with the appropriate advice delivered parallel to their own disease. With chronic kidney disease being a number-driven chronic disease, this application will be able to make clear cut decisions individualized for each patient, given them the opportunity to take ownership of their chronic kidney disease.
Can it be replicated regionally and nationally?
REALITY, the web-based database serves as an intercept of hospital data. Across the central Midlands, we all using Éclair as our hospital storage system for blood results. Since Chronic Kidney disease is blood-result-driven, the installation of RENALREALITY will enable the smartphone app HealthCart to run regionally. As soon as other DHB’s use RENALREALITY as the “intercept”, the smartphone can be used nationally, with all renal data centralized in one web-based deposit. Regional and National trends will then be available.
Patient Participation
Earlier research into using mobile IT devices, such as PDAs or cellular phones, emphasized the collection of data from the patient to facilitate clinician decision making. There are a few applications that provide real-time decision support to patients as well.
Despite the movement toward patient-centric applications, most applications described in the literature follow the old model of decision-making in which the patient is a receiver of instructions rather than a participant in the management process.
In these applications, it is assumed that patients will comply with recommended interventions and there is little follow-up to examine whether and how the patient did so.
Other Mobile Health Promotion and Wellness applications
Patient-centered mobile health care applications have often targeted the areas of asthma, diabetes, and chronic obstructive pulmonary disease (COPD).
Mobile health promotion or wellness applications have primarily addressed smoking cessation, nutritional intake, and vaccinations. In the popular media but not yet in scientific literature, there have been descriptions of how mobile devices like MP3 players and iPods might promote wellness activities and patient education. As noted by Moen and Brennan, consumers use complex strategies for managing their health information (storing information throughout multiple spaces in their household, recording with different media, and organizing data based on perceived urgency of the information). We now can incorporate these strategies into their mobile IT designs for health management.
benefits of patient ownership of chronic diseases
Summary of benefits
The key benefits of the smartphone application (HealthCart) in conjunction with the existing platform created by the application RenalReality will be:
- 1. Enable self-management. Ownership and self-management go hand in hand (see diagram). HealthCart can share clinical information with the patient in a way that will allow shared clinical decision making.
- 2. Disease-specific advice and self-management protocols are provided which are tailor-made to the patient’s disease and progression thereof.
- 3. Reduce risk to patients. CKD is an asymptomatic disease and currently, there is a risk of late presentation to the renal services. Most preventative strategies happen in the earlier stages of the disease. Since HealthCart can quantify disease staging and progress, the patient will become aware of kidney disease well before they become symptomatic. Earlier contact with the renal services and eventual ownership of disease will reduce the risk of disease progression and the consequences of renal disease.
- 4. The additional use of timelines and graphs will mentally warn and prepare patients for the possibility of dialysis in the future. This normally serves as a great reminder to the patient that ownership of disease can prevent/slow down this progress.
- 5. Improve timeliness of preventative actions and interventions. Several preventative actions and interventions exist to slow down the progression of kidney disease. The 3 main parameters are blood pressure, blood sugar levels, and urine proteinuria. Given the fact that we now deliver information well before the patient becomes symptomatic, the patient can share in this responsibility to “care for their kidneys”.
- 6. Push notifications can also alert the timeliness of referral to secondary care for both the patient and the primary care provider. The combination of the smartphone application and ownership of disease will increase awareness of the renal disease in the wider population and hopefully the likelihood of those at risk to be screened in primary care.
- 7. Reduce unnecessary medical intervention
- The main focus will be to take care of the home of the patient through the appropriate IT platform. This will allow for virtual consults in comparison to the expensive consultant reviews in secondary care. Slowing down the progress of disease will also postpone, and sometimes prevent unnecessary medical intervention. With specific reference to dialysis as a medical intervention, the cost-saving can be astronomical.
- 8. Make good use of the health workforce
- The patient becomes a “free” part of the workforce through ownership of disease. Specialist nurses and doctors can now assess patients virtually and the population as a whole through the REALITY application. Our renal multidisciplinary teams already use IT platforms to assess patients as groups and individually in a quick and efficient way.
- 9. RenalREALITY and HealthCart mobile app can provide and achieve sustainable and cost-effective services in the face of the growing demands of ESRD patients requiring dialysis treatments. This economic impact is already proven in our DHB.
Patient Participation
Earlier research into using mobile IT devices, such as PDAs or cellular phones, emphasized the collection of data from the patient to facilitate clinician decision making. There are a few applications that provide real-time decision support to patients as well.
Despite the movement toward patient-centric applications, most applications described in the literature follow the old model of decision-making in which the patient is a receiver of instructions rather than a participant in the management process.
In these applications, it is assumed that patients will comply with recommended interventions and there is little follow-up to examine whether and how the patient did so.
With the use of patient-directed self-management tools on mobile platforms, we can increase the concept of patient participation and "ownership of CKD disease" amongst patients with renal disease
Conclusions
Dialysis is a very expensive treatment of end-stage CKD. Information Technology has great potential to contribute to improving patient health and population-based outcomes, eventually reducing the need for dialysis.
The software application used at Taranaki base hospital (RenalReality) has already indicated the cost-effectiveness of this principle. This proposal takes IT to the next level: patient ownership of disease and self-managing of chronic diseases through shared clinical information.
The smartphone application (HealthCart) can shift the paradigm of CKD care from a costly institution-driven service to become patient-centered. Adding the patient to the renal care workforce is cost-effective in itself. In combination, RenalReality and HealthCart have the potential to complete the cycle of the multifaceted primary-secondary interface, whereby public awareness becomes the final step. This combination can be used in other District Health boards, making it a model that serves as an example nationally. By investing in this proposal, HealthInformatics New Zealand was part of a cost-effective method to change the health care paradigm to become patient-centric in Taranaki and Northland District Health Boards, with the potential to be rolled out regionally and nationally.
We use cookies to enable essential functionality on our website, and analyze website traffic. By clicking Accept you consent to our use of cookies. Read about how we use cookies.
Your Cookie Settings
We use cookies to enable essential functionality on our website, and analyze website traffic. Read about how we use cookies.
Cookie Categories
Essential
These cookies are strictly necessary to provide you with services available through our websites. You cannot refuse these cookies without impacting how our websites function. You can block or delete them by changing your browser settings, as described under the heading "Managing cookies" in the Privacy and Cookies Policy.
Analytics
These cookies collect information that is used in aggregate form to help us understand how our websites are being used or how effective our marketing campaigns are.