KATHY HOLLOWAY looks at e-health from a nursing perspective and the need to remember that the ‘e’ should stand not just for ‘electronic’ health but for ‘enhanced’ health.
Putting an ‘e’ for electronic at the front of a word is now a ubiquitous indication that technology is involved. So we have e-learning, e-commerce, e-sports, e-government and, of course, e-health. The development and integration of technologies (wanted or not) in many aspects of modern life is as much the reality for health services as it is in other industries.
Interestingly, when the Canadian Nurses Association developed an e-nursing strategy in 2006 – centred around integrating information and communication technologies (ICT) into nursing – it believed the need to add the ‘e’ would be redundant within a few years. However, nearly a decade later, New Zealand has a national ‘eHealth vision’ and various related ICT strategies (as outlined in the previous issue of Nursing Review). The ‘e’ is very much still here!
As a critically reflective health professional, I wonder if it is worth considering that simply placing an ‘e’ in front of health should not change the core functions and philosophy of health practices. For example, e-learning is still required to be pedagogically sound and e-business has financial standards to meet. This is a fundamental premise to consider when integrating technology into nursing practice – the intent is to enhance health services, not to provide less with more.
So what is e-health exactly?
The term e-health is broadly understood as being an umbrella term covering two facets: health informatics and telehealth. Health informatics relates to the collection, analysis and movement of health information and data to support health care. Telehealth involves the delivery of health information or health care either directly, for example videoconferencing, or indirectly, such as via a website (definitions drawn from the Standards Australia e-health site
The vision of the National IT Health Board (as covered in the last edition of Nursing Review) was to have all New Zealanders and their treatment providers able to electronically access their personal health information, regardless of setting, by 2014. This is part of a growing expectation for real-time access to a patient’s clinical information and care journey, with nursing work very much tied up with both those areas.
For the College of Nurses Aotearoa, a key strategic direction is the aligning of nursing workforce development with community need. The Institute of Medicine’s 2012 report Best Care at Lower Cost clearly links improved health outcomes for our communities with nurses effectively applying emerging technologies to both improve healthcare efficiency and communication. Communication and collaboration using technological tools is seen as key to sustainable and safe healthcare systems.
Health informatics is key to the development of various electronic patient portal systems being used to share health information across disciplines and with consumers. The health information being shared ranges, at the simplest end, from basic contact details right up to developing shared care plans (you can see more at http://ithealthboard.health.nz/about-us/ehealth-vision). In order for information sharing to work well and transparently, it is essential for clinicians and employers to have carried out the appropriate technical and organisational groundwork.
This means clinicians and consumers must have computer literacy, information literacy and, naturally, health literacy. A critical element is gaining the trust of health consumers, who are often concerned about data security and privacy. As clinicians, we must understand and be mindful of the security processes that protect and support healthcare delivery technologies.
The second e-health facet, telehealth, is about using technology to improve chronic care and to enable people to be supported at home. In New Zealand this can involve telemedicine (providing clinical health care at a distance), telemonitoring (remotely collecting and sending patient data for management) and mobile health (known as m-health). The latter is a rapidly growing area that uses mobile communication technology – usually smartphones and tablets – for the delivery of health information, health services and healthy lifestyle support programmes.
Examples of New Zealand m-health programmes include the text-messaging STOMP (stop smoking over mobile phone) smoking cessation support programme offered by Quitline; and Listen Please, a clinical translation smartphone app helping patients and families to communicate with clinicians in an emergency or intensive care situation.
Integration the key
Nurses need to be both abreast of the new health technologies and tools available and able to step back and critically assess how best to integrate these technologies into their practice. This allows the technology to be used as a tool to help nursing practice, rather than the technology itself taking centre stage.
Ask yourself – what do I need to know about the technology involved in health data capture, storage and secure sharing? If you want to build your skills in this area there are health informatics competencies and standards that have been developed by nursing scholars (examples can be viewed at the nursing informatics page of the American Medical Informatics Association website).
Let technology be transparent in your nursing practice by developing your awareness of, and confidence in, the delivery of health care with a little ‘e’.
Author: Dr Kathy Holloway is the new co-chair of the College of Nurses, sharing the chair with Taima Campbell.