E-Health Workshop Session 1: Empowering patients, carers and members of the public to look after their own healthDelivering Better Health Services – The Fifth

National SDO Conference

Dr Henry Potts, Centre for Health Informatics and Multiprofessional Education (CHIME), University College London (UCL)

In-depth study of three e-Health approaches to the enhancement of clinical care and its delivery

NHS SDO: EH95 “A study of the use of e-Health solutions in the management and treatment of disease and in facilitating change in the organisation and delivery of services.”

Henry Potts1, Justin Keen2, Jackie Nicholls1, David Patterson1, Ann Blandford1, Chris Martin1, Tracy Denby2

1University College London, 2University of Leeds

System 1: Monitoring and adjustment of anti-coagulation therapy Anti-coagulant therapy to reduce chance of stroke Optimised prescription requires an individual and

closely monitored drug regime Instead of frequent out-patient appointments,

patients attend community pharmacies or nurse-led clinics at GP surgeries – pharmacists and nurses acts as supplementary prescribers

Patient home testing being introduced Uses an electronic health record shared with

hospital and a decision support tool to guide prescription decisions

System 2: Electronically mediated diabetes care At Airedale Primary Care Trust, Bradford GPs and secondary care settings, including

diabetes services at Airedale General Hospital, use shared electronic health record

SystmOne electronic health record from Phoenix – off-the-shelf product recommended under Connecting for Health

System 3: Risk communication in cardiovascular disease Laindon Model decision support tool models

survival based on cardiovascular disease risk factors (including smoking, blood pressure, BMI, age…)

Used in a GP consultation to aid risk communication and shared decision-making

Distributed to all GP practices in Thurrock PCT

Methods

Mixed methods, inductive approach Main data collection consists of ethnographic

observational work in the service contexts, supplemented by interviews

Based around the patient journey Combined with mini-studies focusing on

particular issues Consider both the patient experience and the

healthcare professional experience

Workshop: chair’s duties

Introduce some new work Ask questions Challenge assumptions

Patient education and Internet use in diabetes Part of WINDFAL programme to support

diabetes care at Whittington Hospital Building locally-relevant online resources for

patients, including information, communication with healthcare professionals and peer support

Educational sessions for patients include sessions on how to use the Internet well and safely

Questions

What do healthcare professionals want? What do patients want? Everyone wants reliable, high-quality, reputable

online resources, but what does that mean? Is e-health more of the same or is it

transformational? Does e-health support a general move towards

greater patient involvement in their own healthcare, or does e-health drive that process, allowing entirely novel forms of patient involvement in their own healthcare?

Challenging assumptions

All facts are the same Medical facts vs. practical tips vs. experiences

Empowerment We’re playing catch-up for many people: e.g.

10,000,000s of people have joined online support groups (Pew Research Center, 2005)

Good information is all you need Poor meta-knowledge/meta-cognition means

good information gets wrongly interpreted

Workshop tasks What do patients want to

know? What impacts on a patient’s

understanding of and response to information?

What are a patient’s belief systems?

How does the wider social and public context impact on these beliefs?

How does all of the above impact on negotiating the management plan?

Think of a time when you or a relative was ill

What sort of things were you thinking (or worrying) about?

What did you expect from the healthcare professionals you encountered?

What did they say or do that helped?

Did they say or do anything that didn’t help?