Patient-centric technology moves surgical care beyond the hospital walls
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Patient-centric technology moves surgical care beyond the hospital walls. Presented by Rachel Vickery, SHI Global, at HINZ 2014, 12 November 2014, 12pm, Marlborough Room
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Patient-centric technology moves surgical care beyond the hospital walls
- 1. Patient-centric technology moves surgical care beyond the hospital walls Rachel Vickery, Technical Director SHI Global Ltd MHSc (1st class hons)
- 2. The changing health care environment needs: • Solutions that shifts care beyond the clinic walls • Increases the depth & breadth of care with each touch point without increasing demands on clinicians / resources • Enhances the scalability of resources without compromising care • Is measureable and transparent • Enables an integrated approach • Positively influences health economics of the scenario
- 3. Elective Surgery Patient • Time of high anxiety • Punctuated by unfamiliarity with peri-operative pathway • Difficulty recalling & complying with treatment guidelines • Feeling of disconnect from healthcare team
- 4. Elective Surgery Patient • High demands on staff and resources • Requires excellent communication and co-ordination • Restricted by time and financial constraints • Limited access to patients pre-op • Logistic difficulties that prevents co-ordinated management • Time of high anxiety • Punctuated by unfamiliarity with peri-operative pathway • Difficulty recalling & complying with treatment guidelines • Feeling of disconnect from healthcare team Health Professionals / Institutions
- 6. healthlnx™ is a patient-centric online software program that provides patients / clients with online daily action plans over the time period of their care. Plans created / put in place by organisation / provider Suitable for: • Management of (just about) any Injury / Condition • Injury prevention programs • Chronic disease / conditions • Education and Behaviour Change programs Strong ability to influence economics of programs
- 13. What the Surgeon wanted to achieve using healthlnxTM • Enhance clinical outcomes & raise the bar for excellent care delivery • Increase patient’s confidence & decrease anxiety in pre-op phase • Achieve standardization of post op management • Create a point of difference for himself & the hospital • Create a strong team philosophy of excellence with all medical staff working with his patients.
- 14. Patient plans are built using one or more Carepacs™ Information Videos Emails SMS Communications Tasks Alerts Interactive forms Outcome Measures Day 0 Timeframe of event Discharge 3 weeks pre op Day 0 6 weeks Day 0 Day 0
- 15. 3 weeks pre op Day 0 6 weeks Timeframe of event Day 0 Hip Replacement Carepac™ Information Videos Emails SMS Communications Tasks Alerts Interactive forms Outcome Measures Day 0 Discharge Day 0 Day of Surgery
- 16. 3 weeks pre op Day 0 6 weeks Day 0 Timeframe of event Discharge Day 0 Day 0
- 17. 3 weeks pre op Day 0 6 weeks Day 0 Timeframe of event Discharge Day 0 Day 0
- 18. Day 0 Timeframe of event Discharge 3 weeks pre op Day 0 6 weeks Day 0 Day 0
- 20. “I ran Andrew Barron (Hospital GM) through healthlnxTMthis afternoon. He was very impressed and very supportive –he wants to ensure it gets good coverage on St Andrew’s publications, research etc.”
- 21. • 84 patients at various stages of using healthlnxTM • Just moving to formal data collection • Typically younger, more active patients (early 50’s to late 60’s) • Comfortable with technology • International Journal of Advanced Joint Replacement early 2015 • Pilot data incredibly positive
- 22. Pilot Phase 19 Patients, 13 respondents USEAGE 92% found it convenient & easy to use in their day to day life 100% found the information & exercise videos helpful and easy to use 64% logged in daily or 2-3 x week. The remainder logged in weekly 92% used the Mark as Done feature (Compliance Check)
- 23. Pilot Phase 19 Patients, 13 respondents RECOVERY & PREVENTING COMPLICATIONS 80% said viewing the post op information pre-op had them ready for the recovery process 92% felt they understood the post discharge exercise program better than if they’d just received ward physio input 100% felt confident they knew how to look after their wound 100% felt confident they know how to spot potential issues with their wound 87% felt healthlnxTM strongly or very strongly assisted their recovery 100% of patients had post-op physio (range 2-3 times per week to every 2-3 weeks). 63% of patients felt they could have seen their physio less often.
- 24. PATIENTS’ OVERALL EXPERIENCE “This was most helpful in preparing for surgery and also afterwards to remind myself what to expect. It would be especially great for someone who is having a first hip op as it is all quite daunting.” “healthlnxTM is a great tool and should be part of every surgical procedure.” “I have been very lucky to have access to healthlnxTM” “I found the whole process was motivational as well as very useful for being in the best condition for surgery & then as an aid to recovery” “I love the confidence and control it gives me, the challenge of new exercises with the graded increments and the videos so I can see the exercise done properly” “I love that I don't need to leave the house to get stronger and the increments of challenge seem to be perfect for me”
- 25. Lessons learnt so far: • Patients are ready to embrace health technology, often more than clinicians and they want to be empowered to self care. • We underestimate the importance of “peripheral information” that we take for granted, yet makes the world of difference to our patients. • The most impactful application of the carepac that is different to standard care is the pre-op information, preparation & reassurance. •healthlnxTM works exceptionally well for remote post-op patients.
- 26. More Generally…. Patient-centric technology enables care to move beyond the contraints of a physical clinic, reliant on one-on-one time to: • Enhance clinical outcomes • Increase patient satisfaction • And improve the co-ordination of care In a highly cost effective, scalable way.
Editor's Notes
- Once logged in a patient’s page is set up specifically for them
- With their daily…
- And weekly plans
- And Communication and action alerts
- And a suite of other tools that makes interaction with the health care team, or caregiver integrated and seamless.
- Condition specific care is accessed via Exercises, Information, Outcome Measure tabs and may be a combination of video or written content
- In this instance the surgeon wanted to
- In many instances a patient plan is created using one or more carepacs. A carepac is a generic template of information, videos, emails, tasks, forms etc set up as a timeline, then rolled out for a specific patient. Once in place for a patient it is fully editable to ensure it’s relevant and specific for the patient As we know in health care, much of the information and guidance a patient needs for optimal outcomes is generic in nature,. A carepac enables the generic content to be delivered in a resource and cost effective way, leaving the one on one patient time for the patient’s specific needs.
- The hip replacement carepac was created as a 9 week perio-operative carepac. Patients were set up 3 weeks in advance of their surgery date where they accessed preop information and exercises on their own web-enable device. As an inpatient they were given a hospital ipad so they could continue to watch their videos in advance of being seen by staff, and then their program continued for 6 weeks post op.
- We had information videos from the Surgoen, nursing staff, anaesthetist and ward physios. For example the surgeon’s videos covered things like post op precautions, and discharge instructions, and the anaesthetists videos showed patients down inside theatre, talked through what was going to happen and explained how they ensured people didn’t wake up during the procedure.
- Information videos also included key daily tasks like how to dress , or get in and out of a car etc after surgery – basic things that are often forgotten, but are essential for patients!
- 3 weeks of pre op and 6 weeks of post op exercises were also included. These were a combination of the hospital’s own exercise videos, and selections from healthlnx video library. These exercises were a guide only and the treating physio had full ability to change them for an individual patient based on their clinical picture.
- A patient’s private health professionals were invited to access their patient’s file for 2 reasons. The first was to educate them about the surgeon’s specific post op protocols and precautions to achieve standardised post op management , and secondly to enable them to adjust the patients rehab program as appropriate for that patient.
- We engaged with 15 key staff from hospital executives to ward staff. It would be fair to say there was a high level of excitement from all levels about being able to offer patients a much higher standard of care, without blowing out time or financial resources. One key staff member was initially hesitant as she mistakenly thought this would decrease a treating clinician’s autonomy. Once she understood the patient and organisational benefits she was on board.
- 84 patients at various stages of using healthlnx – some have been discharged, some are still in the pre-op stage and we are continueing to add patients weekly. We are just moving to formal data collection now. The patient’s at Brisbane Hip clinic are typically younger, more active patients however many do have other musculo-skeletal issues and health conditions. Most patients are comfortable with technology, however if someone is able to check email, or use facebook they have the technical knowledge to use healthlnx
- This compliance check is visible to treating health professionals who can not only see when the patient last logged on, but can see when a program’s been marked as done. We knew anecdotally that patients loved using healthlnx and really engaged with completing their programs and the pilot data also supports this.
- Anecdotally patients feel more empowered to self manage and far more educated about their entire surgery process. You can also start to see where real cost savings could occur..decreased post op complications, early discharge through better preparation, decreased post op contact points to health professionals
- Here’s a sample of spontaneous feedback received by patients either directly to the surgeon, via the healthlnx website, or directly to me as the trial’s contact person. It’s unfortunate that words on a page don’t do justice to the gratitude that patients had for being put on such a comprehensive program. In their mind it meant the world, yet it took very little work on behalf of the surgeon’s team.
- From this specific trial we’ve learnt some key lessons through the set up and pilot phase Point 1. This absolutely speaks to the need to have a patient centric platform yet one that places minimum demands on clinicians. Pont 2. This is usually the information that get’s lost due to time constraints. It doesn’t take much to fill this gap and it makes a significant difference to patient satisfaction and outcomes when we do. Point 3. This has the potential to decrease costs related surgery through earlier discharge, less post op complications, more complete recovery, and less demand on other clinical resources e.g. home help or physio Point 4. Of the thirteen respondents one lived 10 hours away in a remote town, another 16 hours away, and another lived in Seoul.
- From experience in both this trial, and using healthlnx in many other clinical scenarios patient centric technology enables care to
- The health care environment is changing.. As businesses and clinicians we need to change with it.