George Demiris

Patient-centered applications: use of information technology to promote disease management and wellness. A white paper by the AMIA knowledge in motion working group

Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain.

Defining Obtrusiveness in Home Telehealth Technologies: A Conceptual Framework

The literature of home telehealth technology recommends that systems be designed to minimize their obtrusiveness to end users. However, this term is neither explicitly defined nor consistently used. This paper presents a definition of the concept of obtrusiveness. Within this definition, twenty-two categories of what may be perceived as obtrusive in home telehealth technology are proposed based on a review of the literature. These categories are grouped into eight dimensions. This effort represents an initial step toward developing measures of obtrusiveness associated with home telehealth technology. A validated and reliable instrument would allow for evaluation of individual applications as well as theory-building across applications.

Patterns of Technology Use Among Older Adults With and Without Disabilities

PURPOSE OF THE STUDY The purpose of this study was to describe prevalence of technology use among adults ages 65 and older, particularly for those with disability and activity-limiting symptoms and impairments. DESIGN AND METHODS Data from the 2011 National Health and Aging Trends Study, a nationally representative sample of community-dwelling Medicare beneficiaries (N = 7,609), were analyzed. Analysis consisted of technology use (use of e-mail/text messages and the internet) by sociodemographic and health characteristics and prevalence ratios for technology usage by disability status. RESULTS Forty percent of older adults used e-mail or text messaging and 42.7% used the internet. Higher prevalence of technology use was associated with younger age, male sex, white race, higher education level, and being married (all p values <.001). After adjustment for sociodemographic and health characteristics, technology use decreased significantly with greater limitations in physical capacity and greater disability. Vision impairment and memory limitations were also associated with lower likelihood of technology use. IMPLICATIONS Technology usage in U.S. older adults varied significantly by sociodemographic and health status. Prevalence of technology use differed by the type of disability and activity-limiting impairments. The internet, e-mail, and text messaging might be viable mediums for health promotion and communication, particularly for younger cohorts of older adults and those with certain types of impairment and less severe disability.

Framing the evidence for health smart homes and home-based consumer health technologies as a public health intervention for independent aging: a systematic review.

INTRODUCTION There is a critical need for public health interventions to support the independence of older adults as the worlds population ages. Health smart homes (HSH) and home-based consumer health (HCH) technologies may play a role in these interventions. METHODS We conducted a systematic review of HSH and HCH literature from indexed repositories for health care and technology disciplines (e.g., MEDLINE, CINAHL, and IEEE Xplore) and classified included studies according to an evidence-based public health (EBPH) typology. RESULTS One thousand, six hundred and thirty-nine candidate articles were identified. Thirty-one studies from the years 1998-2011 were included. Twenty-one included studies were classified as emerging, 10 as promising and 3 as effective (first tier). CONCLUSION The majority of included studies were published in the period beginning in the year 2005. All 3 effective (first tier) studies and 9 of 10 of promising studies were published during this period. Almost all studies included an activity sensing component and most of them used passive infrared motion sensors. The three effective (first tier) studies all used a multicomponent technology approach that included activity sensing, reminders and other technologies tailored to individual preferences. Future research should explore the use of technology for self-management of health by older adults; social support; and self-reported health measures incorporated into personal health records, electronic medical records, and community health registries.

Home telecare technologies for the elderly.

There are many home telecare technologies which have been developed specifically for chronic diseases and there are some more generic technologies that could be used as well. For home telecare, the equipment must be certified, the operational routines must be reformed, the infrastructure must be in place, the market must be prepared, the health authorities must be convinced that the system will work and the cost-effectiveness must be evaluated. Organizational and societal changes, such as cost reduction policies and an aging population, are the main driving forces for the development of home telecare, especially for elderly patients. At the moment there is no holistic model for scientific evaluation from different perspectives (e.g. clinical, legal, technical). We suggest that more research on home telecare and its effects needs to be conducted, in order to provide evidence for optimizing the use of this promising technique.

Barriers to Pain Management: Caregiver Perceptions and Pain Talk by Hospice Interdisciplinary Teams

As patients are cared for in their homes by family caregivers, several challenges arise in effective pain and symptom management. Despite hospices reputation as the gold standard for terminal care, there is still a need to improve pain management practices, including challenges that caregivers face, related to pain assessment, reluctance and fear of administering medication, noncompliance with pain medicine regimens, and hesitance to report pain. The hospice philosophy of care promotes service for both patients and their family by an interdisciplinary team, and total pain management is a goal of this care. The aim of this control phase of a larger National Cancer Institute-funded mixed methods study was to understand the current practice of hospice assessment and collaboration on informal caregiver issues related to pain management. This study of 30 hospice caregiver--patient dyads from one rural hospice found that 87% of caregivers indicated concern with at least one question on the Caregiver Pain Medicine Questionnaire. Interdisciplinary team discussions for 23 of the dyads were recorded over nine months for a total of 86 sessions. Although caregiver concerns were identified with the Caregiver Pain Medicine Questionnaire by the research team, there was only one discussion of caregiver pain-related concerns during the hospice team meeting. This despite the finding that 38% of the time involved in a patient discussion is spent on pain-related talk. These findings indicate an opportunity for improvement by hospice teams through focusing on caregiver assessment and intervention.

Communication patterns and technical quality of virtual visits in home care

Ten patients in a home care study received virtual visits from nurses via analogue video-phones in their homes. They received standard home care services and two virtual visits per week. The visits were video-recorded and then reviewed. The study involved 10 patients and 10 nurses from one urban and three rural home care agencies. Six of the patients had congestive heart failure, three had chronic obstructive pulmonary disease and one required diabetes-related wound care. The average age of the patients was 78 years (SD 12). All but one lived in rural areas. One hundred and twenty-two virtual visits were reviewed for technical quality. Their mean duration was 21 min (range 5-60). The technical quality was given an average rating of 95% (range 57-100%). There were no technical problems in 78 visits (64%); in 10 cases (8%) there was difficulty establishing a connection. A content analysis of 30 of the visits identified 13 themes, such as assessing the patients clinical status, promotion of compliance with medication and treatment, psychosocial issues, general informal talk and patient education. In general, the technical problems were minor and did not appear to interfere with care.

Information technology: changing nursing processes at the point-of-care.

Changing societal demographics, increasing complexity in healthcare knowledge, and increasing nursing shortages have led healthcare strategists to call for a redesign of the healthcare system. Embedded within most redesign recommendations is the increased use of technology to make nursing practice more efficient. However, information technology (IT) has the potential to go beyond simple efficiency increases. If IT is perceived truly as a part of the redesign of healthcare delivery rather than simply the automation of existing processes, then it can change nursing processes within institutions and furthermore change the point-of-care between nurses and patients. Nursing adoption of technology within the workplace is a result of the interactions between technical skills, social acceptance, and workplace culture. Nursing needs for information not only influence their adoption of particular technologies but also shape their design. The objective of this article is to illustrate how IT can change not only nursing practice and processes but also the point-of-care. A case study of the use of IT by nurses in telehomecare is presented and administrative implications are discussed.

User-centered methods for designing patient-centric self-help tools

Involving end users in the design process can be challenging and in many cases fails to become a priority for system developers. This is also the case with numerous applications in the health care domain. This article focuses on the design process for applications intended for direct use by the patients themselves, often referred to as self-help tools. A framework for the user involvement in the design process is presented. This framework is inspired both from existing methods and standards within the field of human computer interaction, as well as documented experiences from relevant e-health projects. An analysis of three case studies highlights the importance of patient involvement in the design process and informs guidelines for patient-centric system design.

Interdisciplinary collaboration in hospice team meetings

Hospice and palliative care teams provide interdisciplinary care to seriously-ill and terminally-ill patients and their families. Care teams are comprised of medical and non-medical disciplines and include volunteers and lay workers in healthcare. The authors explored the perception of collaboration among hospice team members and actual collaborative communication practices in team meetings. The data set consisted of videotaped team meetings, some of which included caregiver participation, and team member completion of a survey. Findings revealed that the teams reflection on process was most likely to occur in team meetings, however least likely to occur when caregivers were present. Although team members had a high perception of interdependence and flexibility of roles, this was less likely to be enacted in team meetings with and without the presence of caregivers. Caregiver participation in team meetings had a positive impact on collaborative communication and the potential benefit of caregiver inclusion in team meetings is explored.