Integrating #mHealth in the health care process #3

Today’s subject I’m writing about is related to what I consider implies to square the circle, on the issue that concerns me in this post: “The integration of the #mHealth into healthcare processes in hospitals”.

In the first two posts on this subject I spoke about the #mHealth project we launched a few months ago in the Hospital. We are working on a particular treatment process, the diabetes, and since my last post till now, we have continued to advance and mature the steps slowly towards our final goal.

The current project situation challenges us to close the circle, and try to connect two dimensions, patient’s and professional’s dimensions virtually and forever.

Two dimensions which until now have always been connected to the physical level, in the outpatient clinic, emergency room, hospital day … Where the doctors are sharing information with patients regarding their health, complex information for the receiver (patient and / or familiar), who receive it in a very delicate emotional state at times, which greatly limits their ability to understand.

mHealth Cloud Relationship 2 Dimensions

The connection of these two realities, the healthcare professional and the patient goes beyond an App integrating information with a hospital information system. Giving access to the patient to his information in his medical history, agenda visits to the doctor or the results of diagnostic tests, etc, is an objective as well.

The challenge is that all this information flow safely and naturally between the two dimensions. There should be a meeting point where everything will be integrated, organized, prepared to be accessible to every user, whatever is the dimension he belong to. They must be able to access such information at any time and anywhere…

“Because ultimately, the information is unique, the owner is the patient and recipients are multiple professionals.”

At this point I want to refer to a post I posted 10 months ago about our Intranet, which on May 26, 2015 completed its first year.

In that post I talked about the implementation of the Digital Strategy of Hospital Clinic, and the relationship between the Intranet and the Web.

Knowledge Sphere Dimension ENG

Our Web is what I dare to describe as the cornerstone of the project, because from a strategic perspective, this should be the connection platform for both dimensions I just mentioned.

Our new Web is where we want to make available to society in general, our knowledge of health, identify each of the diseases we treat, the various moments that patients go through, and prepare appropriate information to their expectations.

We are convinced that the need for information and how it is to be presented at each time, is very different for a person who’s just been diagnosed with diabetes, than for a diabetic with 20 years of experience living with his disease.

They are diametrically opposite profiles that require very different approaches. And it is between these two extremes, where we find different moments throughout the care process, where we identify how these needs are different from each.

About how we are working on the content we will provide to our visitors in the future Hospital Health Portal, I will write in a later post.

We are working a methodology side by side with health care professionals, based on this concept that I’m describing, about the moments throughout the care process, and information needs, taking into account important aspects such as language, formats or even emotions

Finally, to achieve our objective of integration of the #mHealth in the daily clinical practice we must land the projects and approach them more to everyday reality.

We’ll NEVER take advantage of the full potential that this new technology gives us, if we don’t incorporate it from the strategic level in the organizational approaches, and obviously if we don’t invest resources and efforts on this landing.

In response to what “Speaking of health blog” explains in his latest post about e-Health: It’s a matter of Projecte or Strategy talking about Health 2.0 European Health Congress 2015. From our point of view, we understand that this should be encouraged and supported inescapably from the highest management level.

Health 2.0

To conclude today’s post, expose that to achieve squaring the circle implies to go through successfully achieving our goals in the different issues on which we are working and we aspire to connect:

  1. The Health Portal content = Information available to everyone, didactic and pedagogical, but with different levels of information according to each patient’s time in the process.
  2. The Patient Portal content = Information for our patients and their needs throughout the care process, operational, practical and to help, facilitate and improve your experience as a patient in our hospital.
  3. Transactional information to share with our patients (HCE, Agenda tests, results, diagnostic information processes…).
  4. The integration of information generated by patients and their mobile or wearable devices.

Only when these four aspects have been solved, connected and systematically integrated and ubiquitously accessible by those who need to meet their health-related needs, we’ll think we’ve started to take advantage in an efficient and integrated way into the healthcare processes all the potential that #mHealth already offers.

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Integrando la #SaludMóvil en el proceso asistencial #3

Hoy os voy a hablar de lo que para mi es la cuadratura del círculo, en relación al tema que nos ocupa en este post: “La integración de la #SaludMóvil en los procesos asistenciales de los hospitales”.

En los dos primeros posts sobre esta temática os hablé del proyecto sobre #SaludMóvil que inicie hace unos meses en el Hospital. Este lo estamos realizando sobre un proceso asistencial concreto, el de la diabetes, y desde mi último post hasta ahora, hemos seguido avanzando y madurando los pasos que poco a poco damos hacia nuestro objetivo final.

La situación del proyecto actual nos plantea el desafío de cerrar el círculo, y tratar de conectar dos dimensiones, la individual de los pacientes y la colectiva de los profesionales que los atienden, de forma virtual y para siempre.

Dos dimensiones que hasta ahora siempre se han conectado en el plano físico, en la consulta externa, en urgencias, en el hospital de día… Donde el médico comparte información con el paciente relacionada con su estado de salud, una información compleja para el receptor (paciente y/o acompañante), que además la reciben en un estado emocional en ocasiones muy delicado, lo que limita enormemente su capacidad de comprensión.

mHealth Cloud Relationship 2 Dimensions

La conexión de estas dos realidades, la del profesional asistencial y la del paciente, va más allá de integrar la información de una App con el sistema de información hospitalario, o de poner al alcance de paciente la información de su Historia Clínica, su agenda de visitas con el médico o los resultados de pruebas diagnósticas, etc, que también.

El reto está en que toda esta información fluya de forma segura y natural entre ambas dimensiones, y que exista un punto de encuentro donde esté todo integrado, ordenado, preparado para estar accesible para cada tipo de usuario, proceda de la dimensión que sea y acceda a dicha información en el momento y el lugar que sea…

Porque al final, la información es única, el propietario es el paciente y los destinatarios son múltiples profesionales.

Es en este punto en que quiero hacer referencia a un post que hice hace 10 meses sobre nuestra Intranet, que el pasado día 26 de Mayo de 2015 cumplió su primer año.

En ese post os hablé de la implantación de la Estrategia Digital del Hospital Clínic, y de la relación entre la Intranet y la Web.

Knowledge Essphere Dimension ESP

Es precisamente esta última, la Web, la que me atrevo a calificar de piedra angular del proyecto, porqué desde una perspectiva estratégica, esta debe ser la plataforma de conexión de las dos dimensiones de las que hablo.

Nuestra futura web es el lugar donde queremos poner al alcance de la sociedad en general, nuestro conocimiento sobre salud, identificar de cada una de las enfermedades que tratamos, los distintos momentos por los que pasan los pacientes, y preparar información adecuada a sus expectativas.

Tenemos muy claro que la necesidad de información y cómo se ha de presentar en cada momento, es muy distinta para una persona a la que le acaban de decir que es diabético, que para un diabético con 20 años de experiencia conviviendo con su enfermedad.

Son perfiles diametralmente opuestos que requieren abordajes muy distintos. Y es entre ambos extremos, donde encontramos los distintos momentos a lo largo del proceso asistencial, donde identificamos cómo estas necesidades son distintas entre cada uno de ellos.

Sobre cómo estamos trabajando los contenidos que pondremos a disposición de nuestros visitantes en el futuro Portal de Salud del Hospital, os hablaré en un post más adelante. Estamos trabajando una metodología, mano a mano con los profesionales asistenciales, basada en este concepto que vengo anunciando, el de los momentos a lo largo del proceso asistencial, y las necesidades de información, teniendo en cuenta aspectos tan importantes como el lenguaje, los formatos o incluso las emociones

En definitiva, de lo que se trata para alcanzar nuestro objetivo de integración de la #SaludMóvil en la práctica asistencial diaria, es de aterrizar los proyectos y acercarlos a la realidad cotidiana. No aprovecharemos NUNCA todo el potencial que esta nueva tecnología nos brinda, sino la incorporamos a nivel estratégico en los planteamientos organizativos, y evidentemente sino invertimos recursos y esfuerzos en este aterrizaje.

Dando respuesta a lo que “Hablando de salud” explica en su último post, eSalud: ¿Cuestión de Proyectos o de Estrategia?, sobre el congreso Health 2.0 Europeo 2015, desde el Hospital Clínico entendemos que esto debe ser impulsado y apoyado ineludiblemente desde el nivel directivo más alto.

Health 2.0

Dicho esto, y para cerrar este post de hoy, la cuadratura del círculo pasa por culminar con éxito los distintos  frentes sobre que estamos trabajando y que aspiramos a conectar:

  1. Los contenidos del Portal de Salud = Información al alcance de todos, didáctica y pedagógica, pero con distintos niveles de información en función de cada momento del paciente en su proceso.
  2. Los contenidos del Portal del Paciente = Información a nuestros pacientes y sus necesidades a lo largo del proceso asistencial, de carácter operativo, práctico y que le ayude, facilite y mejore su experiencia como paciente en nuestro hospital.
  3. La información transaccional a compartir con nuestros pacientes HCE, Agenda pruebas, resultados, información sobre procesos diagnósticos….
  4. La integración de la información generada por los pacientes y sus dispositivos móviles o wearables.

Sólo cuando estos 4 aspectos estén resueltos, conectados e integrados sistemáticamente, y sean accesibles de forma ubicua por quienes los necesite para dar respuesta a sus necesidades relacionadas con su salud, podremos pensar que hemos empezado a aprovechar de forma eficiente e integrada en los procesos asistenciales, todo el potencial que la #SaludMóvil nos ofrece.

HIV care process from Telemedicine to # mHealth

In this post I want to share with you an example of a healthcare reality which is taking advantage of all the potential of new mobile technologies on which I speak since I started this blog, for a long time.

I recently had the opportunity to learn in detail how is organized the process of care for infected patients by human immunodeficiency virus (HIV) in the hospital where I work, the Hospital Clínic of Barcelona.

“The Clinic is the referral hospital for a large part of the city of Barcelona, specifically for Integral Health Area of Barcelona Esquerra, comprising a total of 4 municipal districts with a population around 500,000 inhabitants”

I can assure that this care process is one of the pioneers in implementing new technologies on patient care, and therefore allows me to illustrate and argue in this post, something that I’ve been thinking and now want to share with you about #mHealth.

“I think it’s already clear that #mHealth is the natural evolution of telemedicine, hence probably many healthcare processes have been supported in the latter, naturally will evolve towards a virtual dimension relying on Apps, Mobile Websites or Responsive Websites, and substantially will improve access for end users, allowing them the gift of ubiquity and almost total connectivity.”

HIV care process

Nowadays, HIV infection, which is the cause of acquired immunodeficiency syndrome in humans, is considered a chronic disease, thus requiring prolonged follow-up time of those who suffer.

This disease can be diagnosed from different levels of care, primary care, specialty care or hospital care or from non-governmental organizations related to it.

When a patient is diagnosed with HIV in our care area, it is referred to the Hospital Clínic where makes a first visit with a specialized nurse. She is responsible for making the debut process. It is a patient oriented education visit in the management of their disease, which opens the clinical history, and where the steps to follow are very protocolised. The visit ends up with the demand of, following the protocol, the established medical tests ahead of the visit to the doctor 15 days later.

With the medical tests results, the doctor visits the patient previously to begin treatment and monitoring in the Day Hospital. Once it is considered that the patient is already autonomous in managing their disease (after 2 or 3 visits), the possibility to include the patient in the process of virtual monitoring through the platform of virtual Hospital is considered.

Schematically the process would be something like this:

HIV Assistential Workflow

It’s at this moment when everything starts changing, from now on the patient goes into another assistential dimension, allowing it to have the support of a multidisciplinary team of professionals and to access information about their pathology, or even if the patient need it, he can get in touch with other patients to share their concerns, questions, etc …
The communication between hospital and primary care is essential in the management of chronic patients. So far in our country, the care of HIV-infected patients has been performed only in hospitals.

However, patients have new needs (simplification and integration of care) and health systems too,  having to cope with an annual increase of 10% in new patients.

According to these premises, with political approval and mimicking what was done in other chronic diseases, the Shared Care Unit of HIV-infected patients (SCU) in chronic stage of their illness (most of them) was created by the Hospital Clínic’s infections service and three primary care centers from the Integrated Health Area fo Barcelona’s Eixample Esquerra (CAPSE Les Corts, Casanova and Borrell).

The SCU’s physicians (both primary care and specialty care), rely on the Virtual Hospital, a computer system through which all of them share the same electronic records and relevant information for patients.
Between 2005 and 2007, a prospective case control study was performed during 1.5 years with 30 patients, with results regarding clinical parameters similar to hospital standard control. This unit has been expanded to other primary care teams in Barcelona as are the South Raval, and is planned to do the same in the 4 centers also within the AISBE.

Web Pacienten Hospital Virtual VIH

From Telemedicine to #mHealth

The Virtual Hospital, in addition to health care activity that supports, also allows developing activities such as Teaching and Research.

For Teachers standard platform is used for online sessions with different health centers territory if possible. If not, the medical team moves to the center for clinical meeting in person.

In terms of research, the database on which the program activity develops, enables the approach of research by providing a significant amount of information.

In terms of usability, the Virtual Hospital provides professionals 96% of the information they need about the patient on one screen, making it possible to access 100% of the information by opening additional tabs.

Briefly it is about a Shared Care Unit focus on patients with HIV, where different levels of care are coordinated through the Virtual Hospital System. This is additionally complemented by the possibility of face to face visits if estimated necessary.

Usually, the patients included in this process are visited twice with their referring physician at the primary care level, and another visit with a physician at the hospital level annually.
Being able to visit patients virtually by hospital specialist, has a very positive impact on productivity thereof, attending a volume of patients near the 20 patients in two hours of consultation.

The final objective of this new healthcare dynamic so innovative, is aimed at helping these patients to keep a good control of their disease, which otherwise would impact negatively on their health and those around them.

What I just explained is a reality that has been operating in the Integral Health Area of Barcelona Esquerra since 2010, which can be defined as pure Telemedicine.

However, as expected, this medical team is still working to improve daily this care process, and they are actually working on the jump to #mHealth, which obviously involves the development of a APP focused on patients involved and followed through the Virtual Hospital, empowering them with the ubiquity and the 24/7/365 accessibility and providing them in the near future, the possibility to carry wherever they go, their the Vitual Hosptial’s team ;-D.

 

 

4 key issues about the evolution of the Mobile Health (#mHealth) in 2015

Once more it has arrived the time of writing the end of 2014 and 2015 opening post, the traditional post of trends or key issues from a blogger’s point of view who enjoys writing and sharing it with everyone.

As far as I’m concern, over 2015 Mobile Health (#mHealth) will experience significant changes in 4 aspects closely related, within the context of public health in which we are in Spain:

One aspect that will highlight this evolution is the process of integrating information generated from patients through their mobile devices (Smartphones, Wearables, Laptops …) related to their diseases. The definition of key indicators by healthcare teams will be very important in this process, which will open new dimensions of improving both the quality and capacity of public hospitals with the same resources available aspect.

Integracion mSalud en PA

  • Beyond the physical dimension:

This integration will precipitate a phenomenon that until relatively recently it could seem complex to achieve. This is approaching the assistencial process and knowledge of doctors working in health centers beyond the physical structures of the Hospital. The integration of #mHealth into hospital’s Information Systems will mean that the surveillance which is subjected a patient in a hospital, can be made, somehow, remotely and ubiquitous to certain patient profiles.

  • Improved productivity and quality of care:

This integration of information will enable, without an increase in resources available to hospitals, without increasing the workload of professionals and with the same number of care hours, a greater number of people indirectly assisted without the need of coming to the hospitals and healthcare centers, because they will be monitored by their reference centers in return for a single thing … their commitment and engagement.

  • Web Analytics will work for health:

Web Analytics is a relatively new field, the first application has been doing in the field of e-commerce.

However, the great potential that it hoards, opens endless possibilities if we apply to our sector, aimed at improving the relationship with our reference population and health campaigns are directed towards her goals, nevertheless we could point to more ambitious goals which I expect to write about all along 2015…

Finally and to close the post I think it is important to clarify that these trends I just shared with you are clearly framed in a context of public health, which I consider to be the most benefited from the arrival of #mHealth to our sector.

I think the private sector in this regard must still wait to see how this new dimension of providing healthcare will fit with their business model. However, I think there are already many opportunities to apply the #mHealth in both sectors, with the only difference of the results it can be expected in each case.

Happy new year and I hope 2015 will surprise us on #mHealth related issues :-P.

4 claves de la evolución de la Salud Móvil (#mSalud) en 2015

A llegado el momento de escribir el post de cierre del año 2014 y apertura del año 2015, el tradicional post de tendencias o claves de futuro que a un modesto bloggero le gusta escribir y compartir con todo aquel que me lea.

Desde mi punto de vista, a lo largo de 2015 la Salud Móvil (#mSalud) experimentará cambios significativos en 4 aspectos estrechamente relacionados, dentro del contexto de la sanidad pública en la que nos encontramos en España:

Uno de los aspectos que van a marcar esta evolución es el proceso de integración de la información que generaran los pacientes desde sus dispositivos móviles (Smartphones, Wearables, Portátiles…) relativa a sus enfermedades. La definición de los indicadores clave por parte de los equipos asistenciales será un aspecto muy importante en este proceso, que abrirá nuevas dimensiones de mejora tanto de la calidad como la capacidad productiva de los centros públicos con los mismos recursos disponibles.

Integracion mSalud en PA

  • Rompiendo la dimensión física: 

Esta integración precipitará un fenómeno que hasta hace relativamente poco nos podía parecer complejo de conseguir. Éste es el de llevar la atención asistencial y el conocimiento de los médicos que trabajan en los centros asistenciales más allá de las estructuras físicas de los mismos. La integración de la mSalud en los Sistemas de Información de  los hospitales va a suponer que la vigilancia a la que se ve sometido un paciente en un hospital, se pueda realizar, en cierto modo, de forma remota y ubicua a determinados perfiles de pacientes.

  • Mejora de la productividad y calidad asistencial:

Esta integración de la información va a posibilitar que sin un incremento de los recursos de que disponen los hospitales, y sin un aumento de la carga de trabajo de los profesionales, con el mismo número de horas asistenciales, se abarque un mayor numero de personas que de forma indirecta y sin necesidad de que éstas acudan a los centros, estarán siendo monitorizadas por sus profesionales de referencia a cambio de una solo cosa… su compromiso e implicación.

  • La Analítica Web se postulará al servicio de la salud:

La Analítica Web es un campo relativamente nuevo, cuya primera aplicación se lleva realizando en el sector del e-commerce…Sin embargo, el gran potencial que esta atesora, abre un sin fin de posibilidades si la aplicamos a nuestro sector, con objetivos orientados a mejorar la relación con nuestra población de referencia y las campañas de salud que hacia ella se dirigen, por no apuntar hacia objetivos más ambiciosos sobre los que espero poder escribir en algún momento en el 2015…

Por ultimo y para cerrar el post creo que es importante matizar que estas tendencias que he compartido con vosotros vienen claramente enmarcadas en un contexto de sanidad pública, que considero que es el más beneficiado de la llegada de la #mSalud a nuestro sector. Creo que el sector privado en este sentido aún deberá esperar a ver como esta nueva dimensión de ofrecer la asistencia sanitaria encajará con su modelo de negocio. Sin embargo, creo que ya existen muchas oportunidades de aplicar la #mSalud en ambos sectores, con la única diferencia de los resultados que de ella se puedan esperar en cada caso.

Feliz entrada de año y que el 2015 nos sorprenda a todos en cuanto a #mSalud se refiere :-P.

The Clinic will create the first Public Hospital’s Health Site

Last November 26th was a very special day for me due to two reasons. Personally because I turned seven years working in the Hospital Clínic of Barcelona, for me the best of Spain in many ways, and where I have the opportunity to participate in important projects for the hospital itself and the public health system.

Professionally, because that day it was presented one of the projects in which I participate and that will set a turning point in the digital world and access to health information by Latin citizenship worldwide.

This project is the Hospital Clinic’s Health Site powered by an alliance between the Hospital Clínic of Barcelona and the BBVA Foundation, which began its gestation at that moment and plans to see the light throughout 2015.

Logo ABC Logo Atlas Agencia Logo El Diario.es Logo La Informacion

Besides everything said in the press, I want to emphasize something that I see is very innovative in the digital world.

The main objective of this project is to provide quality information to any Latin citizenship wanting to improve their knowledge about their health.

Quality information generated by a team of professionals whose job is precisely to solve those problems, and also will worry about sharing their knowledge available to citizenship in a comprehensive and pedagogical language.

Being the first “Health Site of a Public Hospital”, supported by a referral public hospital of the Spanish public healthcare system, with a non-profit and completely altruistic vocation.

I invite you to follow up my blog during the gestation of this great project.

Integrating #mHealth in the health care process #2

Analyzing the process of care for diabetic patients from A to Z

Continuing with the series of posts dedicated to the project we are working from our hospital, today I’ll focus in a little more detail about the methodological approach we are following to identify the best alternatives for addressing this integration.

The first goal in this phase is to describe the entire care process, from beginning to end, so first identify which are the one or more entry door(s) for patients in the diabetes care process beyond wherever it occurs, and secondly identifying individual patient profiles and his life style from medium to long term.

Given the nature of our health system (Catalan Health System), and this disease’s peculiarities, most of diabetes diagnosis occurs at the primary care level, by the physician, in the case of adults, and the pediatrician for younger patients.

Diabetes Diagnosis

Another possible entry door is occurring more casually following medical examinations and analyzes requested for other purposes, company health reviews, to enter gyms, health coverage hiring health insurances … that crop suspicious results derived in a diagnosis of this disease.

From here on, we performed a detailed description of the different profiles of frequently patients, depending on the type of diagnosed diabetes.

Type 1 or Type 2 in its two possible variants, complex and say less complex or normal. The latter is one that can be handled by the General Practitioner (GP) without too much trouble.

Another level of analysis required, is to know in detail what are the actions that take place during the first year after being diagnosed with diabetes, and how is the patient follow up after the first period.

The differentiation between the year in which the patient “debut” in sickness and the following is very important in this type of pathology. It is in the first year, when the patient is educated in managing their illness, so they can live a life as normal as possible under the circumstances of this chronic disease.

Image from Canal Diabetes

Imagen obtenida de Canal Diabetes

Therefore, this step is very important for the subsequent management and monitoring of the disease, because it will largely determine the likelihood that in the future this patient can be monitored from the hospital relying on any of the existing devices today.

This is another important point to work together along with the cycle of life of patients and types of devices necessary for the management of the disease, as they will be crucial in the design of this project and decisions arising from this.

It is in this sense that we’ll zoom in deeply once we have well drawn the whole process in detail.

This description allows us to identify the impact on the hospital’s information systems of the information we decide to incorporate and provided by patients’ devices registered daily and ubiquitously.

Define which indicators should be systematically feed and register in the hospital’s information systems from mobile devices will be one of the key issues to be decided by the medical team.

I invite you to read my next post to continue analyzing exhaustively the process as the project evolves.