Blue River Home Care

Blue River Home Care is a for-profit home care agency affiliated with the Blue River Hospital, a private 60-bed hospital. The agency is an early adopter of tele homecare services that are now integrated into the care plans of patients suffering from chronic diseases. The telehomecare technology integrates data from portable monitoring devices, including spirometers, blood pressure cuffs, digital weight scales, and videophones. After eight years, the agency is beginning to reap the benefits of investing in the telehomecare infrastructure, which enhances the quality of delivered services and reduces costs. Specifically, regular patient monitoring enabled by technology has reduced the staff’s travel costs and time, made scheduling home care visits more efficient, and (in many cases) intervened proactively to prevent adverse events. Thus far, it is too early to tell if rehospitalization rates for home care patients with chronic conditions will be reduced, given that the technology enables early detection of symptoms and signs, but anecdotal evidence of such reductions is positive.

Currently, Blue River’s administration is looking for ways to keep pace with emerging technologies, which would give the agency a competitive advantage. The leaders are examining the integration of a PHR and a health social network site into the existing telehomecare infrastructure. Proposed features of this social network include the ability for patients to access and manage their personal health information, for patients to find and connect with others with similar conditions for support and sharing, and for family members and caregivers to participate in virtual support groups. Blue River has held informal meetings with its healthcare providers regarding this plan. While some clinicians are supportive of the communication and information opportunities that the plan will afford patients and their caregivers, other clinicians have some worries, including the following:

The health social network site might propagate unreliable or wrong information.

PHR integration could pose privacy (and thus liability) risks.

Patients may not use the site.

Physician compensation could be affected (and how so) by the online patient–clinician interaction.

Patients, especially older adults and those without experience with technology, may find using the PHR and the site to enter, manage, and find health information (especially to improve health literacy) difficult.

These reactions are indicative of the diverse views and attitudes of healthcare providers, administrators, patients, and family members toward consumer health applications.

Solutions and Considerations

Following are factors Blue River (and other healthcare organizations) should consider and discuss when proposing and implementing an integrated PHR and health social network site:

• Communication between patients and their formal and informal caregivers will greatly improve. This, in turn, may lead to better health outcomes because such a system would

1. form or strengthen the social support for patients,

2. serve as an early detection tool of new health or medical events,

3. ease care coordination across various caregivers and care net- works, and

4. increase the patient’s feeling of independence.

• The viewpoint of each stakeholder group should be solicited and taken into account.

• The potential benefits of an integrated PHR and health social network site may be offset by problems introduced by the new technology.

• More information may be available to patients but they may not know how to interpret it for decision-making purposes. Most patients lack medical knowledge, so health research findings, notes, discussion, and other information could confuse or be misunderstood by the patients. The same holds true for family members who have access to their loved one’s PHR and social network profile.

• Different approaches to integrating PHRs and health social networks should be tried. For example, patients may be left to own, manage, and control their own data, but first the organization should develop a web portal that enables patients to access, annotate, or share their own information. This may address the patients’ desire and willing- ness to play a more active role in their own healthcare.

• The technology will introduce new privacy and information reliability issues. Specifically, family members’ access to their loved one’s information and the ability of other members of the social network to view each other’s profile or pages could breach a person’s privacy and confidentiality. In addition, with the patient in charge of his PHR, concerns about the reliability of the available information will emerge and will affect the provider’s clinical decision making.

• The organization must assess the usability and compatibility of sys- tem interfaces, regardless of whether the system or software was purchased from a vendor or created for the institution’s use. It can- not be difficult to operate or navigate, especially for frail or elderly people (as is the case for Blue River) or those with little or no experience with technology or computers. User friendliness must be maximized to enable and encourage access to the system. Initial and ongoing training and customer support must be offered whenever feasible.

• Because the proposed integrated PHR and health social network site is touted to facilitate frequent communication among members of the network and allow patients to get involved in the decision-making process, the organization should build an IT infrastructure that supports these functions.

• To gain institutional support, leadership must demonstrate that the new system will yield concrete benefits for the organization and its staff (such as increased marketability and competitiveness, improved quality of care, and reduced inefficiencies) without placing undue burden or additional tasks on the staff. Furthermore, leadership must show evidence that the proposed system has proven effective in other clinical settings or similar organizations.

QUESTIONS

1) Name some of the challenges in ensuring continuity of care for patients with chronic conditions. How can emerging technologies solve or at least ease these challenges?

2) List some of the benefits of integrating a PHR with a health social network sites for patients with chronic illness, their caregivers, and the organization.

3) Name the specific impacts of adopting e-health and social media applications on the structure and strategies of a healthcare organization.

4) How might the adoption of an integrated PHR and health social network site change the interaction and relationship between patients and health professionals?