Starting on January, 1 2011 someone will turn 65 every eleven seconds. As the baby boomers age, healthcare is becoming a major focus in their lives. Not only are the Boomers facing the challenges raising children, and often helping out with grandchildren, their parents are now living longer than any previous generation, some well into their 90’s or over 100. This longevity comes with challenges of chronic illness management and an epidemic of Alzheimer’s and other dementia's which are becoming frequent in the over eighty population. Many seniors are ill-prepared to navigate the maze we call a health care system. This combination of chronic illness and need for help with navigating the system has forced many Baby Boomers to become caretakers and/or decision makers for their parents. This very difficult role can sometimes feel impossible if trying to accomplish it with a significant physical distance separating them. As a nurse working with these two groups of people I see one major issue over and over again. The issue is one of communication across the continuum. How do all the physicians and care team members know what each one is doing? Who is responsible for the medication list, the careplan development, the goals and tracking the symptoms? Who needs to know what information and when do they need it. These questions made me begin to look at how the internet may be a tool to help create a communication tool that was accessible to everyone.
It is hard to believe that it has only been twenty years since the internet really became accessible to the general public. I am a baby boomer, as are all of my siblings and cousins. We were born from 1946-1964, thereby representing the full generation. When I entered college, there was no internet. Having a calculator in chemistry was a new thing. Now, we all use computers at work daily, and spend too much time “browsing” the internet for anything and everything we can think of. My adult children have always had the internet, well at least since junior high for my oldest. They “Google” any topic they need information on from healthcare to buying a car or insurance. They buy movie tickets, music and most of their clothes and gifts on-line. My mother became a computer “geek” at the ripe old age of 60. She lost her hearing and turned to the internet as a way to find other people who had gone deaf as adults. She founded a non-profit internet support group that puts on educational conferences, provides chat rooms for different topics, and generally tries to help the people who become deaf later in life. .
Fifteen years ago, when my mother went on line to find out about late onset deafness, there was not a lot available to her. At that time, the first generation tools that were available were really passive information gathering. (Shay, 2000). As second generation tools were developed a few years later, the individual could create their own information (wiki sites, blogs, and social networking sites), the tools available on the internet changed rapidly. Integrated health care organizations began to create sites for their patients. These sites included patient health records where lab results and immunizations may be listed, appointments could be made and some sites allowed for direct communication with the provider (kp.org, mayoclinic.org). Self-help groups also became visible on the internet. Patientslikeme.com is a site that was first used for patients and family members with multiple sclerosis to talk to each other about symptom management, medications and how to deal with situations at work or school. As these sites began to surface, the population became more tech savvy as a whole. Organizations also began to embrace the role that the internet could have in helping people manage their own healthcare. The government began to look at these sites and saw that it could also set up sites that would help the public manage their healthcare and their choices. This could help in the long-term with the crisis we have in the costs of healthcare. Hospitalcompare.org is an example of a site set up by Medicare (CMS) to share patient satisfaction data and quality/outcome data with patients so they can decide which providers and hospitals they may want to choose for their care. The longer term plan is to create value-based pricing for services pushing consumers to the locations that are of the highest quality and lowest costs.
Working with people who are being discharged from the hospital, I have found several issues that are of concern:
- · Most of the discharges have had at least one medication error on the discharge instruction list (omissions, different dosages, or duplicate medications are the most common I have seen);
- · Instructions are often difficult to read and understand
- · Education is done so quickly, I rarely remember everything being said, and I am neither ill nor stressed.
I work hard to help people stay home and not get readmitted to the hospital, so I started to think about how I could use the interactive technology that is continuing to evolve on the internet. The third generation of internet sites, ones that are interactive (You-tube, Second life, Google health record), (Ruiz, 2009), offer a myriad of opportunities to improve patient focused education, care planning, communication with everyone who is involved in a helping a patient or a family attain or maintain health and independence. (Sarasohn-Kahn, 2008; Kronstadt, Moiduddin, & Sellheim, 2009; Sayers, Riegel, Pawlowski, Coyne, & Samaha, 2008)
Last year I began to work on an electronic health record that could be used by everyone that comes into contact with the client. I wanted this record to deal with key issues that currently occur with consumer lead web information creation. These issues include false claims of health care efficacy of products and services, risk for identity theft, and the lack of enthusiasm by physicians to engage in web-based interchange with patients and families if they are not paid to do so. The record is easy to access by anyone because it is web based. It eliminates the issues of identity theft to a great degree because it is password protected and HIPAA compliant, and most importantly, it is controlled by the patient/consumer themselves. In many ways this is a computerized version of the PHR that Eric Coleman has discussed in his research on how to prevent readmissions for the chronically ill patient with multiple comorbidities. This portal can link the client to patient education sites, selected by practitioners, (so they have been vetted for accuracy) for medications, disease management, and it has self-management tools being developed. (Coleman, Parry, Chalmers, & Min, 2006)
I believe this tool has the potential to offer value to the community as it becomes more stable and is better known. It is less public than Google Health Record because it is password protected, but it makes it possible for the patient to have one up-to date medication list that each MD can see when the patient comes to their visits. It can provide the physician with data between visits if needed on blood pressure measurements or other symptom management tools they may want to monitor. In some ways this is a type of telemedicine (store and forward model) where the provider can handle patient symptoms without having them come to the office. This record allows for patients or caregivers to enter notes and send queries to the MD whenever needed. Although this careplan is still in the developmental stages, I believe that it will have a place for a specific set of people trying to manage chronic diseases and stay in their homes. It will also help the adult children stay in touch with and help their parents if they live a distance from them or cannot see them on a regular basis.
I believe the internet will become even more valuable as a tool for helping people manage their health in the future (Sarasohn-Kahn, 2008). Families do not always live close to each other, but the internet and web-based tools will continue to offer many new solutions to educating, monitoring, and communicating to others about our health status and health care needs. I am convinced, based on the information I learned in this class and through my research that my tool has the potential to be valuable. I will continue to develop it and work with agencies and people in my community to test its viability and upgrade it as needed. I hope on day my tool will be used as an example of how the internet is being used to improve the MD-patient partnership for better healthcare across the community continuum of care.
Bibliography
Kronstadt, J., Moiduddin, A., & Sellheim, W. (2009, March). Consumer use of computerized applications to address health and health care needs. Retrieved December 4, 2010, from ASPE.hhs.gov: http://aspe.hhs.gov/sp/reports/2009/consumerhit/report/shtml
Ruiz, R. (2009, July 30). How the internet is changing healthcare. Retrieved December 4, 2010, from Forbes.com: http://www.forbes.com/2009/07/30/helath-wellness-internet-lifesyles
Sarasohn-Kahn, J. (2008). The wisdom of patients: Health care meets on-line social media. Oakland: California Healthcare Foundation.
Sayers, S., Riegel, B., Pawlowski, S., Coyne, J., & Samaha, E. (2008, January-February). Social support and self-care of patients with heart failure. Annals of Behavioral Medicine, 35(1), 70-9.
Shay, E. (2000, March). Evolving uses of health care on the internet. Retrieved November 30, 2010, from Physician's News Digest: http://www.physiciansnews.com/computers/300.html
