The New Year brings out traditions, predictions, and resolutions. It is also a time when organizations post their reviews of 2014 and their lists for 2015. My Inbox has been bombarded with many reviews and lists. In this column, we examine three different prediction lists that will serve as a foundation for future columns on implications for nursing education. (See Table)
A MIXTURE OF NEW AND OLD SHIFTS
At the end of November, Terry Fouts, MD, chief medical officer for MedeAnalytics, offered his perspectives on four predictions for 2015. He noted that "the health care landscape has become clearer in some regards and murkier in others." Fouts' perspectives are important as we examine our curriculum to prepare the next generation of nurses.
Fouts' first prediction, that care and testing will progressively move to patients' homes, highlights the increased use of telehealth. This trend will continue with the pending provider shortage and as more patients with chronic diseases are monitored by devices such as glucose monitors, blood pressure cuffs, digital Bluetooth weight scales, and pulse oximetry. Fouts also talks about the establishment of retail-type clinics located in communities, therefore making care more accessible.
His second prediction is focused on the importance of the social context of the patient and ensuring that relevant data elements are collected and analyzed to meet the needs of patients. We teach our nursing students that behavior, including cultural beliefs, genomics (geographic location and socioeconomic status), and environment have an impact on health outcomes. But are these documented and analyzed so health care agencies can begin to examine other methods to meet the needs of patients? Fouts provides an example of a single mother with an asthmatic child who is without transportation - and the impact of these factors on the health outcomes for this child.
The third prediction, that data analytics challenge best practices, focuses on the emerging field of data science and big data. This is particularly important in health care as we begin harnessing electronic health record (EHR) data to create a learning health system and improve health care quality and effectiveness. The ability to mine data to determine "best practices" within one's institution or across institutions may raise questions about existing clinical guidelines based on consensus models. It will also raise issues of data integrity and legal and policy issues connected with the secondary use of clinical data. The idea of patient-generated health data, and how such data are factored into data analytics and best practices, will also be a continuing topic.
Many in the informatics and health care communities echo Fouts' final prediction about the improvement of EHRs. Since the push for the adoption of EHRs began in 2004, there has been a continuous debate on their value and their impact on patient care outcomes, provider workflow, and patient-provider interactions. Fouts notes that "errors, cut-and-paste problems and practice efficiency are just some of the serious dilemmas that clinicians face when it comes to EHRs - never mind the patient safety and public health concerns." For Fouts, EHR improvements must provide health care professionals with rich, meaningful, and actionable data in order to improve patient care.
TOP 10 HEALTH TECHNOLOGY HAZARDS
Speaking of errors, ECRI Institute released its Top 10 Health Technology Hazards for 2015, which identifies patient safety risks that need attention in the New Year. The institute uses various methods to determine its annual list, including talking with nurses and other health care professionals. Nominations are assessed and then reviewed by advisory boards and staff.
Each hazard is described, with recommendations, in a yearly report. Most are proposed at a system level, but may also be relevant for nursing in the area of patient safety. Perhaps the most relevant hazards concern alarms (physiologic monitors, ventilators, and infusion pumps), data integrity (missing or incorrect data in EHRs), mix-up of IV lines, ventilator disconnects, and patient-handling devices.
Data integrity is very important, as there is more pressure for precise documentation, not only for care transitions and reimbursement, but also for the engaged patient population. Engaged patients with access to their EHRs through patient portals are already catching errors in their records and asking for missing or inaccurate data to be corrected. As a criteria for meaningful use, a mandate from the Center for Medicare and Medicaid Services allows patients to receive copies of their health summaries and ultimately their EHRs. Think about it. When was the last time you reviewed your record and looked to see if there were any errors?
Although cybersecurity is typically a system issue in an organization, mobile devices are being used by patients and providers in the health care arena. That means there is a need for more education and training about potential security issues as well as breaches of privacy and confidentiality.
TOP HEALTH INDUSTRY ISSUES
The top health industry issues for 2015 are compiled by PwC Health Research Institute. This annual report is targeted not only to health care professionals, but also to health insurers and pharmaceutical and life science organizations. It is based on a cross-sectional survey of 1,000 adults about their perspectives of the health care landscape and their health care preferences.
This list reflects some of the predictions noted by {L-End}Fouts (2014) and touches upon cybersecurity and transparency of data. I also think this last list is more targeted to how nursing can begin to address the perspectives and preferences of patients, families, caregivers, and consumers. So let's explore some of these ideas.
Do-it-yourself health care is very evident in the Connected Health era. In this emerging area, there are many new medical devices used for testing/diagnosis and monitoring that health care professionals will want to use with patients. These tools will not only provide data transmissions to health care providers, they will also engage and enable patients to become more in charge of their health care. Patients and families can become members of the interprofessional collaborative care teams.
A second issue speaks to the growing sophistication of mobile health apps. At the current time, most apps are related to health and wellness, with fitness and dietary trackers among the most used apps. In the New Year, there will be more apps that are considered medical devices as defined by the FDA and approved for use in mobile health. This will mean both companies and providers will need more understanding of the regulatory requirements for these medical devices.
With the increasing number of data breaches and the potential for health identity theft, more consumers want privacy and security over convenience when it comes to their health data. The report notes this is particularly true for medical notes, diagnoses, treatments, lab and imaging results, and drug prescriptions but less true when it comes to diet and exercise. We also know that some patient-generated health data are publicly shared in communities such as Weight Watchers and FitBit and other social media health communities.
There is a small percentage of patients that consumes the most health care and is connected with the highest costs. Numerous innovative care management programs and new technologies, such as smart pillboxes and smart homes, will be providing more cost-effective care for this population. New care models will employ various health care professionals and supporting technologies to increase access to care while decreasing costs.
The fourth issue speaks to the demand for more evidence about the value of high-cost drugs for treatments and different definitions of positive health outcomes. This is an issue for patients, who are facing more out-of-pocket expenses, insurers, and health care systems. It also brings up the issue of having genomic data available in EHRs to make better decisions on the effectiveness of drugs.
As noted in the report, "The push to make health care industry data more transparent isn't just about helping people shop for affordable healthcare." It is also about accessible clinical trials data, drug and medical device adverse effects, and disclosures of conflicts of interest, such as physician payments from pharmaceutical companies.
With a new population of previously uninsured consumers joining the health care system, new care models and technologies should be used to engage consumers earlier. There is a need to use various health campaigns to market and support demographic and language differences. This will require both in-person and social media campaigns to help engage this emerging consumer group. There is a similar need for the health care system to understand the growing population of millennials in the workforce who perceive health and their health benefits in different ways than the boomer generation. This population looks for flexibility, convenience, and technologyenhanced personalized care that supports their well-being.
And now, a caveat[horizontal ellipsis]. I know that most health care professionals object to the term, but the report states that 66 percent to 87 percent of consumers feel comfortable seeing a physician extender, that is, a nurse practitioner or physician assistant. Increasing numbers of NPs and PAs are needed as we move ahead with the transformation of health care and require mobile health and e-visits, as well as other health information technologies.
Finally, collaborative partnership is becoming the norm. This is particularly true for companies and for health systems. More strategic collaborations between clinical agencies and academic and research settings are also important for the future.
COMMON THEMES
For me, there are a number of common themes we can explore this coming year in the Emerging Technologies Center. First, what are we doing to prepare future nurses to participate in the growing world of e-visits and mobile health? Second, how are we preparing future nurses to maximize the use of health information tools such as EHRs, clinical decision support tools, and patient-generated health data tools to leverage data and participate in a learning health care system? Third, how do we prepare both faculty and future nurses to understand the use of data analytics? Fourth, which creative partnerships are using new care models, and which supporting technologies are being used? Last, but not least, how do we prepare graduates to examine the ethical, legal, social, and public policy issues that emerge with these new innovations?
I will certainly keep busy researching these topics and talking with faculty about their experiences preparing the next generation of nurses. As always, I can be reached at mailto:[email protected] and would love to hear about your innovative teaching related to these themes.
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