Current Trends and Future Opportunities

There are so many technologies in use today that we take for granted.  Once in a while a patient or family will be astonished at “what can be done now.”  Or, “it’s amazing what they can do these days.”  It puts things into perspective as we go through our daily routine when it is pointed out that a patient would not be alive if the event had occurred even in the recent past. 

The focus area of chest pain in the hospital is very diagnostic and intervention focused.  There is also a large community outreach for prevention component.  The technologies involved in diagnostics alone can be impressive when we stop and think of them.  From 911 call center and dispatch to ambulance capabilities to transmit an ECG to a hospital, and laboratory capabilities that can detect the smallest trace of a single cardiac enzyme. In some cases, live continuous monitoring of a patient in the field can be viewed in the hospital cardiac catheterization lab while the patient is on the way to the hospital.  The technology in the cardiac catheterization lab is impressive in it’s own right with fluoroscopy imaging and medical devises that can access and intervene in an occluded coronary artery.

Cath lab hemo CVIS_image from Ochsner_1

EMR and decision support tools such as population specific work flow sheets not only prompt questions, but record data that can trigger best practice alerts.  Epic narrators allow one step order and administration of emergency medications.

In all the focus of advancing treatment, we often forget that treatment is a failure of prevention.  We also have the technology of information sharing of almost all human knowledge through the internet.  The average person knows more about what is going on in the world or in some celebrity’s personal life than we could have ever imagined before.  This same technology of information is underutilized find proof to help people prevent the need to experience all those amazing things we can do these days to intervene in the event of a heart attack.

heart-attack-and-what-you-need-to-know-to-save-a-life-16-638

The future will put more capabilities and responsibilities back into the hands of the patients.  There already exists the ability to monitor some vital signs and take an ECG from one’s own phone and transmit it to the care team.  However, once that devise sends data to an organization, the action becomes telehealth and safety of the information can be compromised.  There would have to be an agreement between the owner of the devise and the receiving entity for safe transmitting or even encryption.  Medical Homes could monitor patients remotely in between visits.  Virtual or telehealth visits such as Doctor on Demand ,will be able to reduce the physical work volume of the Emergency Departments at a lower cost for the patient.  Add to that the momentum of insurance coverage for tele visits and we are on our way to a solution for the supply and demand disparity of healthcare staff and patient needs.

Patient medical information management is not as restricted by the technology as it is by social and political factors surrounding privacy.  At some point the risk and benefit of medical information sharing must be realized.  A medical ID card that can store information like the military Common Access Card (CAC), could expedite treatment for a patient that is a poor historian secondary to level of consciousness change. Wisconsin state statute 154.17, only recognizes an official state issued DNR bracelet that must be obtained through a state form and a physician encounter. However, a scanable item can give EMS medical information as well as patient wishes to avoid doing harm to a person against their wishes because of threat of litigation.

I learned so much this semester, but I think the top learning point of this semester was bringing engineering systems thinking into the industry of healthcare.  Applying business principles is not new such as Six Sigma, lean, PDSA, but SEIPS brought me to a new way of looking at process improvement.  In healthcare strong personalities and Ego can be obstacles to care.  SEIPS uses data and shows the facts of the workgroup as it influences the process and ultimately the intended outcome.

The second biggest learning point, or a topic that really stuck in my mind was a classmate’s informatics round table topic called Personal Health Records and Data Ownership.  This idea of who owns data when the data is personal yet, isn’t information until it is shared.  The technology used to collect, store ,and share this information brings up the topic of responsibility of the security of that data. We are at a point that technology has developed faster than our current legal concepts can describe. It is fascinating and is open to future thinkers to develop.  I think it segue into my third learning point.

My third learning point was from our guest speaker,David Van Sickle,CEO and Co-Founder, Propeller Health.  He looked at big data and how it was processed into the information and knowledge that we had come to take as normal.  He looked at it again from a different view to find that there was something missing.  He explored that missing source of new data and is changing people’s lives and running a successful business.  The story he shared of how he came to be where he is now is inspirational and reminds us of the impact we can have as doctoral prepared nurses.

My goals as a DNP CNS are the same that motivated my to enter this program in the first place.  I want to improve quality of life and quality of care for the most people possible.

 

 

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