Information and communication technologies to support patients with long term conditions
How nurses can develop and implement initiatives using information and communication technologies to support patients with long term conditions
Jane Fitzpatrick, DEd, MSc, PGCEA, RM, RHV, RGN, is senior lecturer, Faculty of Health and Life Sciences, University of the West of England, Bristol; Elescha Fry, BSc (pending), RGN (pending), has recently completed her studies at the University of the West of England and has taken up a post at Royal United Hospital Bath Trust.
Fitzpatrick, J., Fry, E. (2009) Information and communication technologies to support patients with long-term conditions. Nursing Times; 105: 42, early online publication.
This one part unit explores how nurses can harness technologies to provide efficient and effective care for patients with long term conditions. It also examines the key issues nurses should consider when developing such a programme and looks at some examples of existing systems.
Keywords: Information and communication technologies, ICT, Long term conditions
- This article has been double-blind peer reviewed.
1. Understand the range of possible uses for ICT in nurse-patient consultations.
2. Know the main factors to consider when developing an ICT innovation for your patient/client group.
Information and communication technologies (ICT) allow us to access information and communicate effectively and efficiently (e-Health Europe, 2007). Nurses have an excellent opportunity to contribute to innovation by using them to develop services for patients (NMC, 2009).
Technology is transforming healthcare delivery. Advances in diagnostic technologies enable practitioners to contribute to clinical decision making from a distance. For example, ultrasound scans can be transmitted over telephone lines for specialist opinion. In acute situations, paramedics can call on medical assistance using web technologies, while patients with long term conditions can use SMS text messaging to confirm blood results (Horton, 2008; Shanit et al, 1996).
This article explores how nurses can use ICT to support patients with long term conditions. For example, it considers how telephone and text messaging can be used to complement clinic attendance in providing support for them.
There are 15.4 million people with long term conditions in England (Department of Health, 2009) and their care can be enhanced by using ICT. Davies (2006) showed that technology has made it easy for patients to access high quality, evidence-based information, making them more informed and able to manage their conditions more effectively.
Using technologies, nurses have the potential to reshape how they work, to provide care tailored to the needs of the increasing numbers of patients with long term conditions. Using a range of ICT will lead to both better quality and increased personalisation of patient care.
The NMC (2009) consultation on core competencies for nurses places skills in managing ICT and information literacy as a core requirement. The DH Modernising Nursing Careers strategy argued that nursing care should be based on evidence and critical thinking and aided by new technology (Centre for the Development of Healthcare Policy and Practice, 2008).
Fisk (2008) suggested that the use of ICT could change power relationships between practitioners and patients. As patients use technologies, they have access to more information. They expect and demand faster responses. Fisk (2008) showed this change in practice is challenging for nurses since they find it more difficult to establish a rapport with patients familiar with using technologies.
However, if the use of alternative forms of communication can be harnessed, this may enable nurses to develop a more patient-centred approach to care. For example, if the use of technologies enables people with long term conditions to take a more active role in setting goals and understanding the choices available to them, this can surely only increase opportunities to optimise health (Barlow, 2006).
A range of communication technologies is being adapted for use in the NHS. Some are relatively simple to use, others require greater technical skills in terms of design and use.
Telephone services are the most established ICT (Davies, 2006). These are continuing to be developed for use with other technologies and form a key component of the NHS Direct computerised decision support software. They have been merged with other technologies to transport assessment data to aid clinical decision making. This includes the transfer of data such as vital signs and ultrasound readings.
Shanit et al (1996) showed how a remote access cardiac support system could help people with long-term heart conditions. They used handheld electrocardiogram monitoring devices equipped with a memory card to transfer data. This data informed the GP’s discussion about the patient’s condition with a specialist registrar.
Since then, there has been a rapid expansion in more sophisticated computer-assisted technologies. This has brought about further opportunities for changes in nurses’ communication strategies.
In a study of computer-assisted assessment, Horton (2008) showed that patients with chronic obstructive pulmonary disease were able to use an electrical sphygmomanometer and thermometer to send data to a base computer. A community nurse was then able to offer telephone advice. Patients who were maintaining their condition felt this was beneficial since it offered them effective contact with a clinical nurse specialist while minimising interaction time.
The UK national chlamydia screening programme is an example of harnessing technologies for advice, diagnostic screening and treatment (www.chlamydiascreening.nhs.uk). It uses telephone, SMS, online order and email to offer a comprehensive communication strategy.
The Southampton Hand Assessment Procedure (SHAP) illustrates the potential for innovation in ICT, in developing simulated diagnostic assessments (Ford, 2009; www.shap.ecs.soton.ac.uk).
Fig 1 shows the range of technologies while Table 1 (p??) outlines the advantages and disadvantages of ICT in healthcare.
ICT fit for purpose
A wide range of ICTs are available to nurses. Effective and efficient use of these requires a range of skills.
ICT must be fit for purpose (RCN, 2008), so when adapting technologies, nurses need to consider the needs of the target group. For example, in the national chlamydia screening programme, the target group is young people aged 15-24. Since many in this group are likely to be confident in using ICTs the programme has adopted a range of technologies to target them.
However, it is important not to make assumptions, since some young people may not have access to ICT while older people may have sophisticated access and skills.
Questions to consider
When developing ways of working with patients using ICT, nurses need to consider the evidence and the resources they will need. Consideration should include:
- Why is ICT considered an appropriate way to support a particular patient group?
- Have you made a baseline profile of the numbers and types of patients it may suit?
- Does your employer have a strategy to develop patient-focused ICT initiatives?
- Do you have support from management?
- What technologies are available and are they compatible with other health and social care provision?
- Do you have sufficient knowledge of the types of technologies available?
- Will the client group have access to and skills in using the technologies?
- Are training opportunities available to improve your skills in using ICT?
- Are staff available who can help design and monitor the ICT development?
- What is your timescale for developing a patient-focused support programme?
- How will you test the effectiveness of the programme before rolling it out to patients?
- How will you evaluate the programme?
Nurses need to consider engaging with ICT to meet the challenge of contributing to the design of high quality healthcare.
They need to develop flexible and purposeful methods of care management to meet the needs of the increasing numbers of people with long-term conditions. This will require them to develop skills in designing and managing communication strategies that optimise use of resources. One way this could be achieved is by engaging with ICT programmes to discover new ways of connecting with patients.l
When developing ICT support systems for patients with long term conditions, nurses must adopt a considered, evidence-based approach. They must take into account issues such as:
- The patient/client group’s needs;
- Their access to ICT resources;
- Skills needed to use the system efficiently and effectively;
- The purpose of the initiative;
- Resources needed to set up and manage it;
- Evaluation of the system or monitoring its effects on health;
- Implications for skill mix;
- Implications for organisational changes in managing workloads and patient contact.
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Barlow, J. (2006) Building an Evidence Base for Successful Telecare Implementation – Updated Report of the Evidence Working Group of the Telecare Policy Collaborative. London: DH/Care Services Improvement Partnership.
Centre for the Development of Healthcare Policy and Practice (2008) Towards a Framework for Post-Registration Nursing Careers: Report of the Outcomes from the National Consultation. Leeds: CDHPP.
Davies, J. (2006) ICT in the Health Sector. Literature Review. infoDev.
Department of Health (2009) Long Term Conditions. London: DH.
Department of Health (2008) High Quality Care for All: NHS Next Stage Review Final Report. London: DH.
e-Health Europe (2007) EC Looks to IT to Help Support Older People.
Fisk, M. (2008) Telecare: what role for nursing?RCN News, 26 March 2008. London: RCN.
Ford, S. (2009) Hand function test goes online.Nursing Times; 22 June, 2009.
Horton, K. (2008) The use of telecare for people with chronic obstructive pulmonary disease: implications for management. Journal of Nursing Management; 16: 173-180.
NMC (2009) Review of Pre-registration Nursing Education: Phase 1. London: NMC.
RCN (2008) Telehealth and Telecare. London: RCN.
Shanit, D. et al (1996) Telecardiology: supporting the decision making process in general practice.Journal of Telemedicine and Telecare; 2: 7-13.