Mobilizing medicine: a design response to the accessibility and cost issues in health care

textNationally, there is increasing concern over the accessibility, cost, and quality of the American health care system. While the quality of the care given is generally out of the control of designers, it has received increased attention in recent years, as is evidenced in the trends of healing gardens, private patient rooms, and improved social settings. As beneficial as these trends are to the patients they serve, they often have a negative effect on overall accessibility and cost of care due to the constant construction and renovations needed and their largely urban presence. While quality health care is very important and should not suffer as a result, how can designers address nonenvironmental sustainability issues of cost and access in the American healthcare system? Due to the trend in increasing cases of chronic illness, as opposed to more pathogenic ailments of the past, the necessity for all healthcare settings to be highly controlled and sterile environments should be reevaluated. While less popular and not as fully developed as the typical facilities most Americans are familiar with, an increase in mobilized health care units could be a solution to the lack of economic and social access and sustainability in the current healthcare model while still providing safe, quality care. By examining current instances of mobile clinics, I will explore the design requirements necessary to make mobile clinics accessible and cost effective. In addition, I will look for facilitators and barriers to these systems, such as improvements in mobile communication technologies and lack of stakeholder support.Architectur

Success and failure in eHealth

Introduction In the field of eHealth, there seems to be a gap between promising research and clinical reality. This master thesis aims to give insight in patterns that can be found regarding the possible outcome in terms of success and/or failure. An in-depth review of workflow will be done, to get an understanding of the implications of eHealth on workflow. Methods Using a systematic article search, papers have been collected regarding the subject of this thesis. Through multiple search strategies, one final search string has been formulated. This final search string led to 903 papers. These papers have been assessed on relevance using qualitative methods. This resulted in 258 papers, which have been categorised by topic, entity and success or failure. After categorisation, the topic of workflow has been selected for an additional in-depth full-text review. Results The categorisation led to 27 categories. The categories are separated among the following entities: patient, health professional, health system and all. The first three have been separated in terms of success and failure as well. This led to a quantitative overview of different categories, for different actors in terms of success and failure. Workflow appeared to be essential for the possible success or failure of eHealth implementations. It is important to include workflow in the design of the tool as well. Conclusion Different categories show a unique combination in success and failure, and to what entity they belong. The category costs appeared to be mostly based on the health system and is attributed to failure. Therefore it is a pre-requisite for the implementation of eHealth. Other categories like quality healthcare and user expectations seem to target on success. The category legal was smaller than anticipated, which could have been caused by categories that are closely linked to each other

Health Information Technology in the United States, 2008

Provides updated survey data on health information technology (HIT) and electronic health records adoption, with a focus on providers serving vulnerable populations. Examines assessments of HIT's effect on the cost and quality of care and emerging issues

Mobile Delivery of Treatment for Alcohol Use Disorders: A Review of the Literature

Several systems for treating alcohol-use disorders (AUDs) exist that operate on mobile phones. These systems are categorized into four groups: text-messaging monitoring and reminder systems, text-messaging intervention systems, comprehensive recovery management systems, and game-based systems. Text-messaging monitoring and reminder systems deliver reminders and prompt reporting of alcohol consumption, enabling continuous monitoring of alcohol use. Text-messaging intervention systems additionally deliver text messages designed to promote abstinence and recovery. Comprehensive recovery management systems use the capabilities of smart-phones to provide a variety of tools and services that can be tailored to individuals, including in-the-moment assessments and access to peer discussion groups. Game-based systems engage the user using video games. Although many commercial applications for treatment of AUDs exist, few (if any) have empirical evidence of effectiveness. The available evidence suggests that although texting-based applications may have beneficial effects, they are probably insufficient as interventions for AUDs. Comprehensive recovery management systems have the strongest theoretical base and have yielded the strongest and longest-lasting effects, but challenges remain, including cost, understanding which features account for effects, and keeping up with technological advances

Holistic System Design for Distributed National eHealth Services

publishedVersio

Maryland Department of Health Master Agreement Annual Report of Activities and Accomplishments: FY 2017

This report describes the services The Hilltop Institute provided to the Maryland Department of Health (MDH) under the Master Agreement between Hilltop and MDH. The report covers fiscal year (FY) 2017 (July 1, 2016, through June 30, 2017). Hilltop's interdisciplinary staff provided a wide range of services, including: Medicaid program development and policy analysis; HealthChoice program support, evaluation, and financial analysis; long-term services and supports program development, policy analysis, and financial analytics; and data management and web-accessible database development

Remote Rehabilitation: A solution to Overloaded & Scarce Health Care Systems

The population across Northern Europe is aging. Coupled with socio-economic challenges, health care systems are at risk of overloading and incurring unsustainable high costs. Rehabilitation services are used disproportionately by older people. One solution pertinent to rural areas is to change the model of rehabilitation to incorporate new technologies. This has the potential to free resources and reduce costs. However, implementation is challenging. In the Northern Periphery and Artic Programme (NPA), the Smart sensor Devices for rehabilitation and Connected health (SENDoc) project [1] is focused on introducing wearable sensor systems among elderly communities to support their rehabilitation. It is important to understand the context into which change is introduced. Therefore, an overview of the current state of health care systems in the four partner countries is presented, defining the concept of rehabilitation and how remote rehabilitation is currently delivered. Advantages (e.g. enhanced outcomes, less cost and enhanced patient engagement), and disadvantages of remote rehabilitation (e.g. complexity involved in the use of technology, design and safety issues) are discussed. It is concluded that the key advantage of remote rehabilitation is the potential to support change in patient behaviour, empowering active participation and living independently, with less need to travel for face-to-face sessions. Remote rehabilitation can make enhance quality of health care service delivery. However, all relevant stakeholders including medical staff and patients should be included in the design of the technology employed with a focus on simplicity, usability and robustness. Compliance with Security and the new GDPR regulation will be key to supporting remote rehabilitation. In addition, the diversity of available platforms and devices must also be supported to ensure interoperability. Finally, remote rehabilitation needs to be further validated in practice. Attempts to implement and sustain change should be cognisant of local and current organization of health care and of existing enablers and barriers

Utilization of Telehealth Technology in Addiction Treatment in Colorado

The growing presence of electronic technology in the health service professions is redefining the boundaries of counseling services. Commonly referred to as telehealth, utilization of electronic communication strategies to expand connectedness has opened new frontiers in behavioral health through applications ranging from digital phones, interactive video sessions, to virtual supervision. Substantial research suggests that telehealth is generally equal in effectiveness to traditional forms of treatment, especially for those individuals struggling with substance abuse problems. Unfortunately, research also suggests that telehealth is often underutilized when it comes to providing addiction treatment services. Telehealth trends in Colorado were examined using a Telehealth Survey consisting of 29 items. Participants consisted of 125 members of the Colorado Association of Addiction Professionals. Similar to research published elsewhere, 65% reported that they do not currently use telehealth technologies. Furthermore, findings illustrated that actual use can vary by ethnicity, age group, type of organization, as well as service location. Participants’ reluctance to implement telehealth is related to concerns associated with training, confidentiality, clinician/staff acceptance, and reimbursement. Future research, employing both quantitative and qualitative methods, is recommended to further explore both the challenges and solutions to promote telehealth use, as well as methods to expand relevancy and awareness

Older people and eHealth service use An exploration of a complex learning and care ecosystem in the rural areas of Finnish Lapland

Tämä väitöskirja kohdistuu ikäihmisten (yli 60-vuotiaiden) arkeen digitalisoituvien sosiaali- ja terveyspalveluiden näkökulmasta. Tutkimuksen yleisenä tavoitteena on selvittää, kuinka harvaan asutuilla alueilla asuvat ikäihmiset ja heidän sosiaaliset verkostonsa käyttävät kotihoidon tarjoamia eTerveyspalveluita (eHealth services) oppimisen ja hoivan ekosysteemissä. eTerveyspalveluiden käytön tavoitteena on tukea ja helpottaa ikäihmisten sekä heidän hoitajiensa ja läheistensä terveyttä, hyvinvointia ja arkea parantamalla sosiaali- ja terveyspalveluiden saavutettavuutta ja laatua sekä vähentämällä niiden kustannuksia. eTerveyspalveluiden käyttö herättää myös suuren määrään inhimillisiä eettisiä kysymyksiä. Yksityiskohtaisemmin tutkimuksen tavoitteena on (1) lisätä tietoisuutta digitaalisesta osaamisesta eTerveyspalveluiden käytön oppimisessa ja käytössä, (2) selventää, millä tavalla oppimisprosessi on osa eTerveyspalveluiden kotouttamista, (3) rakentaa teoreettis-käsitteellinen malli eTerveyspalveluiden oppimiseen ja käyttöön, ja (4) antaa kehitysehdotuksia eTerveyspalveluiden suunnittelulle ja toteuttamiselle. Nämä tavoitteet saavutetaan kolmen teoreettisen lähestymistavan kautta. Oppimisen ja hoivan ekosysteemi muodostaa tutkimukselle perustan, hahmottaen ikäihmisten eTerveyspalveluiden oppimista ja käyttöä neljästä eri näkökulmasta: käytännön, sosiaalisen, kulttuurisen ja symbolisen kontekstin kautta. Digitaalisen osaamisen ja teknologian kotouttamisen käsitteet keskittyvät siihen prosessiin, miten ikäihmiset oppivat käyttämään ja käyttävät eTerveyspalveluita arjessaan. Sosiaalisen konstruktivismin paradigmasta ohjaa tutkimuksen suunnittelua soveltuvin osin. Tutkimuksen metodologinen lähestymistapa on laadullinen, sisältäen kirjallisuuskatsauksen ja empiirisiä aineistoja. Väitöskirja perustuu kolmeen osatutkimukseen, joista jokainen on julkaistu erillisenä artikkelina. Ensimmäinen osatutkimus on systemaattinen kirjallisuuskatsaus. Se sisältää 31 empiiristä tutkimusta ikäihmisten erilaisten eTerveyspalveluiden käytöstä ja käytön oppimisesta 12 eri maassa harvaan asutuilla alueilla ja niiden ulkopuolella. Toinen ja kolmas osatutkimus sijoittuvat Suomen Lapin harvaan asutuille alueille. Lääkeannostelupalvelun (osatutkimus II) sekä ikäihmisille seuraa tarjoavan puhelin- ja videoneuvottelupalvelun (osatutkimus III) käyttöä ja käytön oppimista tutkin tapaustutkimuksen keinoin. Lääkeannostelupalvelututkimukseen osallistui palvelua käyttäviä ikäihmisiä (n=2), lähihoitajia (n=4) ja muita terveydenhuollon ammattilaisia (n=2). Lääkeannostelupalvelun tutkimisessa hyödynnettiin etnografista tutkimusotetta: semi-strukturoitujen haastatteluiden lisäksi palvelun käyttöä havainnoitiin ja palveluun kuuluvasta lääkeannostelurobotista otettiin kuvia ikäihmisten kotona. Puhelin- ja videoneuvottelupalvelua koskeviin semi-strukturoituihin haastatteluihin osallistui palvelua käyttäviä ikäihmisiä (n=2), vapaaehtoistyöntekijöitä (n=2) sekä palvelun koordinaattori. Osatutkimusten aineistot analysoitiin induktiivisen ja deduktiivisen temaattisen lähestymistavan avulla. Väitöskirjan kokoavat havainnot syntyivät osatutkimusten keskeisten tulosten metasynteesistä. Metasynteesin tuloksena saatiin selville, että oppimisen ja hoivan ekosysteemin käytännön kontekstiin liittyen eTerveyspalveluiden kotouttamiseen vaikuttaa eniten niiden käytettävyys ja toimivuus sekä palveluiden yhteensopivuus käyttäjien kulttuurisesti rakentuneiden yhteisöllisten käytäntöjen kanssa. Tutkimuksessa havaittiin, että oppimisen ja hoivan ekosysteemin sosiaalisen kontekstin keskiössä on oppimisyhteisö, jonka ikäihmiset muodostavat yhdessä läheisasiantuntijoiden, ammattilaisten ja eTerveysteknologioiden kanssa. Oppimisyhteisö mahdollistaa eTerveyspalveluiden oppimiseen ja käyttöön tarvittavan digitaalisen osaamisen jaettuna, sosiaalisena osaamisena sekä eTerveyspalveluiden kotouttamisen sosiaalisena prosessina. eTerveyspalveluiden kotouttamisen myötä sosiaali- ja terveydenhuollon ammattilaiset ja vapaaehtoistyöntekijät ovat saaneet uuden roolin eTerveyspalveluita käyttävien ikäihmisten oppimisen ohjaajina. Pedagoginen tuki eTerveyspalveluiden kotouttamisen suunnitteluun olisi tarpeen. Oppimisen ja hoivan ekosysteemin kulttuuriseen kontekstiin liittyvät tulokset osoittivat, että ikäihmisten kulttuuritaustan merkitys eTerveyspalveluiden oppimiselle ja käytölle on kaksijakoinen. Toisaalta tulokset osoittavat kulttuurisesti yhteensopivia käytäntöjä harvaan asutuilla alueilla asuvien lappilaisten eTerveyspalveluiden oppimisesta ja käytöstä. Toisaalta jokainen maaseudulla asuva eTerveyspalvelun käyttäjä on yksilö riippumatta hänen kulttuuritaustastaan, ja täten he yhdessä muodostavat hyvin heterogeenisen ryhmän eTerveyspalveluiden käyttäjiä. eTerveyspalveluiden käyttäjien lisäksi tutkimuksessa havaittiin myös ikäihmisiä, jotka eivät käytä eTerveyspalveluita. Heitä tulisi tutkia tarkemmin oppimisen ja hoivan ekosysteemissä. Havainnot oppimisen ja hoivan ekosysteemin symboliseen kontekstiin liittyen osoittavat, että eTerveyspalvelut ovat uusia ja hyödyllisiä palveluita maaseudulle, mutta saman aikaisesti ne aiheuttavat haittaa ja huolta ikäihmisille. eTerveyspalveluiden oppiminen ja käyttö tuottaa ikäihmisille sekä positiivisia että negatiivisia tunteita. Tämän tutkimuksen teoreettiset löydökset osoittavat, että oppimisen ja hoivan ekosysteemi on soveltuva lähetymistapa eTerveyspalvelujen käytön tutkimukseen. Lisäksi löydäkset vahvistavat ajatusta siitä, että eTerveyspalveluiden käyttö oppimisen ja hoivan ekosysteemissä ei ole kertaluonteista, ainoastaan palvelun käyttöönoton yhteydessä tapahtuva asia, vaan se jatkuu läpi koko kotouttamisprosessin vaatien monentyyppistä digitaalista osaamista ja sosiaalista tukea. Tästä syystä eTerveyspalvelujen kotouttamisprosessi tulee tunnistaa samanaikaisesti jaetuksi, sosiaaliseksi oppimisprosessiksi. Tässä väitöskirjassa käytetyn teoreettisen viitekehyksen ja kokoavien tulosten pohjalta esitellään uusi teoreettis-käsitteellinen eTerveyspalveluiden oppimisen ja käytön malli. Malli havainnollistaa eTerveyspalveluiden oppimisen ja käytön moniulotteisuutta, ja sitä voidaan hyödyntää eTerveyspalveluiden suunnittelussa ja kotouttamisessa sekä analyyttisenä työkaluna tutkimustarkoituksiin. Väitöskirjan kokoavien tulosten pohjalta on asetettu myös käytännöllisiä ja poliittisia kehitysehdotuksia eTerveyspalveluiden sunnitteluun ja toteuttamiseen palveluiden kehittäjille ja tarjoajille sekä sosiaali- ja terveysalan päättäjille.The general aim of the current dissertation is to explore digital home-care service use (eHealth) from the perspective of rural older people and their social networks in a complex learning and care ecosystem. The use of eHealth services aims to support and facilitate the health, well-being, and everyday lives of older people and their caregivers by improving the accessibility, quality, and affordability of social and health care services. The use of eHealth services also raises many ethical questions related to human dignity. In particular, the current research aims to (1) increase the knowledge of digital competence in eHealth learning and use, (2) clarify in what way the learning process is part of eHealth service domestication, (3) construct a theoretical-conceptual model for eHealth learning and use, and (4) set development proposals for eHealth design and implementation. The aims are achieved through three theoretical approaches. The learning and care ecosystem provides the basis for the research, constructing older people’s eHealth learning and use through practical, social, cultural, and symbolic contexts. The concepts of digital competence and technology domestication focus on the process of how older people learn to use and use eHealth services in everyday situations. A social constructivism paradigm guides the research design as applicable. The methodological approach of the research is qualitative and includes a literature review and empirical data. The dissertation is based on three substudies, each of which is reported in a separate article. The systematic literature review (substudy I) included 31 empirical studies of older people’s learning and use of different eHealth services in 12 different countries in rural and nonrural settings. It provided background information for the research. The other two substudies took place in rural Finnish Lapland. Learning and use of a robotic medication-dispensing service (substudy II) and a phone and video conferencing service (substudy III) were investigated through a case study approach. For substudy II, older people (n = 5), practical nurses (n = 4), and other health care professionals (n = 2) participated. Substudy II utilized ethnography: in addition to semistructured interviews, the use of the service was observed, and photographs of a medication-dispensing robot were taken at older people’s homes. For substudy III, semistructured interviews with older people (n = 2), volunteer workers (n = 2), and a service coordinator were conducted. The gathered data were analyzed through inductive and deductive thematic approaches. The overarching findings of the dissertation were formed through a metasynthesis of the key findings of the substudies. Based on the findings, in terms of the practical context of the learning and care ecosystem, the eHealth domestication process is most affected by the usability and functionality of eHealth services and their compatibility of the service with users’ culturally situated social practices. According to the findings, in the center of the social context of the learning and care ecosystem, there is a learning community that older people form together with warm experts, professionals, and eHealth technologies. The learning community enables the digital competence required for eHealth learning and use as a distributed social activity and the domestication of eHealth services as a social process. With the domestication of eHealth services, social and health care professionals and volunteer workers have taken on a new role as learning instructors for older eHealth users. Pedagogical support for planning eHealth domestication would be necessary. The findings related to the cultural context of the learning and care ecosystem demonstrated that the meaning of the older people’s cultural backgrounds for eHealth service use in the learning and care ecosystem is twofold. On the one hand, culturally congruent practices can be found in the rural Lappish older people’s learning and use of eHealth services. On the other hand, despite older people’s cultural backgrounds, each rural eHealth service user is an individual, and together, they form a very heterogenous group of eHealth service users. In addition to eHealth users, the study also identified eHealth nonusers, who should be further investigated in the learning and care ecosystem. Finally, the overarching findings related to the symbolic context of the learning and care ecosystem indicate that eHealth services are new and needed services for rural areas yet also a source of inconvenience and concern for older people. Learning and use of eHealth services generated both positive and negative emotions for older people. The theoretical findings of the research showed that learning and care ecosystem framework is an applicable approach for the study of the use of eHealth. In addition, the reseach demonstrated that learning to use eHealth services in the learning and care ecosystem is not a one-time experience that only happens when the service is introduced, but continues throughout the entire domestication process, requiring different types of digital competence and social support. Thus, the domestication process of eHealth services should be recognized simultaneously a distributed social learning process. Based on the theoretical framework utilized in the present research and the overarching findings, a new theoretical-conceptual model of eHealth learning and use, called Learning and Care Ecosystem in eHealth Use, was introduced. The model demonstrates the complex nature of eHealth learning and use and can be utilized when designing and domesticating eHealth services or as an analytical tool for research purposes. Finally, the overarching findings allowed the setting of several practical and political development proposals for eHealth design and implementation for eHealth service developers and providers and for social and health care policy makers