Week 10: Policy Issues and Health Informatics within Nursing

Week 10 is my favourite week thus far because it was my group’s facilitation, and we had the chance to lead the class in discussion. This week focused on developing and implementing public policies, as well as health information technology. As health care makes the transition to electronic care, nurses as well as other members of the health care team are challenged to keep up with the policies in place, and change them when needed. Or perhaps even create brand new policies.

To begin, what is health policy?

“Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society.” (WHO, 2013).

Health Policy. (2013). World Health Organization. Retrieved from: http://www.who.int/topics/health_policy/en/

Then, some nurses may ask themselves, what do we have to do with health policy? Well as we know, nurses are advocates for patients. We are the ones that are supposed to protect their rights, and ensure that they are getting the best health care possible. This is why nurses must use their powerful voice to implement changes that can benefit them in their profession, as well as benefit the patient in their health care.

Within our facilitation, rather than just talk about the policies, we wanted to take it a step further and find out exactly how they are made. What we discovered are four main steps. The first step is data and evidence. In this stage, any data needed to support the policy you wanted to create needed to be gathered and organized here. “Insightful and imaginative…collaborating where appropriate with colleagues from other disciplines.” (Sommer, 2001) Next step was interpretation and conclusions. This was the time to analyze the data as much as possible, show it to other colleagues as well and come to certain conclusions. Third is scientific consensus, where you take your data to a scientific professional who can help back the policy with their professional and statistical evidence. An opinion policy is not enough, it needs straight facts to help it get approved. Scientific consensus can also mean holding a trial or a research study on the topic. Lastly, policy formulation involves going through the costs and benefits of the policy to come to a final conclusion of whether it is worth putting in place or not. “Health policies have an impact on a host of issues which rarely yield to neat regressions. These must be explored by experts in relevant disciplines and solutions reached through a delicate political process.” (Sommer)

Sommer, A. (2001). How public health policy is created: Scientific process and political reality. American Journal of Epidemiology, 154(12), 4-6. Retrieved from: http://aje.oxfordjournals.org/content/154/12/S4.full.pdf

For our first activity with the class, we asked them to get into their small groups, and think from a nursing lens – if they could design a health policy, what would it be about, and how would they do it. The class came up with great examples like banning chewing tobacco to prevent it from getting in the hands of younger adults. I think it is important that we, as nursing students, start to think about the changes we would like to see in health, so that in the future, we use our voice and use the power we have to implement change.

Project Health Design:

(http://www.projecthealthdesign.org/home)

Project Health Design is a system designed to implement applications to self monitor health and share information with other health care providers. They want to better understand how people describe and understand their own health, and incorporate that into the health care documentation and planning.

Check out this video of Patricia Flatley Brennan describing the goal of Project Health Design.

http://www.youtube.com/watch?v=qvEANejfiaE

PHD created within the app, a way for patients to track their own health through “ODLs”. ODLs stands for Observations of Daily Living. With this, patients can track everything they do throughout the day, from how they are feeling physically, and emotionally, what they are eating, if they are doing any exercise, any symptoms, etc. This can be extremely helpful in future situations if they get sick from something, they can collaborate with their doctor to look back on their ODLs, and see what may have changed in terms of diet, or any feelings they had that could have contributed to the problem.The only way that I personally see a fault in this program, is if the patient forgets to chart certain things, or leaves things out that they feel embarrassed by, etc. Because if they are not recording everything, it may not serve a useful purpose.

This excerpt from projecthealthdesign.org shows all the ways they would like patients to use ODLs.

ODLs can include:

      • Quantity and quality of sleep
      • Moods experienced in day-to-day life
      • The ease with which an individual completes daily tasks
      • Level of pain experienced throughout the day
      • Fluctuations in day-to-day stress

ODLs provide:

      • Subtle clues that individuals pay attention to as they monitor their health.
      • A way for patients to gauge how their health is progressing.
      • Cues that alert patients that they need to take health-related action.

“Doctors and nurses are experts in clinical care; patients are experts in their daily experiences. Both need to share more with each other and health data from everyday life can help bridge that gap.” – Patricia Flatley Brennan

I think Project Health Design is a great and innovative idea to better understand patient’s health from their own eyes. No one knows your health better than yourself, so it is an excellent tool. As a potential patient, it makes me feel great to know they want my input on my health care and they will listen to what I have to say. This makes the patient feel like they are part of the health care team, and more likely to have a positive outcome.

“It’s important for doctors and other medical providers to listen to the most important member of the healthcare team, the patient. After all, there is no bigger stakeholder. Involving the patient in the decision making process is essential, to both better the patient outcome and improve patient experience.” – Kevin Pho, MD

Ficarra, B. (2010). The patient, the most important part of the medical team. Health in 30. Retrieved from: http://healthin30.com/2010/11/the-patient-the-most-important-part-of-the-medical-team/

One health policy is called “Meaningful use” and its purpose is to allows EHR to be a communication system that lets patients engage in their health by including ODL’s in the EHR. Health providers now see that patient engagement is key to shaping health policies, and they must address current patient needs.

The second group activity we did with the class involved the ODL concept. We asked them in groups to design a specific health application for the case scenario the group was given. The first group was given an elderly man who was a heavy smoker that wanted to quit, the second group was given a healthy female teenager, and the third group was given an older adult woman who was trying to manage her diabetes. We asked them to include a place to track their ODLs, any information that was important to their health (specifically with whatever ailment the client had), include confidentiality and security features, as well as consider what technology would be able to use this app, and include a section for two way communication between patient and clinician. The groups came up with great strategies, like including their sleeping patterns, exercise and diet. Specifically, the group with the male made an application called “Track your Pack” so that he could track the amount of cigarettes he smoked a day, and this allowed his clinician to see as well. Any symptoms he had would also be inputted to see if the smoking had any relation to his physical health. The group with the diabetic woman had the idea to create sections in the app where she could track her blood pressure as well as insulin levels easily. All very creative ideas.

So how do health informatics and health policy relate to one another? Health informatics is always changing and evolving. It is constantly bringing in new strategies and new technology to tackle the health care system to make it easier, and more efficient for patients, nurses, and every member of the health care team. Because the health care field is always evolving, policy must also evolve with it to address all the needs and issues. Nurses and physicians must always assess be on the constant watch for anything that could disrupt the system, and implement policies to keep everyone safe and on the right track.

“People are experts in everyday living, clinicians are experts in clinical care, technologies bring them together.” (Flatley Brennan, 2013)

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