TECHNOLOGY
of their output in patients’ EHRs does not yet have clearly defined protocols (including security protocols) and pathways. This represents another area in need of further innovation. The potential benefits for using such technologies would be to improve the flow of patients through clinics making the running of clinics more efficient. This is particularly important when dealing with large volumes of patients. It would make data available immediately and enable comparison with previous readings. Patients under the care of multiple specialties simultaneously would avoid duplication of data. It would make the process of communicating information back to the patient easier and could also in future, improve remote patient monitoring and tele- consultations.
Moving towards single patient facing platform
In the management of chronic health conditions (e.g. chronic kidney disease) a key management aim is to empower patients to participate more actively in the management of their condition. This entails involving them in the process of shared decision making and improving the knowledge of their condition. Patients who are more engaged in their care can then become confident self-managers of their care (also known as ‘self-efficacy’), which is, in turn, associated with adoption of beneficial health-seeking behaviours such as increased use of exercise and healthy diets.3,4
While
specialist out-patient care is episodic, by its very nature, active patient participation in their care ensures appropriate management of the patient’s condition occurs continuously in between visits.
Access to healthcare data is an important NOVEMBER 2020
element of enabling patients to participate actively in their management. Technologies to allow this already exist and patients are increasingly proficient with their use. In the field of nephrology (and some other chronic conditions, such diabetes and inflammatory bowel disease), the patient-facing application (‘app’), Patientview5
(by UK Renal Registry
and the Renal Association), aims to achieve this by making kidney-related healthcare records available to patients via desktop computers or mobile devices.
Through this app, patients can monitor the results of their blood tests, record their home blood pressure readings and weights, and view their care plan (only available at selected centres). This is an important achievement, and its users report a high level of satisfaction with the use of Patientview6
(see figure 2). The app is freely
available and is funded by the NHS. The disadvantage for having an app that caters specifically for specialist service only (nephrology in this instance) is that patients under multiple services could find themselves using multiple apps on various devices monitoring different parameters. A patient for instance could be using their general practice’s own NHS approved app for requesting appointments and prescription refills (e.g. GP online services)8
services using another portal (e.g. the Patients Know Best portals)9
; these are in addition
to the specialist apps/portals such as the Patientview. An integrated approach is needed, therefore, to coalesce all the different health apps available accompanied by a degree of regulatory oversight.
Individualising data needs Patient care and treatment data stored in EHRs can be utilised to meet increasing
patient demand for access to more of their data. This is where innovation within each specialty can go a long way in enhancing patient experience and ultimately care. In nephrology, the provision of dialysis therapy for renal failure forms a large part of service activity. Many patients are on long-term dialysis and attend hospitals to receive dialysis therapy on average three times weekly. During each therapy session, data are recorded on a huge array of physiological and treatment related parameters; most of it is stored securely and never looked at again. This includes information such as the measurement of the adequacy of dialysis, performance of dialysis blood-flow access (in the most common form of dialysis i.e. haemodialysis, access to patient’s circulating blood is needed to allow efficient treatment) and blood test results to name a few. At first glance, making this data available to patients through apps, such as Patientview (or similar), seems logical. However, questions have remained on whether this would lead to misinterpretation of risks in patients? Will it worry or reassure them? What can they do about the results? Will patients compare results with others and what impact will this have?7,10
This is a key area of while interacting with hospital
further development and research. It can, for instance, be envisaged that making seemingly ‘technical’ data, traditionally considered difficult for patients to understand, could itself provoke information seeking behaviour and, therefore, result in improved patient knowledge of their condition. In the field of dialysis specifically, the knowledge of an individual’s weight change from one session to another (usually a sign of hydration status) could help patients regulate their fluid intake between dialysis sessions. An understanding of the
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