How e-health can change demand and control : Experiences from healthcare professionals’ monitoring patients through digital exchange of information and communication

• IntroductionThe technological developments in the e-health sector are enabling new and more advanced methods to monitor and care for patients digitally. The general purpose of digital care is to dismantle the constraints of time and space between the provider and the patient. This in turn leads to a possible reallocation of resources to those parts of care where they are needed the most. For the healthcare professionals this transition may imply a shift from personal meetings with the patient to digital communication; from measuring various parameters themselves to receiving health data reported by the patients; from booked patient meetings to a more continuous monitoring of the patient's data and that an algorithm in the digital system suggests which patient(s) should be prioritized. This type of healthcare is a growing area of e-health and patient studies are currently performed to measure the medical effects of digital care systems.One example of such a patient study is SMART HF II; a randomized controlled trial study that was conducted in Region Skåne, Sweden. The aim of the study was to investigate if the e-health solution LifePod® increases patients’ knowledge, compliance and quality of life, and thereby affects readmission and care visits. LifePod® is an e-health solution that enables the exchange of information and communication between healthcare professionals and patients. All patients have their unique care profile in the system where they report their health parameters. An algorithm creates visualizations of the patients' condition and makes an evaluation of which patients should be prioritized. However, the study does not include how healthcare professionals experience this transition from traditional care to digital care. As this is a new area within e-health there is limited knowledge about how systems such as LifePod® affect healthcare professionals’ work environment. In the research project “Between Pod and Patient – what happens when care becomes digital?” we aim to investigate how the healthcare professionals’ work changes when care becomes digitalized. The objective of this paper is to present data from a pilot study that explores how the healthcare professionals’ experience the implementation of LifePod® using the demand, control model as a theoretical lens (Karasek, 1979).MethodologyInterviews were conducted in three healthcare settings in Region Skåne. All three settings participated in the SMART HF II study. In total, we conducted 19 interviews, sixteen semi-structured in-depth interviews with practitioners and three additional interviews with other stakeholders, including the doctor that is responsible for the SMART HF II study, the nurse that operationalized the study and a representative from the company behind LifePod®The interview guide consisted of the following themes: an introduction about the role and duties of the healthcare professional and the organization of the work in the healthcare setting, the healthcare professionals work and communication with patients and colleagues, the use of LifePod® and finally some concluding questions. The interviews were recorded, transcribed and analysed with support of the demand and control model.Research outcomesThe results show that the professionals, generally, express themselves in positive terms about the shift towards digital care. This includes being able to provide care that is based on up-to-date information and the present needs of each patient. They also state that a major advantage of LifePod® is the feeling of control that the system offers by its overview of the patient data. The professionals also describe that they, by looking at the data, can evaluate the medical status of the patients providing an increased sense of security to them.The algorithm in LifePod® creates visualizations of the individual patient’s condition and the system ranks different patients’ need for care. When the nurses log into the system they thus see an overview of their patients’ data and their needs screen through a colouring scheme. The signals indicate whether actions, ranging between no action to immediate actions, are needed. As the patients’ entries of data into the system are voluntary and not scheduled, the nurses neither know the number of patients who have reported data nor how much of the reported data will demand actions on their behalf, when they log in to the system. This, in turn, can make it problematic for them to plan their time schedule visavi other work routines as, for instance, planned patient visits.Being responsible for the system and for responding to the patients’ data may, in turn, be interpreted as increased demands on the nurses. The results thus indicate that LifePod® may change the work conditions of the professionals, mostly in a positive way but also in a more complicated way regarding both control and demands, in some dimensions. In the presentation we will analyse and discuss this complexity in more depth.ReferencesKarasek, R. A. (1979). Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly, 24, 285–308.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)

Publikations- och innehållstyp

ref (ämneskategori)

kon (ämneskategori)