NHS launches drive to improve ‘e-nursing’

NHS Digital has launched its first ever e-nursing week in support of the campaign to re-educate the NHS workforce for a digital future | OnMedica

It has also endorsed the Royal College of Nursing’s (RCN) campaign “Every nurse an e-nurse”, and has pledged to play a supporting role in realising its ambition.

NHS Digital, is the national provider of information, data and IT systems for commissioners, analysts and clinicians in health and social care. It estimates that in many settings nurses provide 80% of patient care and they are often the clinicians leading the way in utilising new technology, and creating innovative ways of improving care using new digital tools.

The RCN says that the effective use of information and digital technologies is a key enabler in delivering better health and social care, now and in the future.

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Bridging The Health Care Gap Through Telehealth

This case study looks at two telehealth models in Mexico and the U.S. targeting low- to middle-income parts of the population | Commonwealth Fund

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Image source: Commonwealth Fund

In many developing nations, the public health system is unable to meet demand for services, driving people to seek costly services in the private sector. Telehealth can expand access to care while, in some cases, reducing unnecessary use of services, such as immediate acute care for non–health emergencies.

Using a call centre as the point of access, these models have reduced unnecessary use of services and supported patient navigation of local health services.

 

Cybersecurity and healthcare: how safe are we?

BMJ 2017;358:j3179

BMJ analysis notes threat of cyberattacks on healthcare is real and growing. It calls for urgent development of practical standards/solutions that are specific to healthcare sector, agreement of clear lines of responsibility and governance, and commitment of appropriate resources

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The cost-effectiveness of electronic discharge communications

The transition between acute care and community care can be a vulnerable period in a patients’ treatment due to the potential for postdischarge adverse events | BMJ Open

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Background: The vulnerability of this period has been attributed to factors related to the miscommunication between hospital-based and community-based physicians. Electronic discharge communication has been proposed as one solution to bridge this communication gap. Prior to widespread implementation of these tools, the costs and benefits should be considered.

Objective: To establish the cost and cost-effectiveness of electronic discharge communications compared with traditional discharge systems for individuals who have completed care with one provider and are transitioning care to a new provider.

Results: One thousand unique abstracts were identified, and 57 full-text articles were assessed for eligibility. Four studies met final inclusion criteria. These studies varied in their primary objectives, methodology, costs reported and outcomes. All of the studies were of low to good quality. Three of the studies reported a cost-effectiveness measure ranging from an incremental daily cost of decreasing average discharge note completion by 1 day of $0.331 (2003 Canadian), a cost per page per discharge letter of €9.51 and a dynamic net present value of €31.1 million for a 5-year implementation of the intervention. None of the identified studies considered clinically meaningful patient or quality outcomes.

Discussion: Economic analyses of electronic discharge communications are scarcely reported, and with inconsistent methodology and outcomes. Further studies are needed to understand the cost-effectiveness and value for patient care.

Full reference: Sevick, L.K. et al. (2017) A systematic review of the cost and cost-effectiveness of electronic discharge communications. BMJ Open. 7:e014722. 

Improving the management of digital government

Improving the management of digital government argues that the digitisation of public services in the UK is happening too slowly | Institute for Government

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It says that appointing a minister responsible for digital government would help drive change and advance standards. Digital improvements would make government cheaper, more effective and more secure. The report points to the recent NHS cyberattack as an example of the fragility in some systems being used in the public sector.

The report warns that the Government Digital Service (GDS), the Cabinet Office unit responsible for leading digital transformation of government, faces resistance from many corners of Whitehall. Without a strong minister in charge, GDS is not able to drive digital improvements in a way that meets citizens’ expectations. It sets standards for digital government, but these need to be improved and extended throughout the civil service, and with IT contractors.

The report also makes several recommendations for both GDS and Whitehall departments on how they can work better together. The Government needs to organise services around people’s needs and to urgently clarify which system citizens should use to securely identify themselves online.

 

IT intervention to support medicine optimisation in primary care

Jeffries, M. et al. (2017) Understanding the implementation and adoption of an information technology intervention to support medicine optimisation in primary care: qualitative study using strong structuration theory. BMJ Open. 7:e014810

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Objectives: Using strong structuration theory, we aimed to understand the adoption and implementation of an electronic clinical audit and feedback tool to support medicine optimisation for patients in primary care.

Conclusions: Successful implementation of information technology interventions for medicine optimisation will depend on a combination of the infrastructure within primary care, social structures embedded in the technology and the conventions, norms and dispositions of those utilising it. Future interventions, using electronic audit and feedback tools to improve medication safety, should consider the complexity of the social and organisational contexts and how internal and external structures can affect the use of the technology in order to support effective implementation.

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Telehealthcare for patients suffering from chronic obstructive pulmonary disease

Lilholt, P.H. et al. (2017) BMJ Open. 7:e014587.

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Image source: Neil Webb – Wellcome Images // CC BY-NC-ND 4.0

Objective: To assess the effect of telehealthcare compared with usual practice in patients with chronic obstructive pulmonary disease (COPD).

Conclusions: The overall sample and all subgroups demonstrated no statistically significant differences in HRQoL between telehealthcare and usual practice.

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