okay welcome again everyone this is dr.

Marge Riley from the CUNY School

of Professional Studies nursing program I'm very pleased to present our
speaker for today's webinar the topic is informatics in a connected health
care environment and our speaker is dr. Diane Skiba she is a professor and
the specialty director for healthcare informatics at the University of
Colorado College of Nursing over her career she's managed numerous
grants to prepare the nursing workforce these included a university based
training grant of 2.6 million dollars funded by the office of the National
Coordinator of health information technology to prepare healthcare
professionals for highly specialized health IT roles she is a fellow in the
American college of medical informatics and an honorary fellow in the
american academy of nursing in the academy of nursing education she is a
mias u.s. representative in nursing informatics and the vice chair of country
membership for the international medical informatics association the
nursing informatics special interest group she is also a member of the NI
2016 scientific program committee and the chair of the NI 2016 student
design competition

welcome dr. Skiba we look forward to hearing your presentation today

thank you so much dr. Ali and I want to thank everybody who is attending
I know you have busy schedules so I appreciate you taking some time out
of your busy day to hear about informatics in a connected health
environment

as Marge said I've been around for a while in informatics and I have
thoroughly enjoyed preparing people for informatics roles as well as
preparing nurses to be able to interact in our ever-growing connected
world

so today we're going to talk about that connected world

we're going to describe the concept of connected hit care

we're going to talk about some of the digital tools that are out there
and what people are using and

also sort of what is the informatics role in preparing nurses for a connected
care age

so, before I start I'd like you to think about so how connected you are

if you're pretty typical you're going to have probably a lot of connections

and I would like it just to take a little bit of time to think about how many
of you have a smartphone with a Wi-Fi connection do you also have maybe
a tablet do you have some kind of tracking device like a Fitbit

or you know an Apple watch or any of those things

when you think about your environment at home do you have any devices
that are connected at home like security systems washing machines
different kinds of things I have an app for my washing machine so that if I
would only remember to put the clothes in there I could actually turn it on
using my mobile app

do you have any connections when you're in the car I do you have any
health at devices that may be connected so?

if you total those up how many objects do you think you have what we're
seeing and what the literature is talking about is

that the majority of the people that are in this new age have anywhere

from three to four there's also a percentage of people who are over five

and I think we're going to see that grow over time

Nielsen who many of you may know as the ones that used to do the

television ratings and who watched what are now monitoring things like

how many people are connected with different kinds of objects and they
talk about a connected life and

as you can see in this timeline a lot has happened over the last five years
you know when in the beginning you know in those first 50 years we were
kind of in this broadcast we used to have things like early cell phones and
we got our mp3 players that we used to use and now you sort of see this
growth where we've got smart phones where we've got connected devices
tablets we have mobile shopping and banking our cars have now
connectivity

and we now have things called wearable devices so it is all part of this

connected age

the association of international electronical engineers talk about it as the

Internet of Things and what they mean by that is the number of physical
objects that can be connected to the Internet and they believed by the
year twenty twenty we will have it reached or exceeded 50 billion
connections of things so I think that's really sort of fascinating that we've
got this

they're also talking about at least these many vehicles will be connected to
the Internet

I don't know if any of you have seen the commercial this has just recently
come out in the Denver area where they talk about the smart refrigerator
this is part of the Internet of Things we're in this particular case this
Samsung Refrigerator actually has a panel on it you can leave messages
you can connect with it you can actually view by look at having cameras
inside your refrigerator sort of the dates of like your milk carton to see if
it's expiring and you need to pick up milk and you can see the

objects in your refrigerator so you know what to purchase when you're at

the grocery store it also can connect with your Fitbit in the future you know
my vision is the refrigerator in the future will be my health coach so every
time I open it will tell me whether or not I've run enough to actually
deserve to take that stick of ice cream out to eat

health care is not immune to this we have a lot of objects that are
becoming a part of the Internet of Things in health care and we're starting
to see this just explode in the last year or so and I think there's going to be
even more of a continued growth in this so when I think about the Internet
of Things and I think about the connectedness of things the Internet of
Things really talks to and speaks to connections with physical objects

whereas the connected age and how we interact as humans in it is more

about those virtual connections you know especially with people resources
and ideas and we're going to talk a little bit more about that Diana obligar
had a great quote that I really thought so it brings out what this whole
notion of connectedness is and connecting is all about reaching out and
bringing people together about building that synergies to create a hole that
is better than the sum of its parts it's a really powerful metaphor

everyone and everything is connected people resources day ideas are all
interconnected by being linked tagged tweeted text followed and friended
and I'm sure many of you utilize these different techniques to stay
connected when we think about it in terms of the health care arena there's
a couple of different definitions that are out there that talk about
connected health and connected health achill

according to Caulfield and Don Lee is a conceptual model for health

management where devices services and interventions are designed
around the patient's needs

and that the health-related data is shared in such a way that the patient
can receive care in the most proactive and efficient way and

we're starting to see more and more people utilize the terminology
connected care takes patience caretakers and provider and connect them
so that they really can get

that information and understand the

patient's status at any point in time

through the use of these different

connected devices and platforms the VA

system has now begun to start thinking

about calling their telehealth projects

and anything that they do that connects

patients and providers as connected

health within their system I like to

think of it as connected care and that

really kind of blends the high-tech

portion of the Internet of Things along

with the high-touch connections that we

get when we're using a lot of the tools

that facilitates those interactions

between patients with their providers or

caretakers with their patients providers

or it's between patients and patients

interacting and talking with each other

and sharing ideas about how they are

connected care is really just an

ecosystem that provides the

collaborative care team which is your

team that you as a patient have that

might include a nurse a physician of

pharmacist whatever in new ways to the

healthcare system so that people can

share experiences content that can be

part of communities and resources and

that ecosystem is to provide connections

between providers to providers providers

to patients and patients to patients it

is really about utilizing a lot of these

different digital tools that we have and

thinking about care has not just been

inside a healthcare system but outside

of the walls of a healthcare system so

it's all of these wireless connections

that patients and providers can have as

well as their families and caregivers to

really help manage and participate in a

patient's health those digital tools

might be things like sensors it could be

mobile apps it could be connecting

through face bait facebook social

support groups patient portals this

whole idea of connecting to patients

with each other through a variety of

different ipe tient platforms as well as

what you see PGH d which is patient

generated health data like the data

that's collected off of fitbit's or

heart monitors or whatever so as you can

see connected care is really about

putting that patient in the center and

really having the community and all the

resources out there whether its primary

care acute care are just living well

along with community

they're all being interconnected and

helping to facilitate that patient in

wellness as well as in sickness it's

really transforming patient care to

become consumer-centric I know we've

talked a lot about that over time I know

that in nursing we consider that we are

patient advocates and we see the patient

as the center of care but it is now

realistic to incorporate them and have

them be an active member of a care team

with them in the center of their care

and as we look at where nursing is going

there was a great article that came out

last year about nursing in a transformed

healthcare system and as you you know

you know we are rethinking health care

and how it's delivered there's more care

coordination more transitional care that

we need to look at the hospital is not

the only place where people get care and

that we need to have nurses that have

skill sets that really deal with what

we're calling a continuous learning

health system and a continuous learning

health system means that we are taking

the clinical data and the evidence-based

practices that we have already in place

and we're taking that clinical data and

feeding it in to begin to generate new

evidence so that we can provide the best

care at the lowest cost for all people

in terms of a health care system nurses

need to be able to not only know how to

coordinate care and help with

transitional care but they have to learn

how to use data and evidence from their

EHR so that they can optimize their care

they're also going to have to be part of

interprofessional teams and be able to

collaborate in

loading that patient and their family

within the team and actively engage in

performance improvement projects

throughout nursing in a transformed

healthcare system will also take into

account telehealth systems allowing the

healthcare providers to remotely monitor

and communicate with patients so that it

provides a more convenient as well as a

safety net for patients once they are

either discharged from a hospital or

after they're seen in a clinic and we

really want nurses of the future to have

effective use of health information and

these systems that really are considered

essential part of having a successful

care coordination project there's also

sort of this whole movement afoot that's

about consumer engagement and there is a

lot happening about really as we move to

a consumer centric model making sure

that we engage the patient I love this

quote from Leonard kiss you said if

patient engagement were a drug it would

be the blockbuster drug of the century

and malpractice not to use it I think

what we're seeing from federal

initiatives as well as initiatives in

hospitals and clinics is the more that

we can engage a patient and have them be

active participants in their care the

more likely it is they'll be able to

improve their health and healthcare and

so the federal government a couple of

years ago started with what they called

the 3 a's to really engage people to

improve their health care through using

health information technologies and the

three prongs of this strategy include

giving them access to their health care

information like to their health care

records giving them access to patient

portals in abling them to take action

with that information and to help have

them be part of the decision-making

process as well as helping to facilitate

the attitude so that patients and

providers begin to think of themselves

and act as partners in managing care and

it's been interesting to look at the

research as the patient and the consumer

people move more into being empowered

and start engaging we still have a

little bit of a lag in getting those

providers particularly our friends the

physicians to think of the patient as a

partner in their healthcare and allowing

them to be much more engaged in this as

you can see there's a lot of writing and

a lot of thing about patient as a

partner in their healthcare and making

them have that accessible information so

that they can have shared and informed

decision-making and this is by the

Institute of Medicine who really

believes that if we do not partner with

patients we will not be able to fulfill

the dreams of the Triple Aim of better

health better care at lower costs for

all of our patients it's even impacting

the way we think about research and how

we think about patients being much more

part of the research agenda and how

important we need to begin to think

about the science of patient input and

how we really can facilitate that to the

point where they can become not just a

passenger but a co-pilot in terms of the

research endeavors that we are trying to

do I'm Eric Topol is a cardiologist to

has been involved in health information

technology for a long time and in 2015

he wrote a book called the patient will

see you now and he kind of uses this

quote to get you to think about all the

options patients have right now and it's

his quote is it takes two point six

weeks to get an appointment with an a

primary care doctor on the average since

it's so hard to see a doctor what is

really interesting in contrast is that

everybody else will see you now the

crowd meaning maybe if you're on a

Facebook group will see you now the

patient's other patients that you might

connect with will see you now dr. Google

will see you now the robot the avatar

everybody will see you now but the

doctor and I think we have to start

thinking about how we can better

incorporate within this

interprofessional care model how you

bring that patient in as part of the

team member and begin to utilize some of

the digital technologies to do that as

you can see from this picture more and

more people are connected and as those

people become more comfortable with the

technology even from the youngest all

the way to the oldest they want to

engage in finding out more about what

will keep them healthy as well as what

will get them to get better if they have

certain kinds of conditions and

particularly with our high populations

of those with chronic disease we need to

help people to better manage those

chronic diseases and begin to lead

healthier lifestyles the American well

organization did a survey of consumers

and this is a link to their particular

survey and missed and the results of it

and they found the

that most employers wanted to be able to

offer telehealth services to their

patients thirty two percent were already

offering them and when I mean telehealth

I mean that patients can actually

connect with their providers using their

smartphone using a tablet or coming in

through you know their laptop or their

desktop computers and have a virtual

visit with their patient they also found

out that seventy-seven percent of the

employers were really looking at how to

be able to offer that and how many were

planning to offer those in the upcoming

year you can also see that users are

beginning to go and find their own apps

and that we find that a lot of health

care providers although they're using

apps they haven't yet gotten to the

point of recommending apps for their

patients and this is something that's

got to increase we've got to make sure

that providers are knowledgeable about

mobile apps and know how to evaluate and

make recommendations to their patients

about what apps might be the most useful

from them and I think providers are

still a little reluctant to do that and

we as educators must begin to educate

our populations to understand how to do

that because I will tell you the

patients go out and find it themselves

and you know they might not have the

skill sets to really evaluate whether or

not those are good mobile apps here's

some of the reasons why people use glo

mobile apps and why patients are

particularly using it a lot is for

tracking their goals that they might set

let's say fitness goals they want to be

aware of health issues some of them use

as motivation if any of you are on

Fitbit you know how you get your little

badges and you can join groups and you

can compete with groups to see who can

walk the most steps many use it for

medication or some use it for medication

adherence connecting with experts and I

think you're going to start seeing that

those will start to increase as more and

more providers and health care systems

begin to push the use of mobile health

when the Pew foundation who has been

studying the Internet has looked at this

and surveyed everyday people to see how

likely they would use mobile apps or

mobile health apps what they have found

is that eighty-five percent of the adult

population have access to a cell phone

with fifty five percent of them having a

smartphone now this was back in 2012 so

you can imagine that we've probably you

know increased in the number of people

who have access to cell phones as well

as those who now have smartphones the

most likely people to use mobile health

from their particular survey that they

had were 18 to 40 eight-year-olds that

were Latino African American and many

had college degrees so you can see that

population there are a lot of mobile

apps that are becoming accessible

hospitals will provide their own mobile

apps there are different organizations

like here's some examples from the VA

for some mobile apps that you can get

that patients can use as well as you

know you as a nurse might be able to use

they actually have the VA has an app

store some of the applications are for

patients and it you don't have to be a

VA patient some of the application

are targeted towards staff so there

might be some mobile apps that would

help a staff nurse others are truly

oriented towards the patient and all are

freely accessible the government has

also sponsored a lot of development of

apps that they want to make available to

the public so as you can see if you go

on to this particular website from the

government there are some apps that you

can recommend that look at PTSD how to

quit smoking there's a BMI calculator

there's things that are for asthmatics

as well as the last one is to solve an

outbreak by the CDC is really targeted

to healthcare professionals to see if

they understand how to sort of look at

epidemiology and some things to

determine an outbreak what we're also

seeing happening with these digital

tools is that more and more people are

starting to get access to what the

government calls consumer-facing tools

that's a term that the Institute of

Medicine and the federal government has

started to do that talks about the

access that people have from an

informatics perspective there is a push

from the federal government that if you

have an EHR that your patients should be

able to access that EHR and they should

be able to get access to their health

record for a variety of things or to a

health portal so here's an example of my

health connection which is my portal and

as you can see I can go in and do a lot

of things including sending messages I

get all my lab results I get a lot of my

results from other tests that come back

almost immediately as a matter of fact

it one of my

that I see he doesn't even bother

looking at the results of my blood test

till he comes in the room because he

knows I'm sitting there with my iPad and

I have the results at the same time he

does so he comes in and looks at the

results with me and we start to look at

things you can also get access to all

your health summaries when you have a

visit or when you're in the hospital you

can get information from in our case we

have access to the Get Well health

network so that if I click on a

particular diagnosis I can go out and

get information about that particular

diagnosis what you're also seeing in

hospitals is that they're beginning to

use these tools in the hospital setting

they are providing different tools that

the patients can use while they are in

the hospital or it might be their family

members to use well in the hospital this

happens to be an example of a study that

was recently done at brigham and women's

hospital and they have developed a

patient facing tool it's part of a

toolkit that they use with all

inpatients so as you can see patients

get a tablet when they come in and that

can be used by the patient or maybe

their family members or who might ever

be their caretaker they get to see

pictures of who's on their team and what

roles they play they get to see the

goals that the particular care team has

set for them they also get to add their

own goals that they would like to

achieve as they're in the hospital and

all of these things are then accessible

to all the providers as well as to the

patient and his family so when lab tests

come back they have access to that they

can see how far they are and the

it's really brought that patient into

the decision-making process it's kept

them informed they can learn about

things they can get access to

information to better understand the

drugs that they might be taking are the

procedures they may be having they can

access their team at any point in time

and one of the things that they

discovered was that by having this

information easily accessible to not

only the patient but the whole team it

got concordia across the providers in

terms of the goals that they were

setting for a particular patient and

including the patient's preferences for

certain goals and activities when we

think of a connected health we can also

think about how we can provide people

that may be in different states of

wellness or illness and provide them

access to healthcare information and to

make connections I was recently in the

fall down at the Tampa VA and I was

working with some of the informatics

nurses and they were showing me the

kinds of things that they were doing at

the spinal cord injury center to include

these patients and to get them to be

part of the healthcare team so this is

just a snapshot from that video but the

video is in the previous slide and here

is a patient who is a spinal cord

patient who is actually connected up

through what they call a sip and puff so

this sip and puff allows them to

interact with what they call a quad Joe

thing that then connects to the computer

so here this particular patient can use

some of the entertainment by playing

chess and can also sort of stay involved

with their health

they can ask questions they can go read

stuff they can stay in contact with the

outside world utilizing these tools and

you know these are all done through

these assistive devices to keep them

connected with their health as well as

connected to the people that might be

worried about them I think we're going

to see more and more of these kinds of

connected care visits and we're going to

see that virtual patient visits are

going to become more and more important

particularly as we try to manage the

growing number of seniors I happen to be

a member of AARP be an old and there's

lots of things that they're talking

about to really encourage their

membership to be come very active in

their healthcare and to begin to use

different tools they mention in their

articles and you know almost on a

regular basis about health apps about

signing up for your patient portal

asking about disease monitoring getting

connected into what they call

crowdsourcing or things like websites

like patients like me so you can talk to

other patients that may have your

diagnosis how you could use this to help

stroke victims fitness devices how to

set up to have virtual meetings with

your doctor or clinician virtual

counseling sessions and how can you

provide in house verchiel conferencing

the VA has been very very aggressive

with this in providing virtual visits

their virtual visits kind of started off

with you going to a provider and having

it from provider to provider then they

started doing clinical visit

that were really focused on home

monitoring and this is an area where

they see is going to be their greatest

growth in having their patients set up

to be able to be monitored at home and

have video visits for many of you on the

East Coast you probably know of CBS and

that they have minute clinics that are

really managed primarily through nurse

practitioners well they have announced

that they have formed relationships with

three different companies so that they

are now going to be able to do virtual

visits so you don't even have to now

drive to the CVS you can actually do a

virtual visit unitedhealthcare also has

the setup if you've never seen their

video this is a great little video where

you can see people at home and a little

accident that occurs and how they

connect with their physician after the

accident from their house again you know

we are thinking and having to think

about how do we prepare the next

generation of nurses and nurse

practitioners in particular who are

going to be engaging with their patients

whether it's a primary care visit or its

monitoring a discharge patient through

video connections so here's some just

some pictures of equipment that we

actually purchased off of Amazon to be

able to use at home for patients to

monitor their blood pressure they can

monitor their blood pressure you can get

a digital stethoscope you can get a

digital weight scale you can get a pulse

oximeter as well as I said the blood

pressure cuff all things that we

purchased off of amazon.com and are able

to sort of give it to our patients and

then we can monitor our patients we've

actually begun to train our nurse

is how to do a virtual visit and here's

a nursing team which included the

patient is our 74 year old patient up

here on the top and then one is a nurse

and one is a pharmacist who meets with

this patient as a follow-up visit to

coordinate his care in his home I think

we're also going to see a big game

changer that's happening as we move from

sort of just having things on your phone

or your tablet as we move to

smartwatches and the SmartWatch you know

is now having different platforms on it

that are really allowing that we can

collect patient generated data and begin

to kind of allow patients to interact

Cerner and epic which are huge systems

have developed patient portals that

access through the health kit which then

connects to the Apple watch and we're

going to see this for any of the

different kinds of smartwatches Humana

has done a thing so that they can

connect with the smart watches to

actually have their patient share data

like from their Fitbit Stanford Hospital

has it going through an ipod touch

screen where their children that have

type 1 diabetes can interact and store

data and communicate back and forth

through the epic system with their

providers I think we need to think about

the fact that these watches that are

coming out are more than just data

collectors they really can become a

dashboard and yet what we're going to

see is that we're going to have patients

who are going to be able to kind of view

where they're going and what's happening

with their healthcare by visually just

looking at their watch you won't have to

even sign into a computer or a tablet

you're just going to be able to look at

your watch

so many believe that this is going to be

a really transformative opportunity that

we can really begin to bring that

patient and their data into our

ecosystem so that we can better utilize

that information to provide the best

care and at a lower cost to our

providers think about this as a game

changer particularly for maybe people

who are elderly and might not want to

use a computer maybe they want to be

able to just you know do something

that's familiar to them well a watch is

pretty familiar to everybody people can

understand that and imagine that you

would send home a patient with chronic

heart failure with their Apple watch a

digital scale some other things you know

and if you could do that and send that

home and spend that slight investment

you could probably save lots of money to

stop readmissions within a 30 day cycle

you know and I think you know people are

much more comfortable if they had a

watch that would remind them of when

it's time to take a particular drug or

how they can step on the the digital

scale and it would talk to their watch

and send their weight gain for that day

to their provider these are all things

that are considered part of the

connected health environment so what I

want to do in this very end before we

open up for questions which I forgot to

tell you if you had questions you could

write them and click on the question box

and we'll take questions at the end I

want to tell you what we see as the

informatics specialist role as you know

I coordinate a program in informatics at

the Masters level and what we're trying

to do in our particular pro

gram is to make sure that our

specialists when they leave our program

have knowledge and skills of digital

tools for connected health because we

want them to really work not only with

consumers but with the staff we want

them to help educate and give them

opportunities so that they can become

more comfortable with digital tools that

their patients might be using as well as

how they can use digital tools with

their patients we also want our

informatics specialists to really help

work on the design of these interfaces

you know the older you get the harder it

is to read so you know making sure that

you can increase the font sizes making

sure that there's some consistency with

how we design an interface is all the

roles of what informatics nurse

specialists do and they work with their

clinical partners they work with the

staff as well as the IT people to say oh

well if we're going to put together this

patient portal here are the things that

we need to be considering when we look

at that interface between the human and

the technology we also want those

informatics specialists to be thinking

about what are the positive and negative

consequences of all of this initially

when there was a lot of things happening

around staff communication and using the

EHR as a mechanism for communication we

found that some of these communications

dropped off and that the nurses weren't

talking to the physicians and the

physicians weren't talking to the nurses

and sometimes valuable information was

not exchanged as it had been in the past

so we need to be thinking about what's

going to be the positive consequence as

we live in this ecosystem of connected

care and of patients you know being part

of that care
and how do we you know really

incorporate them in there but make sure

that they do no harm informatics

specialists really need to also work

with how do we promote and engage

consumers what we have found in the

research that places that have a lot of

consumer engagement really have a lot of

providers who understand and utilize a

lot of the digital tools that then they

can promote that with the consumers and

that there are people that are available

to help consumers you know it's one

thing to Hanuma brochure it's another

thing to sit them down whether in the

waiting room waiting to see their

clinician and helping them login and

showing them how they might engage in

their healthcare informatics specialists

also are going to be key in developing

health campaigns to promote that usage

whether it's for the provider or whether

it's for the consumer and that they need

to have those knowledge and skills we

need to not think about everything just

being on paper but how do we use this

connected care to get health campaigns

out how do we start to say utilize you

know Twitter and these different tools

to inform people about drug recalls or

maybe inform people about making sure

they get their flu vaccines or making

sure that if they travel to the Olympics

that they're aware of the Zika virus the

other thing that you know we are really

providing for our informatics

specialists and promoting that they do

is that they become part of these

connected care teams you know it's

important as we look at

interprofessional care and as we look to

bring the doctors the nurses the

pharmacists the social workers whoever

as part of the team we need to be

thinking about

we bring that informatics specialist in

there too who can help us better use the

technology to really promote better

health better care at lower costs I also

want you to think about your role in

connected care as a nurse and the kinds

of things that you need to be involved

in I happen to have read topples book

many years ago and I started to rethink

about some of the things that he talked

about and he had a commencement speech

that he gave to new physician grads and

he had five questions that he asked them

and I thought well I'm going to steal

that idea and I'm going to talk about

some of the questions that I would pose

to current graduates to get them to

understand that we need to be getting

them engaged in this connected care

environment so here are some of the

questions for you to think about will

you and the care team include me as the

patient as an active partner in your

team will you and the care team advocate

for patient generated health data being

a part of the decision-making so that I

can choose the right digital tools to

capture that data that's most relevant

to my health condition will you and the

care team be supportive of my family or

caregivers being actively and maximum

Lee engaged in my care we you and the

care team share your clinical notes with

me this has always been an issue and

this has been something that's been very

difficult for staff to think about

sharing their clinical notes with

patients but there's a movement about

things called open notes that more and

more healthcare facilities are putting

in place

where clinical notes are being shared

with the patients and their providers so

that's something you'll start to see

more and more in the future will you in

the team leverage numerous forms of data

to inform my clinical decision making

let me give you a perfect example of

that if you're a diabetic patient and

you go in for your quarterly visits if

your provider only sees that the lab

results for the day of the visit they

really don't know what has happened to

you across that quarter but if they had

accents to patient generated health data

from your glucose monitor and they got

that data they could begin to look at

you know what happens across every day

rather than just that day and maybe give

you some different advice about how to

manage your health care and how to look

and deal with where you have spikes or

where you've had problems what kind of

corresponds with that what could you do

differently to modify your lifestyle to

make sure you don't have these

fluctuations in your glucose readings

number six will you in the care team

recognize health and health care goes

beyond the walls and provide care

through these different digital tools

this is going to be particularly

important to those Millennials who don't

want to have to take a half a day off

for work just to go see a primary care

provider they would rather sit down with

their smartphone and have their one hour

visit we you and the care team connect

me to other patients resources and

evidence-based practice so I can be more

informed about my decision making will

you and the care team helped to

transform the way I experience health

care and how that healthcare can be

delivered will you and the team provide

personalized care that's based not only

on clinical data but includes social and

behavioral measures as well as patient

references and last but not least will

you help me understand my health data to

make better decisions so this is where I

think that we need as educators to begin

to open up the world to our nursing

students and 10 staff nurses in practice

about connected care and where we are

going in the future and how informatics

specialists can really help you in your

organization's to utilize the digital

equipment to provide the best and safe

care for your particular patient

population so I want to thank you and I

will look to see what kinds of questions

we might have thank you dr. Skiba this

is Marge Riley again you've given us

lots of things to consider and think

about and reflect upon always

provocative I recently had the

experience that you talked about with

patient generated health data this past

weekend visiting a colleague and friend

in a major medical center here in the

new york city area and pulled up on the

smartphone the most recent labs that the

patient had drawn that morning and we

were able to look at them examine them

and then prepare questions that we were

going to pose when the the doctor came

around to speak with my colleague so

that was one example another example

about using digital tools some of our

students here at the School of

Professional Studies nursing program

were engaged with one of our clinical

partners to bring the information to the

patients as you say in a new format the

idea being that the initiative was

focused on health literacy and they used

ipads and had the students work on

developing an ibook to educate the

patients as they were in the waiting

room about different things that they

needed to know about their particular

ailments and illnesses so those are

really good examples that you

brought forth and again to talk about

actually being utilized in the clinical

settings right now is a really important

thing a couple of questions that came to

us here that were posed to us you

mentioned questions very thoughtful ones

about nurses considering how to prepare

themselves with this new environment how

can schools of Nursing or other health

care professionals prepare themselves

for professional being able to practice

in this new kind of environment what

kinds of things would be good for

programs to look at curriculums to

consider well i think you know there's a

lot of information out on the internet

and there are a lot of organizations

that are putting things forward

particularly around connected care there

is a center for connected care that's

out of the boston area and they have a

lot of webinars they have a lot of

handouts they have a lot of materials

that are accessible to people I think

you're going to see more conferences out

there where people are going to be

talking about connected care and using

this the Institute of Medicine has quite

a lot of information about consumer

facing tools and they did this as part

of their health literacy series and so

the information that is accessible

through the institute of medicine is all

there so all their presentations and any

links to tools any reports that they've

written are freely accessible to people

there the VA as I've mentioned has done

a tremendous amount and just you know

having access to many of those mobile

app tools and you know many of the

videos and different things that they're

putting out about connected care can

easily be used for educational purposes

and you know having them come in from

the different VA's to give presentations

to your students and demonstrating how

to do that would really be you know ways

that you as educators can bring that

information into your system great

suggestions thank you another question

that came up had to do with the growing

geriatric population and what has been

your experience in terms of promoting

digital access to health information

with that particular population are are

they embracing it are there tools and

strategies that can help make it more

acceptable to members of this population

group who might not feel so comfortable

with digital tools that's a great

question and I think that's one that

there's new research that's coming out

you know as we speak in terms of looking

at this I will tell you from talking

with AARP they have made connected

health a mission of theirs and so they

have really been doing a lot to provide

different kinds of opportunities not

only to talk about how to use it in

their health care but they've actually

developed a tablet that's a little more

user-friendly that the you know the

seasoned population can use that don't

really want to buy a computer we also

see that there have been several

research studies that have looked at

different ways to do some training and

to do some engagement with that

particular population and what they're

finding is that the older patient

who have kind of grown up in a non

computer world and do not feel

comfortable with that they have found

that their family members or their

caretakers become the ones who get

engaged in really utilizing the tools as

you look at the younger elderly if you

will sort of those that are you know if

you think about 60 to 70 something many

of them are much more comfortable what

they truly need is someone to sit down

and to engage them into using it and so

one of the small studies we did was if

we sat down with people and show them

how to get online using their cell phone

or their tablet and getting them logged

in and showing them where things were

and how to click around it and where to

look for things we found that there was

a greater likelihood that they came back

in and just again to you the system but

you know if you tell them if you hand

them a brochure and say you can get

access to it they don't do it all right

they need that extra step um I can get a

little touch it is and I think that's

where we've got to do more work with the

providers they don't have to be the ones

to do the teaching but they need to sort

of push it in their system that we need

some people who are available and

accessible to help people get on as well

as they need to be promoting the idea

that they should connect in as they get

used to the idea they're more likely to

use it again you bet I mean I think it's

a great place that we can have our

students do some training not only the

health literacy project that our

students did at early sat in the waiting

rooms and went through the iPads with

the with the patients and help them

learn how to access it and navigate it

and

found a good response with that as well

oh I yeah I think that's a perfect

perfect example of how you know agencies

can utilize that I have to tell you from

a personal experience I had a cat my

cancer journey and while I was in the

infusion center for my chemo injections

I got friendly with what we call the

Monday morning crowd we were all there

and I would say the majority of the

people that were there were older than I

was and they all had smartphones and so

one of the things that I did every

infusion is my goal was to at least

train three to five people during that

time frame and I swear the nurses were

ready to kill me some days because they

couldn't find me you know and I me

because I was kind of going up and down

the transfusion I mean the infusion

center sort of asking people if they had

would they be interested could I show

them let me show you mine and you know

we can get you logged in so you can do

this wow that's great Cheryl a keeper

Tim and then I think it's I think people

are willing to do it if they've got that

little personalized touch yes great idea

I know we're winding down here so we

have one last question that we hope that

you'll be able to respond to from there

was a question about what are your

thoughts regarding the interoperability

Isis that is really still a concern and

I think that the federal government the

office of the National Coordinator has

really put that as the number one thing

that they are pushing right now we are

looking at getting public comments about

the interoperability guidelines that

they're putting forward because they

really want to push that we have

interoperability between

personal devices as well as you know

Hospital devices and making sure that we

can do all the interconnections so from

a technical aspect I would foresee in

the next year or two we will have a lot

more of this figured out a bigger

problem is going to be how we do what we

call semantic interoperability you know

we all call things differently so a

patient might refer to themselves as

having high blood pressure but the

provider calls it essential hypertension

so we've got to kind of have some

mapping that needs to happen in the

background to make sure things get

matched up so that you know the patients

and sort of what they're thinking and

how they're using terminology matches up

with the terminology being used by

providers which you know even the

providers can't agree on terminology so

I think well that'll take a little

longer to get that semantic

interoperability but I would project as

we look at the technical piece of it

that interoperability will happen

quicker well thank you very much again

for your time today for your wisdom

great topic a lot of things for us to

think about and consider we appreciate

your presenting this as we host here at

the CUNY School of Professional Studies

nursing program and I want to thank dr.

Diane Skiba for her expertise and

sharing informatics in a connected

health care environment today those of

you who have registered for today's

webinar we we do have some slides that

will make available to you and we will

do some editing and make the recorded

session available to you as well thank

you again everyone for all of your time

and thank you again dr. Skiba thank you

so much dr. Ali for inviting me

have a great day thank you