Nursing and Informatics for the 21st Century - Embracing a Digital World, Book 1

Realizing Digital Health - Bold Challenges and Opportunities for Nursing

Connie White Delaney, Charlotte A. Weaver, Joyce Sensmeier, Lisiane Pruinelli, Patrick Weber, Connie White Delaney, Charlotte A. Weaver, Joyce Sensmeier, Lisiane Pruinelli, Patrick Weber

• Publisher: Productivity Press
• Year: 2022
• ISBN:
  9781000573381
• Edition: 3
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

In just the past decade, the emergence of digital health has finally become palpable. Enhanced by the pandemic, social justice events, and planetary health urgency, Realizing Digital Health – Bold Challenges and Opportunities for Nursing explores that evolution with a focus on capturing the current state of digital health. Anchored in an introduction to digital health, new technologies, opportunities, and challenges are described. Consideration of the opportunities and challenges of digital health calls for specific attention to ethical considerations. This book includes a current state synopsis of healthcare in the USA, with the inclusion of specific implications for nursing leaders and executives. Engagement of the people (patients, families, communities) working in partnership to enhance health is described. Information management and the necessary definition and access to data are discussed with a particular explication of the function of information management and operational decision-making. The challenges and learnings related to informatics drawn from the experiences of leaders in large health systems shed insight into the current state of informatics-enabled digital health and healthcare. The global example of the integration of technology, nursing, and health systems expands our knowledge of the current state as well as explores possibilities. This book concludes with a commitment to and description of the current state of teamwork and the integral role/functions within informatics, nursing, and healthcare.

This book provides the reader with a succinct overview of digital technologies, a reality-anchored description of the current state in the USA and globally and highlights the core foundation and integration of informatics and information management. This book stimulates thought and actions to advance digital health within a full partnership among the people, organizations, systems, and global imperatives including planetary survival. This book lifts up the next era calling for full teamwork, collaboration, and partnership as we emerge into a true global community.

Nursing and Informatics for the 21st Century – Embracing a Digital World, 3rd Edition is comprised of four books which can be purchased individually:

Book 1: Realizing Digital Health – Bold Challenges and Opportunities for Nursing

Book 2: Nursing Education and Digital Health Strategies

Book 3: Innovation, Technology, and Applied Informatics for Nurses

Book 4: Nursing in an Integrated Digital World that Supports People, Systems, and the Planet

Chapter 1 Digital Health Ecosystems: A Strategy for Transformation of Health Systems in the Post-Pandemic Future

Anne W. Snowdon

DOI: 10.4324/9781003054849-1

Contents

Introduction

Evolution of Health Information Technologies

Mainframe Computer Era (1950–1960)

Health IT Era (1970–2000)

eHealth Era (2000–2020)

Digital health (2020 and beyond)

The ‘Empowered Consumer’

Defining Digital Health

Digital Health is Defined in Terms of the Type and Use of Digital Technologies

Digital Health Definitions Focused on Improvement of Healthcare Delivery

Digital Health as a Strategy for Health System Transformation

Digital Health Frameworks and Concepts

Digital Health Ecosystems

Person-enabled Healthcare

Predictive Analytics

Governance and Workforce

Interoperability

The Role of Nurses in Digital Health Ecosystems

Summary

References

Introduction

Healthcare systems are facing unprecedented challenges, including an aging population, managing a global pandemic, persistent growth of chronic illness, workforce shortages and healthcare costs growing far beyond GDP growth in almost every country. These challenges threaten the sustainability of every global health system and may preclude the capacity of health systems to ensure equitable access and health outcomes for every global citizen. Non-communicable disease conditions continue to place growing demands on an already fragile healthcare system as 60% of Americans experience chronic health conditions and 40% have two or more conditions, costing US health systems over $3.8 trillion annually (National Centre for Chronic Disease Prevention and Health Promotion, 2021). More recently, COVID-19 and related ‘long hauler’ sequelae are contributing to additional chronic health conditions as people recover from the COVID-19 virus. Sustainability and equity of health systems in the post-pandemic future is a renewed priority for every country in the world.

While health systems have struggled to manage the many demands for care delivery, consumers and populations continue to place growing expectations on health systems for equitable healthcare access and outcomes, and more personalized approaches to care delivery, particularly services focused on health and wellness (Statista, 2019). Consumers are now able to connect virtually to health teams, global experts and health organizations and have access to a wide range of health services through internet-based technologies. Reliance on virtual care services offered a lifeline to many global citizens during the COVID-19 pandemic as in-person healthcare services were suspended in an effort to contain the spread of the virus. The rapid shift toward virtual care delivery has resulted in heightened expectations among consumers for access to digitally enabled care. As health systems emerge from the pandemic, there is a renewed urgency to advance digital capacity across health systems in order to support access to healthcare services, support more equitable outcomes for populations and advance health system performance and interoperability that will be required to achieve sustainability well into the future.

This heightened ‘consumerization’ of healthcare is emerging rapidly as individuals are empowered to make health decisions and lifestyle choices fueled and enabled by the growing market of digital tools, wearable technologies, and health ‘apps’ currently available in the consumer market. Yet, health systems have struggled to keep pace with the rapid evolution of digital health technologies resulting in a disconnect between the health and wellness tools consumers are using and healthcare system information infrastructure that has not achieved the technical capacity (e.g., interoperability with consumer applications) to support consumer use of these technologies. As a result, health systems have not been able to engage patients or populations meaningfully to connect them in a way that supports and enables the achievement of personal health and wellness goals. Moreover, there remains a disconnect between the disease-focused health system and what consumers now demand from health systems; a personalized system that fits with their health and wellness needs and unique life circumstances (Snowdon et al., 2014). Evidence-based care pathways today guide a variety of health services, treatments care delivery within a standardized model where there is limited, if any, ability to personalize care strategies to fit with the unique needs, values and life circumstances of every individual person, community or population. Moreover, care pathways have had a limited focus on self-management tools and technologies to meaningfully engage people in managing their health and wellness. The post-pandemic future of healthcare will need a more modernized approach, one that facilitates meaningful relationships between providers and patients in digital societies, where much of the world’s population lives today, focused on approaches that support and sustain health and wellness while proactively preventing illness. A digitally enabled health system focuses on personalized care, leveraging digital technologies to deliver care that is equitable, personalized and prioritizes the overall wellness of a patient. The key to closing the gap requires offering a personalized approach to care delivery while operating within sustainable financial models that offer choice, equity and personalized health services.

This chapter provides an introduction to digital health, beginning with the origins and evolution of digital health, an analysis and definition of digital health, the four key dimensions of digital health and the role of nurses in advancing the transformation of health systems toward digital health ecosystems of tomorrow.

Evolution of Health Information Technologies

Digital health has been described as an era (Rowlands, 2019), a progression along an evolutionary pathway of information and communication technologies (ICT) in healthcare. Digital health extends well beyond adopting technologies to ‘digitize’ today’s care delivery services. Rather, digital health constitutes a transformation of care delivery that transcends technologies to transform and modernize care delivery and health system operations. Digital health as an era is embedded in the evolutionary changes in information technology within the four industrial revolutions illustrated in Figure 1.1.

Figure 1.1 The Four Industrial Revolutions and Progress of Health Systems (adapted from Murray (2016) and Topol (2019)).

Digital health has evolved as information technologies have emerged within the four documented industrial revolutions. This represents a major shift in care delivery and mobilization of data in healthcare systems, presenting an opportunity to transform traditional provider-centric systems focused on disease management, toward a more patient-centric, proactive system focused on supporting and sustaining health and wellness. Big data, advanced analytic tools and artificial intelligence (AI) technologies are the key enablers of the ‘fourth industrial evolution’—the transformation toward digital health. Although almost every other business sector has transformed its operations and delivery of services, including travel, financial services and retail, by leveraging data and analytics to improve business services, healthcare is noticeably lagging compared to other business sectors. While other sectors have embraced technology to enhance the consumer experience, healthcare has remained slow to transform established practices and care delivery models to advance person-centric care delivery and health services that are digitally enabled.

Mainframe Computer Era (1950–1960)

Health information technology began in the early 1950s and 1960s with the introduction of mainframe computers. While mainframe computers were adopted readily by all business sectors, there was only minimal impact in the health sector. Mainframe computers advanced corporate functions in a substantive manner but had little impact on care delivery processes.

Health IT Era (1970–2000)

In the second evolutionary phase of health technology, ‘Health IT’ emerged as health informatics as a discipline evolved and problem-oriented health records were implemented. Over the course of this 30-year period, personal computers came into the consumer market and health IT departments advanced and deployed Enterprise IT systems to manage corporate information in health organizations, such as hospitals. The primary focus of health IT included logistics and organizational functions with a major focus on performance management systems. Examples included systems such as human resources management and finance.

By the late 1990s, the personal computer became normalized, as telecommunication networks and modern software became integrated into hospital systems (Rowlands, 2019).

eHealth Era (2000–2020)

The new millennium ushered in the era of eHealth where healthcare practices were more directly supported by communication and information technologies and computer systems and digital technology (World Health Organization, 2012). Health systems were facing substantial growth in chronic illness (e.g., non-communicable illness), which required a significant need for quality and safety data to inform care delivery.

Consumerism of healthcare has advanced dramatically since 2000 with the rapid evolution of health applications available to consumers worldwide. These were often deployed on smartphones offering consumers personalized health services ‘in the palm of their hand.’ This era of eHealth dramatically shifted consumer access to health information. This access continues to fuel consumer empowerment and self-management of their health and wellness. The eHealth era focused more directly on patient care delivery, whereby digital technologies were adopted to inform provider-directed care leveraging evidence-based care pathways. Likewise, e-commerce emerged during the eHealth era, focused on enterprise-wide shared health records, known as the electronic medical record (EMR), and later referred to as the Electronic Health Record. These were implemented across entire health systems. The first Electronic Healthcare Record (EHR) technologies digitized patient information, making it clearer to read and more accessible to healthcare practitioners across different healthcare institutions (Evans, 2016). The eHealth era significantly advanced the emergence of consumerism in digital societies, as new telecommunications and larger bandwidths enabled health tools and applications designed directly for the consumer, that provided every person with access to personalized tools such as wearable devices and personalized health applications (Rowlands, 2019). As telecommunications boomed, so did digital phone applications (known as ‘apps’), offering the opportunity for people to actively engage and manage their own health and wellness, using apps and wearable technologies available in the consumer market. The rapid advancement of digital technologies for consumers continues to evolve, fueling self-management of health and wellness care, moving well beyond the traditional role of ‘recipient of healthcare’ typically focused on disease management, toward the role of proactive decision-maker in managing personal health goals (Rowlands, 2019).

Digital health (2020 and beyond)

Digital health is now considered an evolutionary leap that will transform healthcare systems from the provider-focused system of today, toward the digital health ecosystem of tomorrow. In this ecosystem of the future, individuals and populations will be actively engaged and empowered to manage their personal health and wellness, supported by provider teams accessible within digital societies. The digital health era is enabled by the integration of artificial intelligence (AI), which mobilizes big data from multiple sources (e.g., clinical data sources, personal health data sources), to support advances in predictive analytics able to proactively identify risk, and inform prevention efforts to mitigate risks and protect or sustain health and wellness. Digital health mobilizes information technologies such as AI, robotics, machine learning, internet of things, self-help applications, virtual reality and many others. Advances in these and other technologies are anticipated to enable health system teams to participate actively in digital societies where consumer demand or need for health services can be responsive when and where care is needed, and mobilization of data from multiple sources (e.g. wearables, apps, smartphones) can be integrated into care delivery processes to support personalization of care delivery.

The era of digital health puts the person at the center, thus transforming the relationship between health and patient (Rowlands, 2019). This era makes it possible to personalize and diversify care delivery, focused on the unique needs of every individual person. In digital health, rapidly emerging information technologies will enable a strategic shift from today’s reactive approach to care delivery focused on diagnosis and management of disease toward a more personalized and proactive approach to supporting health and wellness. New digital technologies and access to information delivered in the palm of the hands of the person, creating and owning their personal health data, shifts the relationship from patients who are recipients of care toward person-centric care models where health providers partner with individuals to support their health journey and life course. The digital health era places a new urgency on interoperability within and across health systems and digital societies where people participate. Interoperability will enable seamless, safe and secure integration of multiple sources of data to enable and inform personalized, data-driven decision-making across health systems.

The evolution of health and information technologies and the four eras which have now enabled the era of digital health provide an important historical context for examining digi...