Patients benefit from access to Internet-based health information and communication resources but the maximum clinical benefit of consumer health informatics applications awaits integration of these tools with formal clinical services. Building on our successful WWW-based information and communication network, HeartCare, patient-targeted home-care service we will create "technology-enhanced-practice" (TEP) an approach to home care nursing augments the clinical nursing services with electronic information and communication resources.
We will work with Aurora Health Care Systems, Milwaukee , WI , to conduct a randomized field experiment. This extension of HeartCare will use human factors engineering design strategies to alter the original service with those deemed necessary to support the home care of patients with heart failure. This approach offers significant advantages over the emerging computerized passive home monitoring strategies by providing patients and nurses with relevant information and engaging patients in active self-monitoring and self-management. This study provides an opportunity to understand the context in which consumer health tools can be employed and the extent to which contextual factors affect the design of these tools. The specific aims of the project are to design TEP then evaluate its impact on the care of patients with CHF.
We will undertake a design strategy consistent with sociotechnical systems theory and current approaches to implementation of information systems. We will first use techniques of industrial engineering to conduct a Work Analysis of the home care nurses' practice to (1) identify aspects of the practice that could be enhanced by technology; (2) better characterize aspects of the clinical situation likely to be altered by the introduction of consumer health informatics tools. The industrial engineers, Aurora's expert cardiac nurses, and consumers will use the results of the work analysis to design a suite of electronic services including communication, personal health records, and educational materials. These services will integrate Aurora 's evidenced-based heart failure protocols. Next the TEP nurses will use local “practical” knowledge to plan how they will implement the TEP intervention into their practice. To equalize attention for the control group, electronic copies of nursing references and bulletin board services will be installed on their laptops. We will engage 400 patients and 20 care teams in a randomized field experiment. Key outcome variable include patient with care, patient self-management, and 30-day readmission rate.
The project benefits from a software licensing agreement between Cerner Corporation and Aurora Health Systems. Human subjects approval has been obtained.
To learn more about the initial HeartCare project click HERE.