Internet & Audiology ehealth in the large perspective Annette Cleveland Nielsen, PhD ehealth Researcher

Transcription

1 Vingstedkursus, August 2016 Internet & Audiology ehealth in the large perspective Annette Cleveland Nielsen, PhD ehealth Researcher

2 Presentation overview 1. ehealth in general What is ehealth? ehealth drivers ehealth and Big data 2. ehealth and audiology ehealth activities and Hearing Aids A Systematic Review Self-fitting Hearing Aid Rehabilitation 3. ehealth in the future ehealth trendbarometer Interventional audiology ehealth for Hearing

3 1. ehealth in general What is ehealth? ehealth drivers ehealth and Big data 2. ehealth and audiology ehealth activities and Hearing Aids A Systematic Review Self-fitting Hearing Aid Rehabilitation 3. ehealth in the future ehealth trendbarometer Interventional audiology ehealth for Hearing What is ehealth?

4 ehealth in general:teaser - Vision ehealth 2025

5 ehealth in general Emerging field of medical informatics Not only a technical development A new way of working, an attitude, and a commitment for networked, global thinking Improving health care by using ICT Gunther Eysenbach, 2001 Editor of Journal of Medical Research and modified by Pagliari et al., 2005 Use of information and communication technologies (ICT) for health Improving the flow of information through electronic means Support the delivery of health services and health systems World Health Organisation (WHO), 2012 WHO, 2016 expands: Covers many domains, including electronic health records, mobile health and health analytics Put information in the right place at the right time Providing more services to a wider population and in a personalized manner

6 ehealth in general: And mhealth, digital Health, Interventional Audiology National ehealth Infrastructure (Unique ID, Summary Care Record, Disease Registries, Image Archives, Portals etc) Acute/Secondary Care Patient Administration Clinical Departments (Radiology, Pathology, Theatre etc) Tertiary Care Community Care Public Health Case Management ehealth Primary Care GP Systems Order Entry Prescriptions etc Modified from: John Crawford, Healthcare Industry Leader, Europe IBM Industry Academy Member mhealth Connected Health Interventional Audiology Home Office Mobile Information Communities Health Monitoring Disease Management Connected Devices Digital Health

7 ehealth in general: The possibility of remote medical consultations via radio in 1924!

8 ehealth in general: Internet of Things (IoT)

9 ehealth in general: The most advanced technology used in everyday life? Smartphones, computers, tablets, smart watches? Did you think about hearing aids (HA)?

10 ehealth in general: Internet of Things and audiology

11 1. ehealth in general What is ehealth? ehealth drivers ehealth and Big data 2. ehealth and audiology ehealth activities and Hearing Aids A Systematic Review Self-fitting Hearing Aid Rehabilitation 3. ehealth in the future ehealth trendbarometer Interventional audiology ehealth for Hearing ehealth drivers

12 ehealth drivers: Technology and evolution Mobile phones GSM Association, 2015

13 ehealth drivers: Demographics and diseases A. Developed countries B. Developing countries (ex. Sub-Sahara) C. Sub-Sahara countries

14 ehealth drivers: Burden of disease in Denmark >1.5 million people with 1 chronic disease % of healthcare costs due to chronic diseases like hearing loss (HL) Increasing elderly burden and healthcare expenses 36 % more Danes 60 years within 35 years - in 2015: in 2050: % higher public healthcare expenses - from 2004 to 2014 (170 billion D.kr. In 2014) Government decision to increase quality of healthcare, especially on chronic diseases through Sundhedsplatformen focusing on: Patient focus, engagement and empowering Cost-effectiveness Access to healthcare From May 2016: professionals and 2.5 million patients One system, one data place HCP treatment decisions and overview of follow ups Placing demands on patients ehealth literacy etc.

15 1. ehealth in general What is ehealth? ehealth drivers ehealth and Big data 2. ehealth and audiology ehealth activities and Hearing Aids A Systematic Review Self-fitting Hearing Aid Rehabilitation 3. ehealth in the future ehealth trendbarometer Interventional audiology ehealth for Hearing ehealth and Big data

16 ehealth and Big Data: Not just a matter of volume Characteristics of Big Data Source: IBM Institute for Business Value, 2012

17 ehealth and Big data: Analytics is making predictions, and optimization of outcomes Advanced, Predictive Foundational Rear-mirror view Basic reporting Spreadsheets Transaction reporting Real-time (or nearly) Dashboards Clinical data repositories Predictive models Outcomes analytics Natural language Machine learning Personalised healthcare Population risk models Optimising care systems Cognitive computing Used for many things Marketing Roskilde Festival Sundhedsplatformen Modified from: John Crawford, Healthcare Industry Leader, Europe IBM Industry Academy Member

18 ehealth and Big data: What is the potential of ehealth + Digital Health? Transform the ambition, design and operation of our systems of health care digital re-invention Give us all more control of our own health, well being and ageing Use data to make care personalised, preventive, participatory, predictive, effective and safe Concerns for elderly clients and relationships in treatment Modified from: John Crawford, Healthcare Industry Leader, Europe IBM Industry Academy Member

19 ehealth and Big data: Hearing Aids as in-earsensors 1. Surveillance/ Treatment (Epilepsia, diabetes through EEG) 2. Rehabilitation 5. Patient empowerment (Dizziness, fall accidents, immobility EEG and accelerometer warnings) Individual Health and Hearing Aids (Hearing loss usage data, EMA data, difficult listening) 4.Fitness and training (Stress and fatigue monitoring and warnings) 3. Disease monitoring (Blood pressure, stroke)

20 1. ehealth in general What is ehealth? ehealth drivers ehealth and Big data 2. ehealth and audiology ehealth activities and Hearing Aids A Systematic Review Self-fitting Hearing Aid Rehabilitation 3. ehealth in the future ehealth trendbarometer Interventional audiology ehealth for Hearing ehealth and audiology

21 ehealth Activities and Hearings Aids - A Systematic Review Elisabeth Ingo, PhD student Caitlin Grenness, PhD Ariane Laplante-Lévesque, PhD Annette Cleveland Nielsen ehealth Researcher, PhD

22 ehealth Activities and Hearings Aids A Systematic Review Objective: Overview of the newest ehealth and hearing aids Activities Efforts Concerns Search questions: 1. Which ehealth activities are used in the adult hearing loss client journey in the context of hearing aids? 2. What are the facilitators and barriers to the successful implementation of ehealth in this area? Found 46 relevant publications published to

23 Records ehealth and Hearing Aids (HAs) publications and ehealth platforms 20 85% (39) publications last 6 years and of these 49% (19) in % (7) publications first 5 years DVD, PC or telephone Online and internet Apps and mtech Across platforms

24 ehealth and HAs publications ehealth services in percentages % of ehealth activities are within Online and internet and Apps and mtech Internet info on HL, client empowerment, HCP interaction Apps for interactive atlases, simulations of HL Apps for selfmonitoring of HL Internet for remote fitting, Apps and mobile phones as HA Auditory training with DVDs, Online rehabilitation Apps for rehabilitation Communication aids and alerts 5 0 Education and information Self-testing Sound enhancement with HAs or other devices Rehabilitation programs DVD, PC or telephone Online and internet Apps and mtech Asistive tools

25 Patient/client motivations also within audiology Systematic review ehealth and HA 75% of clients not heard of ehealth An important factor clients that had previously heard about ehealth and used the internet for health-related matters were more inclined to use ehealth in audiology 32% were willing to use a ehealth appointment, 10% sometimes, 28% unsure, and 30% not willing (Eikelboom & Atlas 2005)

26 ehealth concerns among medical doctors and audiologists (HCPs) Systematic review ehealth and HA HCP receptive to: Exchange of information (i.e. answering questions or providing counseling and aural rehabilitation), Clients living in remote locations Clients experience mobility or transportation limitations (Singh et al. 2014) HCP concerns: Data security and privacy with the risk of misuse of personal data Lack of ehealth policies and legislation Lack of reimbursement models of ehealth services Connectivity issues and limited internet access in some parts of the world

27 Facilitators Across all ehealth activities: Cost and time efficiency Rehabilitation programs: Home-based flexible solutions at own pace and time Awareness and motivation raising

28 Facilitators continued Apps and mtech: 4.99 An abundance of low priced apps increasing individualization and client involvement Online and internet: High internet use some countries, significant others facilitating and easy/neat design

29 Facilitators continued Across platforms: Innovative technology within many areas of audiology Reach previous unreachable persons with HL geographical and client groups Paradigm shift towards a personalized client centered journey

30 Barriers Across all ehealth activities: Data security/privacy Connectivity issues and Internet access Rehabilitation programs: Client adherence ehealth literacy and disabilities/skills to understand online info

31 Barriers continued Apps and mtech: Quality, reliability of apps, misuse and privacy of data, readability of information Online and internet: Low readability, update of websites, vision and reading difficulties

32 Barriers continued Across platforms: Lack of ehealth policies and legislation, privacy of data, lack of re-imbursement

33 Main conclusions of Systematic review ehealth can open for new possibilities in audiology a paradigm shift Give individually tailored cost and time efficient audiologic client journeys Open up for holistic interventional audiologic service Concerns regarding quality and reliability of apps, legal frameworks, data safety and re-imbursement models Underpowered studies with poor external validity, and thereby dubious reference to the target population, cannot support effective evidence-based policy decisions regarding ehealth implementation

34 1. ehealth in general What is ehealth? ehealth drivers ehealth and Big data 2. ehealth and audiology ehealth activities and Hearing Aids A Systematic Review Self-fitting Hearing Aid Rehabilitation 3. ehealth in the future ehealth trendbarometer Interventional audiology ehealth for Hearing Self-fitting Hearing Aid rehabilitation

35 ehealth and audiology : Offer of self-fitting hearing aid rehabilitation is exploding Personal Sound Amplifying Products From Elizabeth Convery, National Acoustic Laboratories, Australia

36 ehealth and audiology : Offer of self-fitting hearing aid rehabilitation is exploding From Elizabeth Convery, National Acoustic Laboratories, Australia

37 1. ehealth in general What is ehealth? ehealth drivers ehealth and Big data 2. ehealth and audiology ehealth activities and Hearing Aids A Systematic Review Self-fitting Hearing Aid Rehabilitation 3. ehealth in the future ehealth trendbarometer Interventional audiology ehealth for Hearing ehealth in the future

38 ehealth in the future will: Offer quality Health Care Increase patient involvement Promote universal access Fully digitize Health Care delivery in 2020 Focus on the patient as a consumer Promote self-management of chronic diseases using health apps In audiology maybe increase auditory training and counselling Over 30% of audiologists provided auditory training in 1980s, but only 16% in 1990s (Schow et al., 1993) This decline not correlated to hearing aids with superior benefits or higher client satisfaction (Sweetow & Sabes, 2006)

39 ehealth and Hearing aids in the future Hearing aids Complex high technological products Wireless technology App development and much, much more Mobile phones have the potential to have as big an impact on global healthcare as Sir Alexander Fleming's 1928 discovery of penicillin. Kathy Calvin, CEO UN Foundation Permanently natural body worn sensor Surveillance - monitoring: 24 hours * 365 days = Cloud clinic

40 1. ehealth in general What is ehealth? ehealth drivers ehealth and Big data 2. ehealth and audiology ehealth activities and Hearing Aids A Systematic Review Self-fitting Hearing Aid Rehabilitation 3. ehealth in the future ehealth trendbarometer Interventional audiology ehealth for Hearing ehealth trendbarometer

41 Which ehealth tools would clients prefer?

42 Which app functions are most important?

43 Which future patient drivers do Health Care Professionals (HCPs) think is important?

44 Will there be future business potentials in ehealth?

45 1. ehealth in general What is ehealth? ehealth drivers ehealth and Big data 2. ehealth and audiology ehealth activities and Hearing Aids A Systematic Review Self-fitting Hearing Aid Rehabilitation 3. ehealth in the future ehealth trendbarometer Interventional audiology ehealth for Hearing Interventional audiology

46 Interventional audiology ehealth and interventional audiology Audiologists teaming up with other HCPs/GPs For a holistic perspective on clients Through data and predictive analyses For evidence based clinical decisions Solutions to the increasing elderly population globally Suffering from HL and other chronic diseases Those not using HA are more prone to cognitive decline (Amieva et al, 2015)

47 Interventional audiology Audiologists General practitioners (GPs) Audiologists propose holistic solutions for clients and are providers of health data for GPs, cardiologists, geriatric specialists, elderly home and familiy Hearing loss, social isolation HAs as in-ear-sensors for health and disease monitoring GPs work closely with audiologists on individualized evidence based holistic client health solutions and monitoring Cardio vascular diseases, diabetes, dementia, vision impairment Clients Clients expect individualized information, guidance and motivation on their health status monitoring, level of health and according to their ehealth literacy level

48 1. ehealth in general What is ehealth? ehealth drivers ehealth and Big data 2. ehealth and audiology ehealth activities and Hearing Aids A Systematic Review Self-fitting Hearing Aid Rehabilitation 3. ehealth in the future ehealth trendbarometer Interventional audiology ehealth for Hearing ehealth for Hearing

49 ehealth in the future: ehealth for Hearing Which services are most relevant to hearing healthcare? How can they be used in the future client journey? What will the role of the audiologist be? How do we preserve or empower good client-hcp relationships? Tognola et al (2015): ehealth for Hearing New views and apps practicalities

50 Acknowledgement Icons regarding facilitators and barriers from The nounproject.com

51 Vingstedkursus, August 2016 Internet & Audiology ehealth in the large perspective Annette Cleveland Nielsen,PhD ehealth Researcher