The transition of face-to-face care to telecare (care at distance using videoconferencing) requires new skills and knowledge for nurses and other health care professionals: eHealth competencies and also competencies on self-management support.

1. Transition of face-to-face care to
telecare in a homecare organisation
A new way of caring
Thijs van Houwelingen MSc,
Ansam Barakat MSc,
Prof. Dr. Helianthe Kort,
Holder Faculty Chair
Demand Driven Care
05/11/13
This project is part of the strategic area
„Healthcare & Technology‟ ,
University of Applied Sciences Utrecht

2. Background
Matter of transition
• Growing number of older adults &
decreasing number of care professionals
• Telehomecare can offer a potential
solution by supporting older adults to agein-place [Pountney, 2009] by substituting more
efficient e-visits for in-person
• Some Dutch homecare organisations are
dealing with the question: how can we
integrate telecare in our care pathways?
• Homecare organisations experience
barriers to implementation (Kort, Van Hoof, 2012).
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Goals
Phase 2
Method
Phase 2
Objective of project:
Obtain insight into
telecare possibilities for
homecare organisations
that did not yet implement
telecare
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

3. Background
Project – partners involved
Collaboration between
Research Centre Innovations in Health
Care [coordination]
“Which telecare
providers do we
have to select for
our pilot?”
“Which nursing
tasks can be
substituted by
telecare?”
Practice - Health Care Organisation
Rivas Zorggroep [facilitator]
Education - Students, Bachelor of Nursing
& Students Management in Health Care
[carried out the research]
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Goals
Phase 2
Method
Phase 2
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

4. Goals
Project
• Phase 1: Comparison
of four telecare
providers, aiming to
advice Rivas which
two telecare
providers to include
in their pilot
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Goals
Phase 2
Method
Phase 2
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

5. Method
Phase 1 – Comparison of telecare devices
•
1. Exploration of vision and values of
healthcare organisation and
demands with regard to telecare
2. Exploration of possibilities of four
different telecare devices
3. Scoring of telecare providers
•
Assesment of devices:
Comparison of demands of
organisation with possibilities
devices, resulting in a scoring list
Interviews
• Nurses
• Managers
• Project manager
Analyses of
• Outcome of workshops
• Vision of organisation
Interviews with
telecare providers
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Goals
Phase 2
Method
Phase 2
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

6. Results
Phase 1 – Comparison of telecare devices (a)
Examples of demands of homecare organisation with regard to telecare
Application of device
• Possibility to monitor
• Puff inhalation COPD
patients
• Wound care
• Medication intake
• Communication with
dietician at distance
Offer of education
Completeness of the course
Functions
• Connection with other
platforms
• Additional possibilities,
non-care related, such
as: gaming, grocery
shopping service
Service
• Security criteria
(requirement of Dutch
health insurance)
• Service desk, in case
of emergency
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Goals
Phase 2
Method
Phase 2
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

7. Results
Phase 1 – Comparison of telecare devices (b)
Table 1. Comparison of (a) demands and (b) possibilities of devices
Demands
and
requirem
ents /
Telecare
supplier
Applicati
on of
device(m
aximum
score =
56 points)
Function
s of
device
(maximu
m score =
21 points)
Service
of device
(maximu
m score =
42 points)
Offer of
training
(maximu
m score
14)
Total
score
(maximu
m
score133
points)
Device a
++ (55)
++ (19)
+/- (25)
++ (13)
112
Device b
++ (53)
++ (20)
+/- (28)
++ (12)
112
Device c
++ (55)
++ (20)
- (24)
+ (11)
110
Device d
+/- (38)
+/- (14)
-- (14)
+ (10)
76
Goals
Phase 2
Method
Phase 2
Conclusion (phase 1)
• Three of the four
telecare providers
showed a
comparable level of
quality
• One telecare
providers failed in
particular on
„functions‟ and
„service‟
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

8. Goals
Project
• Phase 2: Exploration
of care tasks that can
be substituted by
telecare
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Goals
Phase 2
Method
Phase 2
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

9. Method
Phase 2 – Exploration of telecare tasks
1. Development of a complete
list of care tasks, provides by
the homecare organisation
Interviews with district nurses of Rivas
2. Estimation of time required
for each task
Based on experience of nurses and
their managers
3. Assessment of care tasks:
which tasks can be provided
via telecare?
4. Estimation of time for each
possible telecare task
5. Reach consensus of tasks
that can be substituted and
times that can be saved in
this particular organisation
According to:
• Representatives of the two
selected devices
• Homecare organistions that already
use telecare
In collaboration with district nurses of
Rivas
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Goals
Phase 2
Method
Phase 2
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

10. Results
Phase 2 – Exploration of telecare tasks (a)
Care tasks that can be substituted by telecare /e-visits
•
•
•
•
•
•
•
•
Inhalation with nebuliser
Subcutaneous injection
Stoma care
Medication intake monitoring
Structuring conversations
Blood pressure measurement
Glucose value measurement
Et cetera
In total 55% of the 97 care tasks can be done trough telecare…
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Goals
Phase 2
Method
Phase 2
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

11. Results
Phase 2 – Exploration of telecare tasks (b)
and 67% when combining telecare and family carers
However…
Managing 55% of the care tasks instead of providing
them directly, sets high demands on older adults‟
willingness to play an active role in their care process
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Goals
Phase 2
Method
Phase 2
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

12. Discussion
Implications for self-management
So, the transition of face-to-face care to telecare has great
implications for self-management of patients
At the same time, recently (2013) a Dutch survey observed
that “few Dutch older adults choose to use self-management
tools” [Krijgsman et al., 2013]
On of the reasons that UUAS in 2011 already started the
PETZ-project: Predictors for the Use of eHealth by Older
Adults and Professionals (www.petz.hu.nl)
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Goals
Phase 2
Method
Phase 2
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

13. Discussion
Implications for nursing practice
New eHealth competencies are required [Barakat et al., 2013], for example
• Have basic skills for using technology and hardware
• Ability to treat and diagnose effectively at a distance
• Know and be able to translate the benifits of eHealth
technologies to end users (http://www.medicine20.com/2013/2/e10/)
A changing role: less providing care directly, more coaching
Coordinating care, carried out by the patient himself or
his family carers (self-management)
Barakat et al., (2013). eHealth Technology Competencies for Health Professionals Working in Home Care
to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative Workshop. Medicine 2.0.
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Goals
Phase 2
Method
Phase 2
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

14. Conclusion
Future challenges for research and nursing
education
Future research
– More evidence on competencies required for telecare /
eHealth [Van Houwelingen et al., 2013]
– More evidence on competencies required for selfmanagement support
Nursing education
Nursing schools should take the responsibility to offer an
adequate preparation for the rapidly changing health care
sector:
• Education on eHealth
• Education on self-management
Van Houwelingen et al., (2013). Using the Unified Theory of Acceptance and Use of Technology to Explore
Predictors for the Use of Telehomecare by Care Professional. Assistive Technology Research Series, 33:
Assistive Technology: From Research to Practice.
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Background
Background
Project
Goals
Phase 1
Method
Phase 1
Results
Phase 1 (a)
Results
Phase 1 (b)
Goals
Phase 2
Method
Phase 2
Results
Phase 2 (a)
Results
Phase 2 (b)
Discussion
Self-manag.
Discussion
Nursing pract.
Conclusion

15. Thank you for your
attention!
Thijs van Houwelingen
thijs.vanhouwelingen@hu.nl
/
www.innovationsinhealthcare.research.hu.nl
A special acknowledgment goes to Angela van Ark, Maartje van Oorschot, students
Management in Healthcare, and Maria-Lotte Haagsman, Romy van Ruitenbeek,
Sharron Jalimsing, Conny van Ruitenbeek, students Bachelor Studies of Nursing,
University of Applied Sciences Utrecht. We are thankful for the effort they have put into
this research.
References
[1] Pountney, D. (2009). Telecare and telehealth: enabling independent living. Nursing & Residential Care, vol. 11, p. 158.
[2] Krijgsman, Johan, Jolanda de Bie, Arina Burghouts, Judith de Jong, Geert-Jan Cath, Lies van Gennip, Roland Friele. eHealth, verder dan je denkt:
eHealth-monitor 2013. Den Haag: Nictiz en NIVEL, 2013. url
https://www.zorgkennis.net/downloads/kennisbank/ZK-kennisbank-eHealth-monitor-2013-1928.pdf
[3] Barakat A., R.D. Woolrych, A. Sixsmith, W.D. Kearns, H.S.M. Kort. eHealth Technology Competencies for Health Professionals Working in Home Care
to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative Workshop. Medicine 2.0, 2013, 2,
e10. doi:10.2196/med20.2711.
[4] Houwelingen, T. van, A. Barakat, A. Antonietti & H. Kort (2013). Using the Unified Theory of Acceptance and Use of Technology to Explore Predictors
for the Use of Telehomecare by Care Professionals. In: P. Encarnação et al. (Eds.), Assistive Technology Research Series, 33: Assistive Technology:
From Research to Practice (pp. 1223 - 1228). IOS Press, Amsterdam. doi: 10.3233/978-1-61499-304-9-1223
[5] Kort, H.S.M., J. van Hoof (2012). Telehomecare in The Netherlands: Barriers to Implementation. International Journal of Ambient Computing and
Intelligence, 4(2), 64-73. doi: 10.4018/jaci.2012040105
Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl
Transition of face-to-face
care to telecare in a
homecare organization
A new way of caring
date
05/11/13