Involving eHealth: How health care leaders may envelop chronic care management strategies with health information exchange directives
As chronic diseases are becoming a rapidly growing problem in the world, methods to manage and present medical information both to care providers and patients require several avenues of thought. Janet Marchibroda, MBA is the chief executive officer of the eHealth Initiative and its Foundation — both independent, national non-profit organizations based in Washington, D.C., whose missions are to improve the quality, safety, and efficiency of health care through information and information technology.
Janet Marchibroda has devised three plans to bring together chronic care management strategies with health information exchange directives: 1) Leveraging Health Information Exchange Efforts for New Chronic Care Management Programs, 2) Augmenting Existing Chronic Care Management Strategies with New Data Sets and Services from the Health Information Exchange, and 3) Extending the Ability to Communicate with Care Providers and Patients. To summarize these three strategies, the first implies by asking those involved in chronic care management what tools are already existent or lacking, e.g. ongoing health information exchange initiatives, if any; types of data being exchanged and to whom, and so forth. In other words, a system must be put in place to set a helping “leverage” in managing chronic diseases. Secondly, the next paradigm focuses on improving an already existing chronic disease management initiative. Missing data elements may be included here, as well as methods to improve the measurement of quality of care and cost effectiveness. Thirdly, the final theme emphasizes an active patient-practitioner relationship, and methods should be identified for the patients themselves to be actively involved with the regimen of treating their diagnoses and preventing the onset of worsening or secondary conditions.
With this in mind, there are also some recommendations that may improve chronic disease management. Databases of eHealth ought to have a storage of health indicators, determinants, and conditions. Certain conditions could each have a specific variable (with a proper categorization, i.e. what type of condition is it, e.g. autoimmune, etc.) assigned to them and a constantly updated list of symptoms (entered and updated by the care providers). The database could draw data of symptoms from each patient with a specific condition, and this should be accessible to health care providers to give them more clues for an accurate diagnosis and for the prevention of misdiagnosis. Finally, each of these specific conditions assigned with a variable should have a list of viable treatments and its strengths and weaknesses. These treatments could be taken from studies done in medical databases, i.e. PubMed, The Lancet, and contain and explore as many treatments as possible — both conventional and unconventional. The care provider informs the patient and/or family of the patient not only with the type of treatment they deem the most effective, but also viable alternatives. These methods of managing of eHealth may lead to effective treatment and prevention of chronic diseases.
Marchibroda JM (2008) The Impact of Health Information Technology on Collaborative Chronic Care Management. Journal of Managed Care Pharmacy 14:2, s3-10. Retrieved Apr 27 from: http://www.amcp.org/data/jmcp/JMCPSupp_March%2008.pdf
A topic not actively discussed includes the potential therapeutic effect of architecture as well as horticulture to produce an innovative effect in preventing or slowing the development of chronic disease. Could architecture regarding the application of human factors and re-engineering serve as a significant treatment for the elderly?
The Medical Architectural Research Unit (MARU) of London South Bank University evaluated some European cases of architecture that specifically targeted the elderly, as cited in the World Health Design organization’s website. Field visits from 2005-2008 included Finland, Spain, and France.
Various facilities that focus on dementia care were visited by MARU and offer innovative architectural experiences with holistic approaches that appear to influence the elderly. The Viola-koti of Tampere and Kamppi Service Centre of Helsinki facilities are highlights of Finland, and include human factors-oriented recreational facilities with special exercise activities and workshops; multi-level saunas; and buildings with bi-folding windows that give elderly a wonderful view of the on-goings of the world even in the times of cold, dreary winter months. Next, in Spain, the Madrid Alzheimer Centre has been engineered to conduct bio-mechanistic studies on the probable causes of Alzheimer’s, while at the same time influencing those staying at the clinic with units of residence all independent of each other in design – each topped with well-protected, inspiring courtyard gardens. By understanding ways to incorporate a whole spectrum of care, a central garden even is integrated as being part of a horticultural therapy program. Finally, in Paris, France, the Residence de l’Abbaye allows the elderly in a secure environment simulated as a ‘salon’ on a ‘street of activities’ to learn and discuss about the matters of modern politics and societal issues, keeping their worldly lore active and up-to-date.
This process of course is up to the human experience and how we each individually perceive phenomena. Therefore, architectural human factors and re-engineering would have – like any method of therapy – different effects on different individuals. Yet, the truth remains: an often under looked yet obviously significant stimulus is there, right before our eyes, influencing how we move, perceive, and experience our world. What would our world be like, after all, if our city squares were circles, and our buildings ovals instead of rectangles?
World Health Design (2012) Elderly Care: Active Ageing. WorldHealthDesign.com. Retrieved April 19th, 2012 from: http://www.worldhealthdesign.com/Elderly-Care-Active-Ageing.aspx
Discoveries of the effects of Tibetan monk practices: Can meditation be useful in addressing psychological stress and physiological well-being?
Life adaptation – particularly to a brave new world of ever-new gadgets and gizmos – is particularly relevant for the aging population, requiring fundamental mechanisms apparently implicit in the human mind in order to prevent and treat the potential dangers to mental and physical well-being as caused by psychological stress and the fight-or-flight response.
Author William Cromie of the Harvard Gazette in the April 18, 2002 issue revealed one such implicit mechanism to counteract stress, accessible within the human mind. This article, titled, Meditation changes temperatures: Mind controls body in extreme experiments, revealed the works of Dr. Herbert Benson, Associate Professor of Harvard Medical School. Beginning in the 1980’s, with support from His Holiness Dalai Lama, Dr. Benson has been conducting metabolism experiments on Tibetan monks practicing g Tum-mo meditation from Buddhist monasteries in remote areas of northern India. Obstacles due to low funding proved difficult for continued research – including the lack of electricity in the Himalayan areas – until the turn of the century, where g Tum-mo monks were brought to a Guinness estate in Normandy, France, to be involved with another temperature experiment.
Studies which commenced in the 1980’s and on have shown that these monks could lower their metabolism by 64 percent and reduce oxygen consumption by 17 percent just by simple meditation. This may lead to less free radicals in the body, thus less oxidation, and thus less “aging.” The g Tum-mo technique is known for its by-product of producing large amounts of body heat still unexplainable today. Through g Tum-mo meditation, Dr. Benson recorded that monks could raise the temperatures of their bodies to breathtaking amounts of heat – with increases as much as 8.3°C in their hands and toes. Large, chilled, wet towels placed on these monks’ bodies which would normally produce a shivering response did not produce noticeable shivers, and proved to be dry within an hour. Techniques such as g Tum-mo could prove priceless to preventing the onset of illnesses for the elderly – whom are more susceptible to the cold, thus leading to a weaker immune system, which may lead to considerable conditions, i.e. pneumonia.
Dr. Benson – inspired by meditation – has developed the renowned “relaxation response,” published as a book over 40 years ago but used widely today. This technique counters the stressful state of mind and targets physiological equilibrium. The components involve choosing a word, sound, prayer, or phrase, relaxing the body, and letting any thoughts that come to mind simply pass by while continuing to repeat the chosen saying. It is regularly recommended in treating patients suffering from heart conditions, high blood pressure, chronic pain, insomnia, and many other physical conditions. Requiring only minutes to learn and just between ten to twenty minutes of practice twice a day, it can bring cost-effectiveness in all forms of public health ranging from general health clinics to those focusing on elderly care. Although g Tum-mo meditation – a well-guarded secret by the Tibetan monks who meditate hourly per day – may require years to learn and cannot be easily performed by the layman who would meditate 10-20 minutes twice a day, it is shown that simple meditation such as the relaxation response is all that is required to produce physiological, DNA-affecting changes in the body to alleviate the stressful fight-or-flight response and balance the body by putting it into homeostasis. To summarize, there is an indication from the trends of experiments that study some forms of meditation as practiced in Tibet that there may quite be something to the expression, “mind over matter.”
Dr. Benson’s experiments with Tibetan monks
ABCNEWS.COM – Simple relaxation techniques to help after a hectic day
Cromie, William J. 2002. Meditation changes temperatures: Mind controls body in extreme experiments. Harvard Gazette. April 18 2002 Issue. Retrieved April 12th, 2012 from http://news.harvard.edu/gazette/2002/04.18/09-tummo.html
As a response to the growing number of elderly people living alone in their own homes, the AGNES project was initiated by six EU member countries; Sweden, Germany, Spain, Greece, Italy and Austria. The AGNES project follows an approach to keep the elderly mentally and socially stimulated and in contact with others by combining information and communication technologies (ICT) and social network technologies. The objectives are to prevent, delay and help manage common chronic conditions of the elderly to improve and maintain the well-being and independence of elderly people wishing to continue living in their own homes and to reduce healthcare costs. The idea is that the technology should be embedded in everyday activities and objects that the elderly recognizes.
Scientists at a European Union Research Project are developing both the software and the hardware. It is a three-year project started in September 2009 and the aim is to develop systems and devices that can be turned into useful and usable products within two years of completion. One of the developed prototypes is the interactive curtain that turn green when new e-mail has arrived and red when reply is needed urgently. Another
one is the small wooden box containing motion-sensitive sensors. The box is connected to the Internet and can send messages when the elderly touches on one side of the box. If the other side is touched, it means the message is urgent. Shaking the box means that the elderly changes his mind and takes back the message. Seniors from the six member countries are testing the prototypes during three years.
This is a great initiative in today’s environment where it is critical to rationalize elderly care and decrease hospitalization among elderly to be able to cope with the aging baby boomers.
Ageing in a Networked Society – Social Inclusion and Mental Stimulation by John A. Waterworth, Soledad Ballesteros, Christian Peter, Gerald Bieber, Andreas Kreiner, Andreas Wiratanaya, Lazaros Polymenakos, Sophia Wanche-Politis, Michele Capobianc, Igone Etxeberria, Louise Lundholm
Video Source: Euronews Futuris
“Noncommunicable diseases (NCDs), primarily cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, are responsible for 63% of all deaths worldwide (36 million out of 57 million global deaths)” – World Health Organization, 2011
Noncommunicable diseases – also referred to as chronic diseases – remain the number one global cause of deaths worldwide and cardiovascular disease (CVD) or heart disease remains at the top of the pedestal. Chronic diseases significantly concern the elderly, as 75% of 36 million global deaths attributable to chronic disease occurred beyond age 60 in 2011. In this report, we must highlight Japan – the country with the highest average elderly age yet the lowest cases of heart disease.
As early as 1981, Professor Geoffrey Rose of Epidemiology wrote an article in the British Medical Journal about taking the action of preventing CVD. He showed staggeringly low numbers of how Japan in 1968 had just over 100 deaths per 100,000 population attributable to coronary heart disease (CHD), whereas before the United States was able to drop their rates considerably over time, in 1968 they had the highest number – with over 800 deaths per 100,000 population. Sweden was around the middle, with approximately 450 deaths per 100,000 population. Further, Rose adds, “The Japanese owe their low rates not to their genes but to their way of life: when they move to America they rather quickly acquire American rates.” In addition to affirming Japan’s low death ratio, the United States and Australia had shown drops of 25% till year 1977, indicating that therapeutic advancements and prevention strategies can considerably reduce the deaths from CHD – which represent approximately half of CVD deaths (Iso, 2008). Japan has been able to keep their low CHD death ratio similar with a slight drop till 1977 (Rose, 1981) and has considerably dropped further – with over a 50% drop from this time frame to year 2000, having now around 37 deaths per 100,000 population (Iso, 2008). Dr. Hiroyasu Iso of Social and Environmental Medicine wrote in the Journal of the American Heart Association that Japan still has the lowest CHD ratio of high-income countries – between one-third and one-fifth that of the United States.
The decline of CHD deaths in Japan is attributable to the decline of mean systolic blood pressure levels and the prevalence of smoking. However, an issue is arising with a high prevalence of western fast-food diets increasing the mean serum total cholesterol and triglyceride levels (Iso, 2008). It is curious as to how Japan started with such a low ratio of deaths from CHD, and as we have heard from Professor Rose, it is due to their lifestyle. Is this lifestyle perhaps significantly affected by the practice of Complementary and Alternative Medicine (CAM) or Traditional Medicine (TM) involving the use of exercise, herbs, or other techniques? In order to explain a counterbalance for a high-fat-intake diet, I recommend collaboration with a national research organization such as the Japan Society of Oriental Medicine to investigate how the effects of Japanese Traditional Medicine, i.e. Kampo, derived from Chinese Traditional Medicine might be attributable to the low incidence of CHD deaths in Japan.
According to Dr. Johan von Schreeb of Karolinska Institute’s Public Health Sciences, approximately 1/3rd of Japan’s population is over age 60 and the country has the highest average aged population in the world – leading with 84 as the mean age of life expectancy. Prevention of chronic diseases is on the forefront of today’s world, with so many medical advances leading not only high-income countries but countries all over the world to jolt up in life expectancy. And as life expectancy rises, so does the demand for prevention of chronic disease. Is there a golden formula somewhere out in the Far East that could face this issue? As the country with the leading population of elders, perhaps there really is something about Japan that the world could need.
The Epoch Times. Image Retrieved April 4th, 2012: http://www.theepochtimes.com/n2/world/40000-japanese-aged-100-over-survey-says-22351.html
World Health Organization. 10 FACTS ON NONCOMMUNICABLE DISEASES. September 2011. Retrieved March 29th, 2012: http://www.who.int/features/factfiles/noncommunicable_diseases/facts/en/index.html
Schreeb, Johan von. Lecture on Disasters & Relief. January, 2012. Karolinska Institutet, Solna, Stockholm. IHCAR Department of Public Health Sciences.
Hiroyasu, Iso. 2008. Changesin Coronary Heart Disease Risk Among Japanese. Journal of the American Heart Association 118:2725-2729.
Rose, Geoffrey. 1981. Strategy of prevention: lessons from cardiovascular disease. British Medical Journal 282:1847-1851.