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Transforming cancer care with the help of information technology
EDI TORI AL
Transforming cancer care with the help of information technology Information technology has already had a profound influence on the culture of information exchange in everyday life, but perhaps this is insignificant compared to its future potential for health-care practice. We now reside in a datadriven health-care environment in which there is a continual necessity to implement new methods for gathering, sharing and evaluating relevant information about patients and their care needs. The use of information technology such as internet based resources, e-mail, and telemedicine have been lauded as some of the solutions to encourage patients to become more active players in their own care. These developments cannot be seen in isolation from other societal changes, particularly the move away from seeing the doctor as expert and as the person who will make the decision on behalf of the patient. There is a great deal of rhetoric about participation of patients in health-care decision making. Actually engaging patients in shared decision making, where the patient is an active partner, has been much talked about but with few real attempts to create both structures and processes to underpin this ideal. The Internet has been proposed as a seductive solution to ensuring patients get access to information as a first step. But Internet-based applications to promote transfer of knowledge can merely act as a transition from paper-based to electronic means to process and distribute information in text. Technology is now becoming available where we may move beyond just text, where we can put together and deliver relevant and valid information, of different types, using more engaging ways to package messages and multisensory modes of communication. There are varying levels of interest in, access to and experience in using e-mail to communicate with patients and caregivers. One example of where e-mail might play a significant role is ambulatory care. Currently, a picture exists of where nurses might continually be chasing patients (and visa versa) on the telephone. This creates dissatisfaction for both patients and nurses and could contribute to poor outcomes through European Journal of Oncology Nursing 6 (4),187^188 # 2002 Elsevier Science Ltd. All rights reserved. DOI: 10.1054/ejon.2002.0225, available online at http://www.idealibrary.com.on
inadequate, delayed or misheard responses. E-mail is now a viable alternative to communication of this sort. For example, as an alternative to telephone follow-up after chemotherapy or as a vehicle for patients to present unanswered questions and queries following on from or in between appointments. This is far from common place at the moment. Recently at the European School of Oncology Masterclass in Clinical Oncology in Montecatini, Italy in August 2002 the audience were asked by Professor Jadad, the Director for the Centre for Globale health Innovation in Canada, for an indication of whether they had experience of this form of communication. Only a very small percentage indicated this to be case. However, when asked to reconsider this communication option if fears of litigation were removed the majority of the audience expressed enthusiasm for this mode of information sharing. While strong arguments are made for its clinical utility in communicating with patients, there is little if any research establishing the feasibility and current use of e-mail in this context. As well as direct care delivery information technology is purported to be our saviour in terms of information transfer supporting the delivery of co-ordinated care, the most obvious example of this is the electronic patient record. Technology has the potential to create a work environment that provides quality and accurate care to patients whilst simultaneously promoting effective resource use and improving health-care professional satisfaction. Perhaps more radical is the suggestion that patients be given access to their electronic health record through the Internet. This offers countless opportunities with individuals accessing information that is relevant to them and integrating it with their own personal data with explanatory information. Internet health records that are embedded in a system that allows patients to research their cancer, its treatment and side-effects, seek information on self-care, check blood results, track symptom histories and request more drugs and communicate directly with their cancer nurse or physician are a reality.
188 European Journal of Oncology Nursing
All these innovations are here to support rather than undermine face-to-face patient–healthcare professional communication. Dialogues with patients can be undertaken through more than one medium. Currently consultations often revolve around giving and receiving information, if a significant proportion of this could occur outside this context then consultations could assume a more active participation style. This form of consultation would be both interactive and challenging. The use of information technology in planning and evaluating care is a relatively young but rapidly growing area. One of the most pressing issues is therefore to address the abilities and needs of cancer care professionals. Aspects such
European Journal of Oncology Nursing 6 (4),187^188
as access, skills, knowledge and degree of comfort in working in this manner all need to be tackled and this will require both investments in terms of physical resources and education and development. Cancer care professionals must be willing to expand their thinking about how we take care of patients. We must be prepared to be creative in the use of technology in the care of patients and remember that information technology exists not to transform us but to help us transform cancer care. Alison Richardson Editor Lorraine Robinson Associate Editor London, UK
Transforming cancer care with the help of information technology Information technology has already had a profound influence on the culture of information exchange in everyday life, but perhaps this is insignificant compared to its future potential for health-care practice. We now reside in a datadriven health-care environment in which there is a continual necessity to implement new methods for gathering, sharing and evaluating relevant information about patients and their care needs. The use of information technology such as internet based resources, e-mail, and telemedicine have been lauded as some of the solutions to encourage patients to become more active players in their own care. These developments cannot be seen in isolation from other societal changes, particularly the move away from seeing the doctor as expert and as the person who will make the decision on behalf of the patient. There is a great deal of rhetoric about participation of patients in health-care decision making. Actually engaging patients in shared decision making, where the patient is an active partner, has been much talked about but with few real attempts to create both structures and processes to underpin this ideal. The Internet has been proposed as a seductive solution to ensuring patients get access to information as a first step. But Internet-based applications to promote transfer of knowledge can merely act as a transition from paper-based to electronic means to process and distribute information in text. Technology is now becoming available where we may move beyond just text, where we can put together and deliver relevant and valid information, of different types, using more engaging ways to package messages and multisensory modes of communication. There are varying levels of interest in, access to and experience in using e-mail to communicate with patients and caregivers. One example of where e-mail might play a significant role is ambulatory care. Currently, a picture exists of where nurses might continually be chasing patients (and visa versa) on the telephone. This creates dissatisfaction for both patients and nurses and could contribute to poor outcomes through European Journal of Oncology Nursing 6 (4),187^188 # 2002 Elsevier Science Ltd. All rights reserved. DOI: 10.1054/ejon.2002.0225, available online at http://www.idealibrary.com.on
inadequate, delayed or misheard responses. E-mail is now a viable alternative to communication of this sort. For example, as an alternative to telephone follow-up after chemotherapy or as a vehicle for patients to present unanswered questions and queries following on from or in between appointments. This is far from common place at the moment. Recently at the European School of Oncology Masterclass in Clinical Oncology in Montecatini, Italy in August 2002 the audience were asked by Professor Jadad, the Director for the Centre for Globale health Innovation in Canada, for an indication of whether they had experience of this form of communication. Only a very small percentage indicated this to be case. However, when asked to reconsider this communication option if fears of litigation were removed the majority of the audience expressed enthusiasm for this mode of information sharing. While strong arguments are made for its clinical utility in communicating with patients, there is little if any research establishing the feasibility and current use of e-mail in this context. As well as direct care delivery information technology is purported to be our saviour in terms of information transfer supporting the delivery of co-ordinated care, the most obvious example of this is the electronic patient record. Technology has the potential to create a work environment that provides quality and accurate care to patients whilst simultaneously promoting effective resource use and improving health-care professional satisfaction. Perhaps more radical is the suggestion that patients be given access to their electronic health record through the Internet. This offers countless opportunities with individuals accessing information that is relevant to them and integrating it with their own personal data with explanatory information. Internet health records that are embedded in a system that allows patients to research their cancer, its treatment and side-effects, seek information on self-care, check blood results, track symptom histories and request more drugs and communicate directly with their cancer nurse or physician are a reality.
188 European Journal of Oncology Nursing
All these innovations are here to support rather than undermine face-to-face patient–healthcare professional communication. Dialogues with patients can be undertaken through more than one medium. Currently consultations often revolve around giving and receiving information, if a significant proportion of this could occur outside this context then consultations could assume a more active participation style. This form of consultation would be both interactive and challenging. The use of information technology in planning and evaluating care is a relatively young but rapidly growing area. One of the most pressing issues is therefore to address the abilities and needs of cancer care professionals. Aspects such
European Journal of Oncology Nursing 6 (4),187^188
as access, skills, knowledge and degree of comfort in working in this manner all need to be tackled and this will require both investments in terms of physical resources and education and development. Cancer care professionals must be willing to expand their thinking about how we take care of patients. We must be prepared to be creative in the use of technology in the care of patients and remember that information technology exists not to transform us but to help us transform cancer care. Alison Richardson Editor Lorraine Robinson Associate Editor London, UK