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Harnessing technology to benefit nursing

Izunna Okpala

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Technology is now an inseparable part of good nursing practice and nurses themselves have become leaders in the development of health informatics in New Zealand. Yet the term “nursing informatics” is comparatively new, having first being used there in the early 1990s.

Technology is now an inseparable part of good nursing practice and nurses themselves have become leaders in the development of health informatics in New Zealand. Yet the term “nursing informatics” is comparatively new, having first being used there in the early 1990s.

Initially the use of computer technology in health care was limited. However, today all nurses would be familiar with a range of digital data collection devices–from electronic blood pressure machines, tympanic thermometers and blood sugar level equipment–and information technology (IT), eg electronic laboratory results, patient records and email communication, in both their personal and professional lives.

The increase in the use of information and computer technology in health care has led to health professionals, the government, through the Ministry of Health and New Zealand technology companies, to work together to consider how best to harness the opportunities technology-supported health care can provide. The umbrella group uniting those interested in this area is Health Informatics New Zealand (HINZ). Nurses are an active group within this organisation.

All of us are aware of the increasing place of technology in our lives, including our personal lives–such as audiovisual appliances and home computers. The common experiences of using automatic teller machines, internet banking and household devices such as video and microwave ovens are further examples.

Technology is also part of our professional lives, whether we work in clinical, management, administration, education or research. Nursing practice is seen as information-intensive, with one study estimating nurses spend nearly half their time documenting patient information. (1) Therefore, technology that reduces the time and effort in routine aspects of care delivery and documentation could lead to more quality time caring for our patients.

Technology can provide further gains beyond computerised documentation, including co-ordination of care, communication and medication management. There are many advantages for the profession of increasing the use of technology because of the storage, processing, retrieval, display, processing, analysis and communication capabilities of the computer. (2) For nursing to take advantage of the potential benefits of technology, it is essential nurses articulate what the profession needs and how technology can support nursing practice.

What is nursing informatics?

The International Medical Informatics Association special interest group in nursing informatics’ (IMIA-NI) definition of nursing informatics was ratified by the 2009 general assembly as: “Nursing informatics, science and practice integrate nursing, its information and knowledge and their management with information and communication technologies to promote the health of people, families and communities world wide.” (3)

A history of nursing informatics in New Zealand states: “Nursing and the use of information to improve patient care have gone hand-in-hand since at least the time of Florence Nightingale.” (4) In fact, Florence Nightingale is often attributed as being the first nurse informatician, as she used data she collected during the Crimean War to change the way she cared for her patients. (5) The challenge for nurses is to consider how we can also use data to inform and improve our nursing care.

In the early 1990s, computers were becoming more common, though how the technology could be used in health care, and more specifically to support nursing practice, was less understood. In 1991, following a conference entitled Nursing informatics in New Zealand: An impetus for learning, organising committee chair Jan Hausman sought a mandate to form a group to continue sharing knowledge and ideas engendered by the conference.

The first meeting to set up a national nursing informatics group was held six weeks later. The objective for the fledgling group was: “to foster throughout New Zealand the development of knowledge and utilisation of information systems within all areas of nursing practice”, and the name Nursing Informatics New Zealand (NINZ) was adopted. (4) The new millennium saw NINZ merge with the New Zealand Health Informatics Foundation (NZHIF) to form a new incorporated society, Health Informatics New Zealand (HINZ).

Role of HINZ

HINZ is a national, not-for-profit organisation. Its focus is to facilitate improvements in business processes and patient care in the health sector through the application of appropriate information technologies. (6) HINZ helps improve the effectiveness of health informatics business and acts as a single portal for the collection and dissemination of information about the health informatics industry. Membership is open to anyone with an interest in health and informatics who wants to be part of an organisation that can provide relevant, up-to-date information about health informatics, through information sharing, seminars and annual conferences.

HINZ has established working groups to mirror some of those within the IMIA-NI. The HINZ nursing informatics working group is the most active of HINZ groups.

The Ministry of Health is interested in information collection and hosts 17 national collections and systems. New Zealand is fortunate to have a National Health Index (NHI) database where each person has a unique health care identifier which follows the individual through each health care event in his/her life, allowing easier tracking of information through health care episodes. All information collection, storage, access and retrieval is governed by the Privacy Act (1993) and the Health Information Code (1994) and subsequent amendments.

Health care is guided by a national health strategy. This acknowledges the importance of good information management for better health outcomes, to reach the goal of good health and well-being for all New Zealanders throughout their lives. (7) The overall vision for information management is set out in this strategy. (8) Subsequent to a Ministerial review in 2009, changes to the health sector have been instigated, with the overall objective of “better, sooner, more convenient health services’; A major change has been the establishment of the National Health Board (NHB) and the formation of a sub-committee, the Information Technology Health Board. A number of informatics-related recommendations have been made, including strengthening health IT and prioritising new technologies and medical devices. The IT Health Board is seen as a health sector leadership group to support the delivery of high quality health care by providing strategic leadership on health information investments and solutions across the health and disability sector, and ensuring health sector policy is supported by appropriate health information and IT solutions.

Health technology plan

In July this year, the IT Health Board published a national health information technology plan. This aims to “drive a culture of innovation, partnership and respect to support health sector leaders to make appropriate health information technology investments in the context of the whole sector” (9) and to work towards the eHealth Vision. This vision has a clear aim: “To achieve high quality health care and improve patient safety, by 2014 New Zealanders will have a core set of personal health information available electronically to them and their treatment providers, regardless of the setting as they access health services”. (9)

Conclusion

Nurses deserve to have quality information at their fingertips, when and where required, to ensure they can deliver the best care possible to individuals, communities and populations. Nurses cannot expect to practise effectively without reliable information delivered at the right place, in a timely fashion. Work is underway to achieve this, with the plans focusing on information exchange to support the continuum of care. Nurses need to be actively involved in this, so the right information and knowledge required to support care is targeted. The infrastructure and communications and IT have now matured sufficiently, so high quality health care can be achieved, and patient safety and health outcomes improved.

Apps & Services

Coronavirus: The Covid Tracker software from Ireland is out

Izunna Okpala

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Ireland’s just-released contact-tracing app this morning, where it joined Germany’s Corona Warn-App, which was released three weeks ago.

Gibraltar recently released its Beat Covid Gibraltar app, based on the Irish code.

The Republic’s Covid Tracker software is also the foundation of an app. Northern Ireland is promising to release within weeks. And now there’s a hint Wales could go the same way.

The focus henceforth would be on building a “decentralised” app with the toolkit offered by Apple and Google, which is also being used by Germany and Ireland among a growing list of others.

On Monday, Baroness Harding gave evidence to the House of Lords Science and Technology Committee alongside Simon Thompson, the Ocado executive she drafted in to take responsibility for the app.

Mr Thompson started by saying how urgent it was to get the job done. He went on to stress that collaboration with other countries and with Google and Apple meant that “we have growing confidence that we will have a product that will be good, so that the citizens can trust it in terms of its basic functionality”.

Bluetooth doubts

Now it is true that there is very little evidence that Bluetooth-based apps have so far been successful in tracking down people who came close to someone diagnosed with the virus.

People who point to the success of countries like South Korea ignore the fact that its efforts have been based not on Bluetooth but on the use of mass surveillance data, which would almost certainly prove unacceptable here.

Scientists at Trinity College in Dublin who advised the Irish app development team have produced a number of studies showing Bluetooth can be a very unreliable way to log contacts.

After tests on a bus they warned “the signal strength can be higher between phones that are far apart than phones close together, making reliable proximity detection based on signal strength hard or perhaps even impossible”.

‘Good enough’

Germany has celebrated the fact that in three weeks its app has been downloaded by 15 million people out of a population of 83 million. But there is little or no information about whether it is performing well in its core mission of contact tracing.

Then again, countries like Germany, Ireland and Switzerland have taken the view that an app does not have to be technically perfect, and that if there is any chance of it making even a small contribution to the battle against the virus, it’s worth a go.

Countries like Germany might be tempted to point out that they have had that “cake” in the form of an effective manual tracing programme all along. Incidentally, if public trust is vital to the app’s rollout, the people of the Isle of Wight may have something to say about that.

Following the trial of the original, scrapped NHSX app on the island, some residents have been asking what will happen to their data. We’ve asked too – and have yet to receive an answer.

While the Covid Tracker app has been launched by the Health Service Executive (HSE) in the Republic of Ireland, people living across the border in Northern Ireland are able to download it and use it.

Its terms and conditions state that it is intended to be used by anyone living in or visiting the island of Ireland.

They also state that its availability for people living or visiting in Northern Ireland “is intended to help us to inform people living in border areas and to trace cases in those areas”.

Anyone using the app in NI is able to activate the contact tracing facility and can also self-report symptoms using the “Covid Check-In section”.

However, in the section which asks users to enter personal details, including gender and age-range, those living in Northern Ireland can’t add their county of residence. Only counties in the Republic of Ireland are listed – not the six in NI.

It isn’t yet clear what impact this has on the functionality of the app for NI users.

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Apps & Services

The Adoption rate of the Apple-Google COVID-19 tracker feature in Nigeria

Izunna Okpala

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The COVID-19 exposure tracker has recently been rolled out by Google and Apple on every Android and iOS device globally. According to the notice released in May, this was done in an effort to fight the spread of the virus through contact tracing — a technique used to stay aware of exposure to an infected person.

When enabled, the feature allows your Smartphone to receive notification of likely COVID-19 exposure.

However, there is a disclaimer that the software is an API that can only be enabled when the device has installed a third party tracking app.

According to the statement, the feature will remain dormant until it is activated by a COVID-19 contact tracing app, which can be deactivated at any time.

COVID-19 Exposure Notification feature cannot be activated without an installed contact tracing app

Google and Apple therefore say that the devices won’t be theirs thus saying that the identity of the user won’t be shared with other users.

To ensure this, Google announced that “Access to technology will only be provided to public-health users. Their applications must meet strict Privacy, Protection and Data Use requirements.”

Still, app creators should be committed to minimise the vulnerabilities of their products.

On Android phones, the feature can be found in ‘Google‘ under ‘Settings‘ where ‘COVID-19 exposure notification‘ is displayed. For Apple devices, ‘COVID-19 exposure logging‘ is found under ‘Health‘ in ‘Privacy settings‘.

Apple-Google COVID-19 Exposure Notification feature

By design, this technology is meant to support the efforts of governments and private players that are building contact tracing apps. When an app is used to opt in, it generates randomly changing IDs based on location. Through Bluetooth, it periodically checks other IDs to confirm if any is associated with the infection. And if it finds any, it sends a notification.

For this to work, a person who is affected or has been exposed to the infection needs to share their IDs with the app, which will immediately alert all that have come in contact with them.

While countries like India make contact tracing apps compulsory for residents, only a few startups have made an attempt at this technology in Nigeria; this explains why adoption is low.

In fact, on the Google Playstore, there’s currently no authorised contact tracing app available in the country currently. Conversely, on the Apple app store, it shows two apps, one of which has already been disabled.

Despite some countries already putting the pandemic behind them, infection cases are unfortunately still increasing across Nigeria. Currently, the figure stands at 25,694, with Lagos state  — 10,510 confirmed cases — still the epicentre.

As economic activities resume fully in states that were previously on mandatory lockdown, this appears to be the time for the adoption of massive contact tracing tools to reduce citizens’ chances of infection.

Recall that before now the use of smartphone tracking and surveillance for COVID-19 tracing have been adopted across the world in China, Hong Kong, Israel, and even in Rwanda.

But there are concerns that this feature has privacy risks, disproving Google and Apple’s promise. Considering past events, this scepticism is not misplaced.

Google, like other tech giants, has at some point been accused of turning user data into narrowly targeted ads without consent. This is often possible because users are usually unaware of the data they are agreeing to share and the company’s plan for the information.

While these privacy concerns remain, we cannot undermine the possible positive impact of the tools this Apple-Google feature will effectively support. Perhaps, it is a case of choosing the lesser evil.

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General News

COVID-19: An update on the success of Coronavirus treatment

Izunna Okpala

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There is hope in the fight against Covid-19. New evidence now exist in the United States of America supporting this procedure. Physicians in the Kansas City area, including Joe Brewer, Dan Hinthorn and Dr. Jeff Colyer, continue to see a lot of patients and some have shown progress. Hydroxychloroquine has been applied to treatment options by major medical facilities including the University of Washington and Mass General.

In addition, before this, according to a study conducted by French researchers on 80 cases who recovered from the virus within six days of treatment, a combination of hydroxychloroquine and azithromycin has been found effective in treating patients with the COVID-19 coronavirus.

Hydroxychloroquine is an anti-malarial and anti-inflammatory medication used to treat autoimmune conditions such as lupus and rheumatoid arthritis, although it has been tested against symptoms of the novel coronavirus with some results.

Bahrain is one of the first countries to study hydroxychloroquine as a COVID-19 medication, having first used the drug on 26 February, two days after the first case of coronavirus was reported.

Countries around the world are increasing access to hydroxychloroquine and chloroquine, similar compounds that are synthetic versions of quinine, which derive from cinchona trees and have been used to treat malaria for decades.

Considering the urgent therapeutic need to control this disease with efficient and safe medicines, and considering the negligible cost of both hydroxychloroquine and azithromycin, we believe that this therapeutic approach should be tested urgently by medical practitioners both to prevent the spread of the disease and to treat patients until serious irreversible respiratory complications.

Even now, medical experts are still questioning the use of chloroquine as a drug. Usage of chloroquine for symptomatic treatment of coronavirus has not been licensed by the World Health Organisation. The U.S. Food and Drug Administration (FDA) is currently researching a way to make the drug available for emergency use in the United States, but in a way that gives the government data about whether it is safe and effective.

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