Nurse-Engineer Constructs Health Care’s Future

The philosophy of Mahatma Ghandi supports Brennan's research to shape a health care system that best serves the patient.

“A patient’s right to trust the health care system to act in his or her own accord really is no longer valid. We have not held the patient’s trust well,” says Patricia Flatley Brennan, PhD, RN, professor of nursing at UW-Madison School of Nursing.

Brennan, also a professor of industrial engineering at UW, adds, “The tools that I build should help the patient participate in his or her own health care activities and own health care.”

Brennan’s take on the state of health care grows from two converging spheres—nursing and engineering. As nurse-engineer, she’s working to reshape the nation’s health care.

Seeing the big picture

The key to designing a better health care system, says Brennan, is a patient’s access to data. “Patient records must be designed for and accessible to the patient—not the health industry,” she says. The first step is supplying patients with the proper tools: knowledge, peer support, and computers to make access viable.

“The vision is called the National Health Information Infrastructure,” notes the nurse-scientist, “which is a set of computer communication pathways, utilities resources, languages, terms, and files, that support a lifelong personal-clinical record to be developed for any individual.”

But in order for this system to work, Brennan clarifies, all medical information holders, that is, the health institutions, must be involved. “So, the value of any one institution participating in this information exchange depends on the number of institutions that are in that exchange—sort of like the futures market.“

On the homefront: HeartCare I and II

In mapping health care’s future, Brennan is guided by the here-and-now. She is currently working on the HeartCare II project—a step beyond Heart Care I, which gave patients full computer support in order to communicate with doctors, other health care experts, and peers. HeartCare II aims to modify nursing care practices to take advantage of what patients can do for themselves when given a full computer support system.

The focus is on the dynamic between patient, nurse, and technology. Brennan likens it to building a three-legged stool. If the stool were patient care, she says, its three legs would represent a) the capacities of the patient, b) the competencies of the nurse, and c) the resources available on the computer.

“You need to find the right balance,” Brennan adds, “and that balance may vary. Sometimes the nurse will be very, very involved … and the computer system may be much less involved. But in other cases, where the patient is more self-directed … has better functional skills, the nurse’s role may diminish.”

Aurora Health Care is a willing partner HeartCare II. For the past three years, it has given its patients access to personal health information through “My Aurora.” Aurora chose 400 patients—200 will have computers; 200 will receive conventional nursing care. Patients with congestive heart failure were chosen because they require intensive nursing care over an extended period of time.

Professor Brennan's team researches the use of the Internet to support SMART patients. SMART is an acronym representing the following terms: Self-assured, Motivated, Aware, Resourceful, and Talented.

A human factors engineering team will monitor the changes in nursing practice when technology is present. Ultimately, Brennan wants to build a system level of design that answers an essential question for the patient: Did the nursing care and information technology components come together properly for you, the patient, to achieve your personal health care goals?

Brennan firmly believes that patients are up for the task of using self-management tools to keep their health records.  “We’re looking to make sure that people of all levels of motivation and skill are able to use the system,” Brennan states. “It doesn’t matter if they’re nurses or patients, frankly. We found in earlier studies that, if we give people computer systems that are useful to them, they’ll use it.”

Confluence of health and finance produces visionary

Brennan finds the career path carved in health informatics to be a very natural and logical progression. Her mother was a nurse and, therefore, influenced Brennan’s direction in health care. But it was her father, she says, who influenced her most. He was in the business of making dreams work by raising funds to support them.

She explains, “I became a nurse and thought it was identity with my mother, but, in fact, expressing world vision is what my father did. He was the financing vision behind World Mission Sunday … he worked for Archbishop Fulton Sheen for years.”

Holding the coveted title

Brennan is a member of the prestigious Institute of Medicine (IOM). The IOM exists to ensure that the government has access to the scientific knowledge needed to frame the future of health care. By networking with this powerhouse of scientists and scholars, Brennan believes that she can “mobilize their tools to make it better for patients to be functional and to live.”

Components of a health care information system allow people to access and coordinate their life-long health information and to make appropriate parts available to those who need it.

“So the work that I do … HeartCare, the national health infrastructure … is to make clear that this is not just secure communication among members of a small industry,” Brennan explains, “but it is set up for the patient who can independently engage in health promotion. The patient then has something that, as a health care consumer, can be accessed from anywhere ... like Visa.”
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For more information on tools and resources to support self-care and health self-management, visit http://healthsystems.engr.wisc.edu/