Thursday, August 7, 2008

Health Care and E-Health

Americans are very interested in getting information about health care information on the internet. The Pew Internet Project just released indicates that 10% of internet users say they searched for health information "yesterday," which in a tracking survey like this one yields a picture of the "typical day" online. Health has moved up in the "typical day" list (from 7% in 2006 to the current 10 percent of internet users), but for most people the average day includes lots of emails (60% of internet users), general searches (49%), and news reading (39%) if they are online at all (30% of internet users are offline on a typical day). The internet is an important source of health information and a force for change in health care.

The Journal of Medical Internet Research (JMIR) defines e-health as an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology. Also, eHealth describes the application of information and communications technologies across the whole range of functions that affect the health sector, from the doctor to the hospital manager, via nurses, data processing specialists, social security administrators and - of course - the patients.

According to Wikipedia, eHealth (also written e-health) is a relatively recent term for healthcare practice which is supported by electronic processes and communication. The term is inconsistently used; and some would argue it is interchangeable with health care informatics and sub sets, while others use it in the narrower sense of healthcare practice using the Internet. The term can encompass a range of services that are at the edge of medicine/healthcare and information technology:
1.) Electronic Medical Records: enable easy communication of patient data between different healthcare professionals (GPs, specialists, care team, pharmacy)
2.) Telemedicine: includes all types of physical and psychological measurements that do not require a patient to travel to a specialist. When this service works, patients need to travel less to a specialist or conversely the specialist has a larger catchment area.
3.) Evidence Based Medicine: entails a system that provides information on appropriate treatment under certain patient conditions. A healthcare professional can look up whether his/her diagnosis is in line with scientific research. The advantage is that the data can be kept up-to-date.
4.) Consumer Health Informatics (or citizen-oriented information provision): both healthy individuals and patients want to be informed on medical topics.
5.) Health knowledge management (or specialist-oriented information provision): e.g. in an overview of latest medical journals, best practice guidelines or epidemiological tracking.
6.) Virtual healthcare teams: consist of healthcare professionals who collaborate and share information on patients through digital equipment (for transmural care).
7.) mHealth or m-Health: includes the use of mobile devices in collecting aggregate and patient level health data, providing healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vitals, and direct provision of care (via mobile telemedicine).
8.) Medical research uses eHealth Grids that provide powerful computing and data management capabilities to handle large amounts of heterogenous data.

The publishers of Telemedicine and e-Health magazine indicate that eHealth covers all aspects of clinical telemedicine practice, technical advances, enabling technologies, education, health policy and regulation and biomedical and health services research dealing with clinical effectiveness, efficacy and safety of telemedicine and its effects on quality, cost and accessibility of care, medical records and transmission of same. Telemedicine applications play an increasingly important role in health care and provide tools that are indispensable for disease management, home telemetry, and remote care that encompasses not only rural health and battlefield care, but nursing home, assisted living facilities, and maritime and aviation applications. Advances in technology including wireless connectivity and mobile devices will give practitioners, medical centers, and hospitals important new tools for managing patient care, electronic records, and medical billing to ultimately enable patients to have more control of their own well being. As the nation once more addresses health care reform, the contributions of telemedicine need to be fully understood and appreciated and reimbursement policies must be in place for these applications.

Additionally, according to the eHealth Institute, eHealth resources can help:
--Improve health status by supporting healthy lifestyles, improving health decisions, and enhancing health care quality;
--Reduce health care costs by improving efficiencies in the healthcare system and prevention;
--Empower people to take greater control of their health by supporting better-informed health decisions and self-care;
--Enhance clinical care and public health services by facilitating health professional practice and communication; and
--Reduce health disparities by applying new approaches to improve the health of underserved populations.

Here are the 10 E's of eHealth, according to the JMIR:

1.) Efficiency - one of the promises of e-health is to increase efficiency in health care, thereby decreasing costs. One possible way of decreasing costs would be by avoiding duplicative or unnecessary diagnostic or therapeutic interventions, through enhanced communication possibilities between health care establishments, and through patient involvement.
2.) Enhancing quality of care - increasing efficiency involves not only reducing costs, but at the same time improving quality. E-health may enhance the quality of health care for example by allowing comparisons between different providers, involving consumers as additional power for quality assurance, and directing patient streams to the best quality providers.
3.) Evidence based - e-health interventions should be evidence-based in a sense that their effectiveness and efficiency should not be assumed but proven by rigorous scientific evaluation, and much work still has to be done in this area.
4.) Empowerment of consumers and patients - by making the knowledge bases of medicine and personal electronic records accessible to consumers over the Internet, e-health opens new avenues for patient-centered medicine, and enables evidence-based patient choice.
5.) Encouragement of a new relationship between the patient and health professional, towards a true partnership, where decisions are made in a shared manner.
6.) Education of physicians through online sources (continuing medical education) and consumers (health education, tailored preventive information for consumers)
7.) Enabling information exchange and communication in a standardized way between health care establishments.
8.) Extending the scope of health care beyond its conventional boundaries. This is meant in both a geographical sense as well as in a conceptual sense. e-health enables consumers to easily obtain health services online from global providers. These services can range from simple advice to more complex interventions or products such a pharmaceuticals.
9.) Ethics - e-health involves new forms of patient-physician interaction and poses new challenges and threats to ethical issues such as online professional practice, informed consent, privacy and equity issues.
10.) Equity - to make health care more equitable is one of the promises of e-health, but at the same time there is a considerable threat that e-health may deepen the gap between the "haves" and "have-nots". People, who do not have the money, skills, and access to computers and networks, cannot use computers effectively. As a result, these patient populations (which would actually benefit the most from health information) are those who are the least likely to benefit from advances in information technology, unless political measures ensure equitable access for all. The digital divide currently runs between rural vs. urban populations, rich vs. poor, young vs. old, male vs. female people, and between neglected/rare vs. common diseases.

In addition to these 10 essential e's, the JMIR says e-health should also be:
--entertaining (no-one will use something that is boring!), and

Electronic medicine and eHealth are the future, and we need to use it now. Being able to access health care data quickly and efficiently will definitely help to reduce costs and decrease inefficiencies in the medical marketplace. eHealth is beneficial to insurance companies, medical providers, government, and patients. Americans deserve the best.

Until next time. Let me know what you think.

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