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E-health (E-health (Eysenbach): emerging field in the intersection of…
E-health
E-health (Eysenbach)
: 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. Broader sense, state-of-mind, way of thinking, attitude and commitment for networked global thinking to improve health care locally, regionally and worldwide by using information and communication technology
Health services delivery: health care, health system, health sector, health industry
Welness: public health, health and welness, health and well-being, health promotion
Technology
Internet
Commerce
Activities: managing, educating, arranging, connecting, obtaining, providing, redefining, supporting, using, assisting, accessing
Health care providers: doctors, health care professionals, health workers, managers, caregivers
Public: patients, consumers, non-professionals, citizens, governments, employers, payers
Process of care
Outcomes of care
Distance, geography, location
Advantages
Wide appeal
Convenient use
Networkability/online social support
Low cost
Internet as delivery system
Multimedia
Credible simulations: engage in behaviors in virtual environment, experiencing positive and negative outcomes of behavior with actual consequences - provide guided practice in a complex behavior - role playing
Individualized tailoring: personalizing => targeted communication => personal characteristics
For customers: anonimity, convenience, low cost, increased access to info
For researchers: flexibility/modifiability, automated data collection
Expectancy, usage and acceptance of mobile technology of clinical staff and patients UMC (Illiger et al.)
Professional context does not depend on age, professional experience or function
Use more common among male doctors than female doctors
Correlation between use of mobile devices and age as well as education in patients => digital divide
Patients more critical of using devices for storing and processing patient data
Minor concerns about credibility of the provided content or technical reliability of devices (staff and patients)
Staff: apps for literature searches, medication databases, provided by medical journals
Concerns use of mobile devices during physician-patient encounters: safety of patient data, hygiene, credibility of provided content
Patients: looking up health related info, managing own health data => search for info about symptoms and specific health conditions, specific diagnostic methods as well as treatments, looking up desired and adverse effects of specific medications, medial devices and therapies, search for doctors or pharmacies
Patients: app fitness, provided by insurers, obtaining heart rate, weight loss, vision tests, specific pharmacies
Business modeling
Lack of fitting infrastructures, inability to find funding, complications with scalability, uncertainties regarding effectiveness and sustainability
Problems of Ehealth technologies
: currently established financial structures slow down innovation - necessary legaslisations for modernizing health care lag behind - involved parties are reluctant and uptake remains low - ehealth development focuses too strongly on engineering-driven solutions - ehealth technologies are deployed in a fragmented fashion and have poor scalability - number of stakeholders and dependencies cause complexity - lack of cost effectiveness studies - ehealth research tends to focus on finding clinical evidence in terms of health outcomes, but there are more factors that determine the success of ehealth technology
CeHReS roadmap
: value-driven - stakeholders are involved in development process and based on their values an ehealth technology can be designed matching with intended collaboration and cocreation, and eventually an implementation can be found
Implementation
: starts with detecting and involving concerned parties and results in a business model that describes the value creation and acts as the basis for a care infrastructure for collaboration and cocreation, possibly with multiple organisations involved
Sensemaking
: before taking proper action, the situation needs to be carefully assessed
Bottom up approach
Business model erosion
: over time stakeholders can come and go or their values need change and the implementation needs to be reevaluated and redesigned
Business case
: concrete descriptions of the necessary activities, resources and costs can be written down - several financial prognoses based on estimated usage of technology, based on multiple usage scenarios (low, projected and high usage)
Recommendations
Recognize digital inclusion
Involve target audiences
Integrate evaluation
Better job of sharing
Learn to apply e-health strategies appropriately to enhane interventions
Use evaluation methods
Include ehealth design, development and evaluation in core cirricula for professional development
Cautions
Population of subgroups for whom its not appropriate or not the best option
Issues related to access to internet
Privacy concerns
Moving to increasing dependence on technology and technical support
Lack of experience in technical skills, health content or evaluation among developers
Costs of development and maintenance
Opportunities
Web 2.0: social media
Gaming
Technology to enhance privacy and external clinical services (telemedicine)
Use of cell phone technology for health promotion
Equalizing access to information, democratizing it
Predictors of ehealth usage (Kontos et al.)
Lower levels of education: lower odds of going online to look for health care provider, using email of internet to communicate with dotor, tracking their personal health info online, using website to help track diet, weight and physical activity or dowload health info to mobile device
Female: consistent predictor of ehealth use across health care and user generated content/sharing domains
Age: primarily influential for health info seeking
Chronic Care Model
: interaction between informed activated patient and prepared proactive practice team
Digital native
: young generations who have grown up with technology, being more comfortable using technology for everyday needs including managements of their health care needs <=>
digital immigrants
: older generations have to learn and acquire the necessary skills needed to navigate the internet and are generally less comfortable using technology
eHealth research from the user's perspective (Hesse et al.)
What could the computer do? evolved to What can people do => how can advanced computing and telecommunications be used in conjuction with existing systems of care to ensure that people live longer and higher quality lives
4 overarching goals
Safety
: make healthcare system foolproof by designing the interface between components to be consistent, predictable and controllable by all of its users
Effectiveness
: bringing science and evidence of medicine into care process at the right times - create a system of knowledge to guide evidence-based delivery
Patient-centeredness
: improve patient outcomes - customized care - population-centeredness (universal design)
Timeliness
: environment that fosters healing relationships over time
Communication approaches
Interpersonal communication approaches
: most persuasive - lowest reach
Mass communication approaches
: greatest reach - low efficacy
Hybrid communication approach
: interpersonal communication for persuasive properties and mass communication for reach properties
Distinctions
online versus offline
Portable versus not portable
Inherent entertainment value versus didatic and informational
Attitudes to ehealth of doctors and nurses in rural general practice UK (Richards et al.)
Barriers
: lack of suitable training, high cost of buying telemedicine equipment, increase of GP/nurse workload
Potential
effects
of ehealth on primary care: improvement in patient care, improved access to care, reduction of costs, successful integration with existing work patterns
Videoconferencing can be detrimental to patient privacy and confidentiality, reduce the enjoyment of educational meetings
Challenges
Digital divide: disparity in access to and use of internet among racial and ethnic minorities
Keep content interesting, updated and interactive to ensure people will stay engaged in sessions and use technology over time
Health communication
: art and technique of informing, influencing and motivating individual, institutional, and public audiences about important health issues
Public health communication
: scientific development, strategic dissemination and critical evaluation of relevant, accurate, accessible and understandable health information communicated to and from intended audiences to advance the health of the public
Interactivity
: the degree to which a communication technology can create a mediated environment in which participants can communicate, synchronously and asynchronously, and participate in reciprocal message exchanges and the ability to perceive the experience as a simulation of interpersonal communities
Transactional
: interaction allows for give and take of both persuader and target
Response dependent
: receiver driven process ultimately leads to the messages being viewed as more personally relevant
E-health
: use of emerging info and communication technology, especially the internet, to improve or enable health and health care
M-health
: use of mobile communications such as PDAs and mobile phones for health services and information
