E-health

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

Communication approaches

Interpersonal communication approaches: most persuasive - lowest reach

Mass communication approaches: greatest reach - low efficacy

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

Hybrid communication approach: interpersonal communication for persuasive properties and mass communication for reach properties

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

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

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

Distinctions

online versus offline

Portable versus not portable

Inherent entertainment value versus didatic and informational

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

Opportunities

Web 2.0: social media

Gaming

Technology to enhance privacy and external clinical services (telemedicine)

Use of cell phone technology for health promotion

Lack of experience in technical skills, health content or evaluation among developers

Costs of development and maintenance

Equalizing access to information, democratizing it

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

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)

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

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

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

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

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