eHealth & Multimedia

June 7, 2010Nancy Chen, Nan Zao & Yujung Nam

Overview

eHealthThe rise of the internet health information undercuts the

carefully established hegemony of the medical profession as the gatekeepers to expertise and knowledge

Medicine can now be seen through various debates as taking a role as guardian of public safety, moving its gatekeeper function onto the web, e.g. “Quackwatch”, Hardey, M. (2008)

Multimedia Technology for Health and Social Services include

changing role of the patient in health careInternet health information seekingsocial networking for healthmedical simulation and traininggames for healthTelemedicinedigital divide issues in access to health information.Costs of development and disseminationNeed to develop culturally appropriate contentInformation overload

Source: http://bit.ly/cBTc0P

eHealth and the Role Patient

To increase people’s health decision-making competencies and promote health, (1) how should we reconceptualize ‘patient,’

and (2) consider the effects of decision-making environments??

Reconceptualizing ‘Patient’

New: Health CitizenBi-directional decision-making

Wellness-centered

Focus on social determinants of health

Emphasize interaction & participation

Old: Patient Uni-directional

influence

Illness-centered

Focus on patient compliance

Transmission (or instrumental) model of communication

Sillence et al. (2007), “How do patients evaluate and make use of online health information?”

eHealth and the Role of Physician

How does Internet use affect the degree to which people believe physicians are the sole source of

expert medical knowledge?

Threats to control occur when clients increase access to and understanding of professional knowledge base

In health care contexts, threats have occurred when:Internet has led to increased transparency of physician workSpecialization of medicine has undermined individual MDs as omniscient

sourcesAlternative health movement has grown

eHealth and the Role of Media

How can new media better support people’s health needs?

Motivational Needs & MediaNeed Definition Examples of how new media can support need

Autonomy Perceiving that one’s actions stem from internal sources

* Self-help tools, e.g., online smoking cessation

* Personal health records w/ reminders & status reports

* Health portals

* Connective journalism that links to resources

* Ubiquitous health care in consumer-friendly locations

Competency Gaining mastery over skills & talents

* Functional health literacy

* Information prescriptions from physicians

* Skill augmentation, e.g., online meal planners

Relatedness Gaining sense of respect & belonging from valued others

* Health advocacy groups

* Networks of care, e.g., carepages.com

* Shared communities of knowledge

Barbara Johnston, M.S.N.Executive Director of the Medical Board of

California Neil A. Solomon, M.D.

Founder & President of NAS Consulting ServicesClinical Director of the California Quality

Collaborative

Telemedicine in California: Progress, Challenges, and Opportunities

Telemedicine

Definition: The use of telecommunications and information technologies to provide health care remotely

Modes of delivery:1. Real-time communication (synchronous)2. Store-and-forward systems (asynchronous)3. Digital, audio and visual Goal: To increase access to health care by

transcending the boundaries of time and space with technologies, thus reducing health disparities, especially for rural and underserved populations

History

Late 1950s:1. First cited telemedicine application pertains to the

use of a two-way closed-circuit TV system in the psychiatric setting in 1959 (Perednia & Allen, 1995).

2. NASA has been developing and applying telemedicine to monitor its astronauts’ health during missions since the Agency’s inception.

Early 1970s: Applications developed by NASA began to be applied to rural areas in the U.S. and developing countries.

In California

Early 1990s: Proponents for telemedicine began to grow because it’s perceived as a solution for:

1. Widening disparities in health care, especially in rural areas

2. An aging population with greater health care needs

3. A rising shortage of health professionals: By 2015, California will face a shortage of 17,000 doctors, many in rural areas

= Medically underserved areas

Source: Office of Statewide Health Planning

Some successful programs in CA

Telestroke Program at UC San Diego: Effectiveness in correct diagnosis evaluated with a randomized control group study published in Lancet

Central California teleophthalmology Network: A license-free software, Eyepacs, was developed by UC Berkeley and used to evaluate retinal scans of diabetic patients remotely to prioritize patients for treatment

Kings View Telepsychiatry program Sutter Health’s eICU

Barriers to wider adoption of telemedicine

Technology1. High costs for purchasing equipment2. Complexity of operating equipment3. Slow data transmission due to the lack of

high-speed Internet connections Regulation: Telemedicine sessions could

involve multiple parties in more than one state, and it might be unclear which state laws regarding licensure and malpractice coverage apply under such circumstances

Barriers to wider adoption of telemedicine (cont.)

Financing1. Resistance from Insurers concerned about rising

service volumes and therefore increasing costs resulting from telemedicine

2. Reluctance from individual practices to adopt because the business model is unproven, and the costs of implementing the technology and altering practice routines can be high

3. Large integrated systems (e.g. VA and Kaiser Permanente) which manage health care and costs concurrently, constitute a financially viable model for telemedicine

Barriers to widespread adoption of telemedicine (cont.)

Provider issues1. Resistance to change as it requires disruption to

traditional practices, learning of new skills, costs for acquiring new equipment, and time to work out how to bill for telemedicine encounters under different reimbursement schemes

a. Concern over erosion of patient-provider relationship and quality of care

Patient issues:1. Telemedicine technologies may raise some privacy,

confidentiality and security problems for patients

Concluding remarks & future trends

More thorough analyses of existing programs are needed to demonstrate if a business case can be made for telemedicine

Lessons from early programs - both successes and failures - and personal experiences of early adopters need to be collected and applied to new ventures

Regulators, payers, providers, and consumers need to work together to determine how to prioritize the use of investment capital to roll out telemedicine services and to develop the relationships and financing mechanisms necessary to sustain telemedicine ventures

Health Care Unplugged: The Evolving Role of Wireless Technology

Richard Adler, MBAPrinciple of People & Technology

The wireless revolution

The explosive growth of cell phones “…a personal, portable, multipurpose, multimedia

computing and communication device (p.5)” Cell phone networks

Text & still images; downloadable music, ringtones, & videos; web-surfing

Demographics of U.S. Cell phone users Age is related to the usage of cell phones and the

use of more advanced cell phone features Related technologies

Short- & medium-range digital networks, sensors, and batteries

Wireless health care applications

Cell phones are Personal, ubiquitous, connected, increasingly

intelligent Pervasiveness and low cost Well-suited for delivering health care application,

particularly for supporting the treatment of chronic diseases

The demographic imperative Aging population & increasing occurrence of

chronic disease urgent need for better tools to monitor patients’ health status and help manage their health

Caring for patients with chronic conditions=$$$ Better chronic disease care could produce substantial cost savings

Wireless health care application (cont.) The emergence of wireless health care

Developed in foreign countries, relatively new, limited evidence regarding effectiveness

Types of applications Applications that monitor physiological

functions Applications that provide information and

feedback directly to patients, encouraging them to pay attention to and take a more active role in managing their health

Types of Wireless Health CareSENSOR PLACEMENT

INFORMATION FLOW

COMMUNICATION TYPE

Portable Wearable Implantable

Upstream

Downstream

2-way

Data Text Multimedia

2-way video

Physiological Monitoring

Cardiac C C C C C

Glucose C F C C

Vital signs C C F C C

Patient Communication and Support

Appointment reminders

C C

Health education & promotion

C F C F F

Patient compliance

C C

Patient engagement

C C C F F

Patient consultations

C F

*C=current use, F=future use.

Glucophone

Already used in South Korea, received FDA approval in June 2006.

The patient places a small sample on a test strip, inserts the strip into a reader integrated into the phone’s battery pack, and views the results on the phone’s screen.

The results are also sent automatically to an online medical management database and can be forwarded to a personal physician, family member, or caregiver.

3G Doctor Launched in the United Kingdom in late 2006 Enables patients to consult with physicians using the

video capacities of advanced 3G phones Patients complete a Web-based “instant medical

record” . The participating physicians can access the data at the time of the video consultation ($50). A written report summarizing the doctor’s recommendations is available for download.

Issues & Implications

Health industry issues Uncertainty about reimbursement Unproven benefits Health system not configured to use wireless

applications Privacy and security

Technological issues Potential information overload Lack of standards

Cell phone market issues Incomplete coverage Network fragmentation The mismatch factor