eHealth: Innovations and Issues

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eHealth Innovations and Issues

• Lecture 8
• Some Issues in Self Management of Healthcare
• Norm Archer

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Agenda

• Introduction
• Consumer health informatics
• Information from the Internet
• Potential self-management eHealth intervention
  for obesity
• Physicians and the Internet
• Access to medical information in institutions
• Conclusions

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Introduction

• What is self-management of healthcare?
• This is the action taken by patients (often with
  chronic illnesses) to care for themselves,
  usually with the help of caregivers, and using
  procedures and medications prescribed by
  physicians
• The healthcare system continues to evolve to a
  situation where interaction between patients and
  physicians as they care for the patient through
  teamwork, will become the cornerstone of the
  healthcare system. Technologies, processes, and
  procedures are highly desirable if they can
  enhance this interaction without negatively
  affecting physician-patient relationships.
• This discussion will centre on how online
  information can affect both patients and
  physicians

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Consumer Health Informatics (Eysenbach 2000)

• Consumer health informatics is the field in
  medical informatics concerned with
• Analysing and modelling consumer preferences,
  information needs, and information use
• Developing and evaluating methods and
  applications to support consumers in obtaining
  and using health information
• Developing and evaluating methods and
  applications to integrate consumer needs and
  preferences into information management systems
  in clinical practice, education, and research
• Investigating determinants, conditions, elements,
  models, and processes to design, implement, and
  maximise the effectiveness of computerised
  information and telecommunication and network
  systems for consumers
• Studying the effects of these systems on public
  health, the patientprofessional relationship,
  and society.

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Health and Medical Information from the Internet

• Patient benefits from Internet health information
• Take more responsibility for managing their own
  health
• Make their own decisions
• May learn as much or more about their conditions
  than their physicians know
• Satisfy information needs not met by physicians
• Sometimes self-assessment tools to help patients
  determine the existence or severity of conditions
• Question advice or diagnosis of physicians,
  potentially leading to reduction in diagnosis
  errors
• Request alternative treatments
• General benefits from understanding healthy life
  styles (exercise, diet, relaxation, etc.)

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Internet

• Negative aspects of patients accessing Internet
  for health and medical information
• Information may be misinterpreted by patients
• Delays in seeking appropriate treatment
• Taking inappropriate non-prescription treatments
  that may harm health
• Internet sites often have unreliable or incorrect
  health information
• Internet information may be anecdotal and unsound
  scientifically
• Patients may stop taking medications due to
  negative information (side effects, etc.) they
  find on the Internet. This lack of adherence or
  compliance with physician-prescribed regimens is
  known to be a major cause of problems in
  healthcare.

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Information from the Internet (with thanks to
Michael Bliemel, Ph.D. candidate)

• Open Directory Project (ODP 2006)
• Health Conditions and Diseases (15,000 entries)
• Google Directory (Google 2006)
• Health Conditions and Diseases (18,000 entries)
• Internet Usage for eHealth purposes - survey by
  Health On the Net Foundation (HON 2005)
• Certification of Healthcare Sites
• HON Code of Conduct (HONcode) displayed on
  medical and health Web sites

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Internet Health Information Quality (Eysenbach et
al 2002)

• Review of 79 published studies of Internet health
  information quality
• Quality indicators were typically
• Accuracy
• Completeness
• Readability
• Design
• Disclosures
• References
• Quality of the 79 published studies rated as
• Problematical 69.5
• Neutral 21.5
• Positive 9

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Sample Healthcare Websites

• Healthbulletin (http//www.healthbulletin.org)
• Mayo Clinic (http//mayoclinic.com)
• Dr. Weil (http//www.drweil.com)
• Pillstore (http//www.pillstore.com)
• MedicineNet (http//www.medicinenet.com)
• Dr. Koop (http//www.drkoop.com)
• Canadian Health Network (http//www.canadian-healt
  h-network.ca)
• Lung (http//www.lung.ca)

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Potential Selfcare eHealth Intervention for
Obesity
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Potential eHealth Interventions for Obesity
(Tufano Karras 2005)

• Obesity is the most prevalent chronic health
  condition and highest priority public health
  problem in the United States. Americans are
  putting more effort into losing or maintaining
  weight, with decreasing success.
• Public health campaigns designed to promote
  successful weight loss or maintenance have not
  been effective in changing behavior.

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eHealth Interventions for Obesity

• Can eHealth behavioral interventions be effective
  in promoting and sustaining weight loss and
  maintenance behavior changes?
• Tailored informational interventions have proven
  to be the most effective form of health behavior
  intervention for weight loss.
• Interactive interventions based on design
  principles suggested by Social Cognitive Theory
  and the Social Marketing Model. E.g. consciously
  entering and organizing data (e.g. estimating
  food portions, calculating and entering
  nutritional values for foods eaten) may be more
  relevant to promoting desired behavior changes
  than retrospective use of captured data.
• What appear to be needed are mass customization
  capabilities, reach, and interactivity required
  for the development, administration, and adoption
  of effective population-level eHealth tailored
  informational interventions for obesity.

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Mobile Weight Management
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Physicians and the Internet
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Physician Internet Use (Bennett et al 2005)

• 2005 Survey of Physicians (GPs and Specialists)
• A critical clinical skill for family physicians
  is timely access to wide variety of clinical
  information sources that contribute to patient
  care decisions.
• Specific questions about patient management arise
  (about 3.2 questions for every 10 patients seen),
  with drug-prescribing queries being the most
  common.
• Pursuing answers to questions that arise only
  occurs about a third of the time. The most
  frequent motivation to track questions comes from
  the belief that a definitive answer exists or the
  patient's problem is urgent.
• It is estimated that about half of questions may
  readily be answered by information in a clinical
  record, one-quarter of questions require
  traditional resources as journals or textbooks,
  and one-quarter of the questions require
  synthesis of information from a biomedical
  knowledge base.

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Physician Internet Use (Bennett et al 2005)

• 2005 Survey of Physicians (GPs and Specialists)
• Essential for any information source is success
  in quickly and accurately finding the desired
  information. Family physicians spend an average
  of less than 2 minutes finding an answer using
  traditional textbooks and journals, compared to a
  study of a palmtop drug reference system where it
  took a group of physicians only 20 seconds to
  find answers to their questions. Care may be
  fragmented or diminished and less evidence based
  when access is not readily available or available
  only through specialists.
• The Internet provides extensive options to search
  for answers, and may influence the way family
  physicians shape their questions and look for
  responses. Many physicians have also adopted the
  use of handheld computers for reference materials
  and to access necessary information at the point
  of care. One study indicated that Personal
  Digital Assistants (PDAs) were used in 64 of
  outpatient clinical facilities, with 69 of PDA
  users accessing pharmaceutical information.
• This study surveyed 2200 U.S. physicians (457
  family physicians and the remainder specialists).

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Physician Internet Use (Bennett et al 2005)
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Physician Internet Barriers (Bennett et al 2005)
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Handheld Computer Functions (Bennett et al 2005)
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Access to Medical Information in Institutions

• Physicians working in hospitals or research
  institutions typically have better access to the
  latest technologies than physicians in clinics or
  private practice
• Hamilton Health Sciences
• Accesspoint/Medseek Clinical Connect portal
• Access to medical records for all hospital
  patients, including tests, etc.
• Considering trials of wireless access
• LHINs will encourage interoperability of
  hospitals, labs, pharmacies, long term care
  facilities

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Conclusions
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Physician Support for Internet Health Information
Use by Patients

• So that physicians and patients work effectively
  as a team in taking advantage of online resources
• Physicians need to be knowledgeable about online
  information sources
• Physicians can take advantage of online eHealth
  education or short courses
• Patients need to be directed to sites that
  physicians believe will provide reliable and
  complete information on the specific disease or
  conditions affecting the patient
• Patients need to confer with physicians if they
  find information that is counter to what
  physicians have told them (e.g. drug side
  effects, etc.) before terminating specified
  medication or treatment.
• Continuing online physician-patient interaction
  awaits adjustments to the fee for service
  compensation model.

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References

• Bennett, N. L., Casebeer, L. L., Kristofco, R.,
  Collins, B. C. (2005). Family physicians'
  information seeking behaviors A survey
  comparison with other specialties. BMC Medical
  Informatics and Decision Making, 5(9).
• Eysenbach, G., Diepgen, T. L. (1999). Patients
  looking for information on the Internet and
  seeking teleadvice. Archives in Dermatology, 135,
  151-156.
• Eysenbach, G. (2000). Recent advances Consumer
  health informatics. British Medical Journal, 320,
  1713-1716.
• Eysenbach, G., Powell, J., Kuss, O., Sa, E.-R.
  (2002). Empirical studies assessing the quality
  of health information for consumers on the World
  Wide Web. Journal of the American Medical
  Association, 287, 2691-2700.

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References

• Google (2006). Google Directory. Retrieved March
  1, 2006, from http//directory.google.com/
• HON (2005). Your usage of Internet for
  health/medical purposes. Retrieved March 1, 2006,
  from http//www.hon.ch/Survey/Survey2005/raw_data.
  html
• ODP (2006). Open Directory Project. Retrieved
  March 1, 2006, from http//dmoz.org/
• Tufano, J. T., Karras, B. T. (2005). Mobile
  eHealth interventions for obesity A timely
  opportunity to leverage convergence trends.
  Journal of Medical Internet Research, 7(5), e58.

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eHealth Innovations and IssuesEnd Lecture
8Some Issues in Self Management of
HealthcareNorm Archer, Ph.D.archer_at_mcmaster.cE
xt. 23944