Electronic Medical Consultation: a New Zealand Perspective

1
Electronic Medical Consultation a New Zealand
Perspective

• A Dissertation by HEIN 702 Group 4
•  
• Campbell Brebner, Raymond Jones, Jayne
  Krisjanous,
• Wendy Marshall, Graham Parry
• Tutor Alec Holt

2
The Proposal

• Our aim was to investigate electronic medical
  consultation with emphasis on
• History and evolution
• Social impact
• Legal issues
• Ethics
• Marketing strategies
• The future

3
History and Evolution

• Traditional face-to-face interaction

• The telephone revolutionised communication but
  did not alter the mode of interaction

• Predictions of profound alterations
• Tele-evangelists vs tele-luddites

4
E-health Has Arrived

• Internet technology allows
• Enhanced communication.
• Fast, Efficient, Accurate.
• Improved information exchange capability.
• Predictions of profound alterations in healthcare
  infrastructure.

5
E-health Is Here to Stay

• Numbers of web-doctors are likely to increase
  Jones (2000)
• Providers benefit - from individual providers to
  large multinational corporation initiatives
• Patients want it !!
• Our study
• Other studies
• Egger (2000)
• Borowitz Wyatt (1998)

6
Types of e-health

• E-mail consultation
• Dr Global, The Health Network, xtra Health
• E-mail information
• Chat sessions
• Dr George, Dr Koop
• Telephony
• Audio-visual

7
NZ Initiatives

• Waikato Teledermatology
• Waitemata Telepsychiatry
• South Island Telemedicine Project
• Christchurch Telemedicine Service
• The New Zealand Telepaediatric Service

8
Social Issues

• Health sector is unprepared and lacks protocols
  or guidelines
• Developmental environment relatively unfettered
  by usual standards
• Issues likely to affect development include
• Equity
• Consumerism
• Provider-Patient relationships

9
Equity

• Internet-enabled consumers are
• in higher socio-economic groups
• better-educated
• Internet-enabled consumers need
• access to resources
• adequate language
• adequate literacy
• technical knowledge

10
Equity

• Disadvantaged
• Ethnic minorities
• The elderly
• The poor
• The disabled
• Those with literacy problems

• Advantaged
• Rural
• Computer literate
• Time pressured
• Those with stable conditions

11
Consumerism

• An informed patient is capable of participating
  more actively in health care decisions
• Providers may feel faced with more aggressive and
  demanding patients, who require more time and
  explanation
• Burgeoning number of e-health providers
• Responding to the demands of consumer-driven
  health-care seekers

12
Consumerism

• Providers will gain competitive advantage by
  offering e-health services
• A way of attracting new clients
• A new service for existing patient
• Unbounded by physical aspects
• Niche services on a global basis

13
Provider-Patient Relationships

• Internet may radically redefine traditional
  relationships viz a viz Industrial Revolution
• No geographic constraints. This works both ways
• Healthcare seekers can decide where to get
  information, or seek expert opinion world wide
• Providers have access to a global pool of patients

14
Provider-Patient Relationships

• Influences on how patients and practitioners
  interact in the future will include
• The vast array of information available through
  websites
• Increasing need for financial constraint
• Software development
• Hardware development

15
Provider-Patient Relationships

• Patients will
• potentially be exposed to more risk
• have to expend extra time and effort researching
  questions
• have to assess quality of responses
• co-ordinate their own healthcare

16
Legal Issues

• There is no special legislation covering
  electronic consultation
• The Health Act (1996) and Privacy Act (1993) are
  deemed to apply by default
• The US Congress is considering regulating
  internet medical consultations (Check 1999)

17
The Health Information Privacy Code (1994)

• Twelve rules regarding use and disclosure of
  health information
• Patient empowerment and informed consent
• Four rules of relevance to e-health are 3, 5, 10
  and 11

18
Privacy Policies

• Of the three NZ sites providing electronic
  consultations, only Dr Global provided any sort
  of privacy policy
• This nevertheless falls well short of the
  standard set by OECD

19
Ethics

• There are several non-profit organizations that
  aim to ensure ethical use of medical information
  on the Internet
• Internet Healthcare Coalition.
• International e-Health Code of Ethics.
• Health On The Net Foundation.
• Code of Conduct for medical and health websites.

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Code of Ethics

• Issues covered by these codes include

• Implementation of codes by
• Cyber metrics
• Human ratings systems

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Pros.and Cons

• Security
• Disadvantaged groups
• Diagnostic limitations
• Anonymous
• Risk management/ potential professional exposure
• Possible abuse by prescription/ drug seekers

• Convenience
• Second opinions
• Specialists of choice
• Anonymous
• ? Less expensive
• Global remote areas

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Conclusions

• Technological progress cannot be slowed.
• Unresolved issues remain
• quality, accessibility and confidentiality.
• Control needs to be flexible and manageable - it
  is unlikely to be perfect.
• There is a place for both services.
• Our challenge is to help make it work for the
  benefit of all.