Welcome and Introduction

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Welcome and Introduction

• Dr Claudia Pagliari
• Senior Lecturer in Primary Care
• Division of Clinical and Community Health Sciences

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Apologies
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Aims of the half day

• To pool information about ongoing eHealth
  research in the University
• To explore opportunities for multidiciplinary
  collaboration
• To share ideas about possible funding
• To plan for the future of the Edinburgh eHealth
  Research Network

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What is eHealth?
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Relatively new concept emerging post 2000
eHealth-specific publications over time
(Pagliari et al, 2004, 2005)
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What journals do ehealth articles appear in?

• Information technology in medicine 207 (95)
• Clinical 77
• Medical education 3
• Finance-related 7
• Legal 4
• Health Services related 61
• Others 28
• (After excluding hits due to journal title)

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What topics are covered in eHealth papers?
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How is eHealth being defined?

• Multiple definitions
• Variable scope
• Very wide e.g. something to do with computers,
  people health
• Very narrow e.g. the healthcare industrys
  component of business over the internet

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Content analysis of definitions

• Functions Most cover multiple medical
  informatics applications for facilitating
  management delivery of health care (e.g. data
  storage exchange, CDSS, patient-provider
  interaction, education, telemedicine, public
  health information etc). Some narrower (e.g.
  e-business, consumer informatics, telemedicine)
  Common theme communication.
• Technologies Most specify networked digital
  technologies (Internet)
• Stakeholders - Providers organizations
  patients citizens all.
• Geographical focus Single organizations -gt
  healthcare systems -gt worldwide
• Conceptual breadth Technologies place or
  function of eHealth in the modern world (e.g.
  patient-provider roles) changes required for
  implementation (cultural organisational
  factors), benefits

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Working definition

• e-health is an emerging field of medical
  informatics, referring to the organisation and
  delivery of health services and information using
  the Internet and related technologies. In a
  broader sense, the term characterizes not only a
  technical development, but also a new way of
  working, an attitude, and a commitment for
  networked, global thinking, to improve health
  care locally, regionally, and worldwide by using
  information and communication technology.
• Eysenbach, 2001, adapted

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The scope of research within HI/eH

• People and organisational factors
• individual and group behaviour of health care
  personnel in their interaction with information
  and information technologies
• Health care delivery quality factors
• Facilitating clinical care and evidence based
  medicine e.g. decision support
• Providing information services for patients
• Health outcomes health status
• Public health factors
• Epidemiology, population health, public
  engagement
• Technological factors
• Systems, hardware, software, networks
• Information factors
• Data issues e.g. standards, nomenclature, data
  management, security and confidentiality
• Management policy factors
• Diffusion of innovations, effectiveness QM,
  change management, ethics legislation

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Relevant disciplines

• Social sciences
• psychology, sociology, social anthropology
• Computer sciences
• Software engineering, artificial intelligence
• Health sciences
• Clinical medicine, nursing, allied health care
• Management sciences
• Business, organizational theory, management
  theory

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Multidisciplinary collaboration needed!
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Sample projects
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ECCI NPfIT (SEHD)

• Origins
• ECCI programme/ NHSS IMT (eHealth) Strategy
• Scope
• Processes /issues for programme implementation,
  technology adoption, perceived outcomes
  barriers. Policy implications.
• Methods
• Key respondent interviews, measurement of
  implementation indicators, stakeholder surveys,
  participative evaluation
• Key findings
• Programme evolved though various stages
  difficulties (human, organisational, technical)
• Wide regional variations linked to existing
  baselines cultures
• Dependence on SCI
• Gradual implementation of most deliverables,
  although not in original programme timescale
• (Pagliari et al, 2003, 2005a,b)

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Scoping the eHealth landscape (SDO)

• Origins
• NHS needed a steer on RD commissioning eHealth
  policy
• Methods
• Traditional innovative reviews to chart
  definitions, place of eHealth, issues for
  implementation, evidence of effectiveness
• Key messages
• No consensus definition of eHealth, all aspects
  of HI represented but increasing focus on
  internet technologies
• Key areas Electronic Medical Records/Systems,
  Telemedicine and telecare Decision support, the
  Internet
• Systematic reviews suggests need for more RCT
  evidence but experts caution that this may not
  always be appropriate
• Areas with greatest potential
• Applications Tools for chronic disease
  management tailored patient information and
  personal health records flexible consulting
  (e.g. email).
• New technologies Wireless Computing, Grid
  Computing, Broadband, DTV

(Pagliari et al, 2004, 2005)
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SCI-DC consumer informatics (DUK)

• Origins
• National SCI-DC system being rolled out
• Previous research highlighted patient engagement
  issues
• DARTS at centre of MCN, but no patient-focused
  elements
• Patient empowerment through electronic tools has
  great potential for chronic disease management
• Proposed scope
• Formative RD
• Focus - information/education, decision aids,
  social support
• Methods
• Scoping reviews, survey, focus groups etc
• User-centred design usability testing with
  patients and clinicians
• Pilot in practice evaluate uptake subjective
  impact
• (Pagliari et al, 2004)

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Text messaging for adolescent diabetes - Sweet
Talk (DUK)

• Scope
• Psychosocial intervention (social support,
  reminders, goal setting) using text messaging,
  for teenagers with diabetes
• Methods
• RCT of TM intervention embedded within RCT of IIT
• Findings
• Iterative, user-centred design led to good
  uptake. Intervention improved patients
  self-efficacy adherence

(Franklin et al, 2003, 2005)
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e-mail consultations (DLHCC)

• Scope
• Intervention - 3 email accounts - Repeat
  prescriptions, appointment booking, clinical
  queries (triaged)
• RQs GP attitudes, usage, patient satisfaction,
  nature of e-interactions, impact on workload
• Methods
• Initial GP survey, qualitative analysis of
  interactions, user survey
• Key findings
• GPs reported little e-consulting uncertainty
  over legislation. Intervention had high perceived
  value for patients, appropriate usage, no
  perceptible impact on practice workload.

(Neville et al., 2004 a,b)
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Other eHealth projects

• Lothian Primary Care Database Project
• Variations in and predictors of coding behaviour
• Validity/meaning/value of codes
• Large-scale intervention study to improve coding
• Epidemiological studies using the high quality
  data
• Pilot observation shows use of diagnostic codes
  in Lothian PC has changed in response to new GP
  contract.
• Mobile phone technology for asthma
• Mobile phone technology for prompting
  self-monitoring feeding back measurements
• Attitudes to mobile technology for asthma
  self-monitoring feedback, experiences of pilot
  (benefits/barriers etc) logistics
• Attitudes to records access
• Public patient attitudes. Challenges faced by
  ethics committees

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END