Post on 11-Jan-2016
E-HEALTHPRESENT AND FUTURE
Ramona MayerEBG MedAustron GmbH, Wiener Neustadt, Austria
eHealth . . .
"eHealth is the single-most important revolution in healthcare since the advent of modern medicine, vaccines, or even public health measures like sanitation and clean water”
Silber D. The case for eHealth. (Presented at the European Commission'sfirst high-level conference on eHealth May 22/23 2003.) European Institute of Public Administration 2003.
From medical informatics to eHealth
Classical Medical Informatics – stand alone era (1970+)
Health Telematics – early telecom days (1985+)
eHealth – Web era (1995+)
Pervasive and ubiquitous eHealth - ambient intelligence era (2005+)
From medical informatics to eHealth
Classical Medical Informatics – stand alone era (1970+)
Systems for the storage, retrieval, sharing and optimal use of biomedical data, information and knowledge
Health Telematics – early telecom days(1985+)
Regional health care networks Remote diagnosis and telemedicine applications Decision Support Systems
From medical informatics to eHealth
eHealth – Web era (1995+) Internet based applications and services Medical content for prevision Intranets for health service management
Pervasive and ubiquitous eHealth - ambient intelligence era (2005+)
Health knowledge infrastructure Wearable and implantable systems Biomedical informatics for personalized health Health GRIDs
eHealth
mHealth
Health knowledge management
Electronic Medical Records
Telemedicine
Consumer Health InformaticsVirtual healthcare teams
eCardiology
eRadiology
„eHealth“…
eHealth encompasses a range of services that are at the edge of medicine/healthcare and information technology
e-health encompasses much of medical informatics, but has to prioritise the delivery of clinical information, care and services rather than the functions of technologies
No development of basic technology, but development of beneficial applications
for patients physicians care facilities health care insurance companies etc
EC definition of eHealth
“….the use of modern information and communication technologies to meet needs of citizens, patients, healthcare professionals, healthcare providers, as well as policy makers"
http://europa.eu/
WHO definition of eHealth
"eHealth is the cost-effective and secure use of information and communications technologies in support of health and health-related fields,
including health-care services health surveillance health literature health education, knowledge and research"
(World Health Organization , Ninth plenary meeting, 25 May 2005 - Committee A, seventh report)
5 Steps of eHealth
Information
Communication
Interaction
Transaction
No information
Stage 4
Stage 3
Stage 2
Stage 1
Effi
cien
cy a
nd q
ualit
y of
ser
vice
Level of process orientation
Low
Hig
h
Low High
Integration
Stage 5Electronic Patient Record
Electronic Health Record
Electronic diabetes diary
Steps of eHealth…
Step 1 - Information Providing information for patients or doctors e.g. via
the web (information in one direction), Medical databases like PUB MED
Step 2 - Communication (action) The exchange of information between two people
involved (patient - doctor, doctor - doctor...) without direct and current reaction of the communication partner (e.g. on-line diabetes diary)
Step 3 - Interaction (action + reaction)
Exchange of information or dates between people involved with immediate reaction of the communication partner (e.g. telemonitoring, telesurgery…)
Steps of eHealth…
Step 4 - Transaction Electronic handling of a complete (treatment)process (“All
or nothing”)
Step 5 - Integration (e.g. Electronic health record - EHR)
Electronic health biography – central documentation for all health relevant data from birth to death
Information
Communication
Interaction
Transaction
No information
Stage 4
Stage 3
Stage 2
Stage 1
Effi
cien
cy a
nd q
ualit
y of
ser
vice
Level of process orientation
Low
Hig
h
Low High
Integration
Stage 5Electronic Patient Record
Electronic Health Record
DIAB-MEMORY
Providing information for patients or doctors e.g. via the web
(information in one direction)
Step 1 – Information
Step 1 – Information
Provider of the information Publishing companies, authors Provider of medico technical equipment Pharmaceutical companies Health insurance companies Physicians and health care professionals …
Information medium Print media CD, DVD, … Computer network / Internet
Recipients Physicians Patients Family members …
Internet
Step 1 – Information
Physicians Medical literature
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db= PubMed
Medical database (z.B. Drug informaton systems) http://www.druginfosys.com /…
Patients Health advisor
http://www.netdoktor.at/
Dictionary of medical terms http://www.medterms.com/ …
Step 1 – Information
Health on the Web
Estimated ~ 20,000 health websites Used by 98 million adults
75% of people who have web access Average of 3.3 times per month
More than consult doctors each day
Step 1 – Information
Health on the Web
Pro Correct information
can lead to more knowledgeable and less anxious patients
more participatory health decisions
Con Misinformation
can lead to confused patients Bad decisions, false hope, harm
Information
Communication
Interaction
Transaction
No information
Stage 4
Stage 3
Stage 2
Stage 1
Effi
cien
cy a
nd q
ualit
y of
ser
vice
Level of process orientation
Low
Hig
h
Low High
Integration
Stage 5Electronic Patient Record
Electronic Health Record
Communication = ActionThe exchange of information between two people involved
(patient - doctor, doctor - doctor...) without direct reaction of the communication partner
(e.g. online diabetes diary)
Step 2 – Communication
Electronic diabetes diary
Diabetes-diary allows to document the blood glucose values enables the physician to access the data adjust the insulin dosage accordingly
The patient can communicate with the physician online save time and unnecessary office visits.
from: http://www.diabetes-diary.com/
Step 2 – Communication Online diabetes diary
Step 2 – Communication Online diabetes diary
From: http://www.diabetestagebuch.de/
Step 2 – Communication Online diabetes diary
Step 3 - Interaction
Information
Communication
Interaction
Transaction
No information
Stage 4
Stage 3
Stage 2
Stage 1
Effi
cien
cy a
nd q
ualit
y of
ser
vice
Level of process orientation
Low
Hig
h
Low High
Integration
Stage 5Electronic Patient Record
Electronic Health Record
Electronic diabetes diary
Interaction = action + reaction
Exchange of information or data with immediate reaction of the communication partner (e.g. telemonitoring,…)
Step 3 - Interaction
Telemedicine
Most useful when Specialist services are in very high demand or patients are extremely isolated
( Antarctica or remote communities in Australia, Africa and Alaska)
Telemedicine encompasses any medical activity
involving an element of distance (R. Wootton)
Online versus store-and-forward Functional
Telecardiologye Teleradiology Telesurgery Teledermatology Telecare (homecare)
Action Telemonitoring Second opinion Telediagnosis etc…
Multimedia (Text, Audio, Image, Video, Augmented Reality)
Step 3 - Interaction Telemedicine
1. Live telemedicine via videoconference2. Store-and-forward telemedicine –
transmit for assessment offline Typical telemedicine interaction: store
and forward followed by live interaction
Data types Text ( e.g. patient's notes) Images (e.g. x-ray, CT, etc) ( Telemedicine often relies
on images)
Step 3 - Interaction Telemedicine
1. Patient with an implant with home monitoring function
2. CardioMessenger sends a SMS daily and additionally in the case of an event
3. Automatic data processing at the service centre
4. Physician with secure internet access
Step 3 - Interaction Telemonitoring
www.biotronik.com
Quelle: http://www.chili-radiology.com/
Step 3 - Interaction
Teleradiology
Step 4 - Transaction
Information
Communication
Interaction
Transaction
No information
Stage 4
Stage 3
Stage 2
Stage 1
Effi
cien
cy a
nd q
ualit
y of
ser
vice
Level of process orientation
Low
Hig
h
Low High
Integration
Stage 5Electronic Patient Record
Electronic Health Record
Electronic diabetes diary
Transaction Electronic handling
of a complete (treatment)process (“All or nothing”)
For example : Austria
Rollout until end of 2005 Electronic handling of a complete (treatment)process
Includes: On the reverse side = EHIC - European Health
Insurance Card Digital signature
At present the ecard cannot be used at: Private medical practice Other contractual partners (e.g. optician, midwife, …)
Step 4 – Interaction Electronic health card
Step 4 – Interaction Electronic health card
Administrative dataEHIC - European Health Insurance Card
e-medication
Health care provider index
Patient recordPhysician letter
√
}W
ork in progress
Step 5 - Integration
Information
Communication
Interaction
Transaction
No information
Stage 4
Stage 3
Stage 2
Stage 1
Effi
cien
cy a
nd q
ualit
y of
ser
vice
Level of process orientation
Low
Hig
h
Low High
Integration
Stage 5Electronic Patient Record
Electronic Health Record
Electronic diabetes diary
Electronic health biography
= central documentation for all health
relevant data from birth to death
Central data repositoryor
Local data repositories + central index
Case record (e.g. under discussion in Germany)or
Live long electronic health record
Any combination is under discussion in countries across Europe!!
Step 5 - Integration
E-health in different environments
for example:General HospitalIon beam facilityeHealth on the EU-level
eHealth in a general hospital Administration
Billing Hospital information system (HIS) Procurement Logistic
Medical data Radiological images and findings Lab- Information System Discharge letter Teleconference etc…
Step
1 -
3
Clinicians are very busy and under constant pressure to perform !
They will NOT change their behaviour, unless the new workflow is clearly more efficient on a personal and individual level !
Sulivan2002; Holzinger & Errath 2004
Usability …..
For an interface to be a success it must provide
the right functionality at the right place at the right time and in the right form
from the user's point of view!Holzinger 2000
E-health in different environments
for example:General HospitalIon beam facilityeHealth on the EU-level
Concrete project: Platform for the planned co-operation between the Ion beam Research
and Treatment centre MedAustron in Wiener Neustadt, Austriaand Hungarian hospitals
MedAustron eHealth services Provided services
Accept patient information Accept medical findings Accept radiological images and findings
Provide RT planning information Dose information Plan details
Provide medical reports
Scenario IPatient referral without pre-irradiation
Possible data inputfrom referring hospital
Patient base data Medical relevant
data Histological data Surgical report Other findings
CT/MRI/PET-CT/US
Available data output from MedAustron
RT planning documents Applied dose
Medical report
Teleconference
Scenario IIPatient referral with pre-irradiation
Possible data inputfrom referring hospital
Patient base data Medical relevant data
Histological data Surgical report Other findings
CT/MRI/PET-CT/US RT plan + applied
doseAvailable data output
from MedAustron
RT planning documents Applied dose Sum dose
Medical report
Scenario IIIPatient referral with pre-irradiation
Possible data inputfrom referring hospital
Patient base data
Medical relevant data Histological data Surgical report Other findings
CT/MRI/PET-CT/US
RT plan + applied dose Available data output from MedAustron
RT planning documents Applied dose Sum dose
Medical report
Step 5
Electronic Health Record
1 2
34
E-health in different environments
for example:General HospitalIon beam facilityeHealth on the EU-level
eHealth for RegionsA network for transnational co-operation
Aim Support of an innovative process by building a
platform for the exchange and generation of ideas for co-operation
Provision of experiences and knowledge about the specific challenges of transnational collaboration in the field of eHealth among the network partners
Finally the co-operation should be run by the partner themselves!
eHealth for RegionsCo-operation fields and pilots (examples)
Personal information medical sticks Developed for patients with chronic diseases, who
are often travelling in European neighbouring countries on business or vacancies
Objectives To improve the cross-border medical service, esp. for
travelling pts. with chronic diseases
To support physicians with information treating foreign patients
To omit unnecessary examinations of patients USB sticks are prepared with structured medical information based on
the
European emergency health card
Partners: Denmark, Finland, Germany, Lithuania, Norway, Poland, Sweden
Step 1
eHealth for RegionsCo-operation fields and pilots (examples)
Ferries with Tele ECG at the Baltic Sea
Objectives A better health care support for travelling citizen to reduce time from symptoms to treatment
TT Line transports 2000 to 4000 passengers every day between
Trelleborg (Sweden) and Travemünde or Rostock (Germany) First aids room equipped with a transtelephonic ECG
recorder ECG transmitted to multilingual server of telemedicine
centre in Bad Segenberg (Germany) routed from there to co-operating cardiac centres in a readable format
Step 2
Summary : eHealth =
„ … in a broader sense, 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 G. What is e-health? J Med Internet Res 2001;3(2):e20,
adapted by Pagliari et al. 2005
Challenges…
National legal regulations and obligations AND: Legal and ethical implications of using health
information technologies which may result in harmful effects in certain cases are not yet clear...
Safety (data integrity and completeness) Data security and protection
System developers need to employ quality and safety assurance methods to avoid clinical risks and legal liability
Interoperability Implementation and integration of eHealth systems into care processes
are constrained by insufficient levels of systems interoperability (though moves to ensure standardisation in many current e-Health implementation programmes will reduce this)
Acceptance (availability and usability)
5 Steps of eHealth
Information
Communication
Interaction
Transaction
No information
Stage 4
Stage 3
Stage 2
Stage 1
Effi
cien
cy a
nd q
ualit
y of
ser
vice
Level of process orientation
Low
Hig
h
Low High
Integration
Stage 5Electronic Patient Record
Electronic Health Record
Electronic diabetes diaryModerate progress
Used in daily practice
Accelerated progress
Summary
eHealth is not able to solve the problems of
the health and social systems
BUT
the problems of the health and social systems cannot be solved WITHOUT
eHealth
...working together towards an ehealthy future