1. eHealth COMP6047: Further Web Science Catherine Pope 1 march 2012

2. What is eHealth? 2

3. Internet medicine Linking computers and medicine electronic communication Digitized health records Websites about health and medicine Health 2.0; Medicine 2.0 mHealth (mobile medicine) 3

4. WHO 2012 definition E-health is the transfer of health resources and health care by electronic means. It encompasses three main areas: The delivery of health information, for health professionals and health consumers, through the Internet and telecommunications. Using the power of IT and e-commerce to improve public health services, e.g. through the education and training of health workers. The use of e-commerce and e-business practices in health systems management. a new method for using health resources …in time should help to improve efficient use of these resources. The Internet also provides a new medium for information dissemination, and for interaction and collaboration among institutions, health professionals, health providers and the public. 4

5. “e-health is the use of emerging information and communications technology, especially the Internet, to improve or enable health and healthcare” Eng TR (2001). The eHealth Landscape: a Terrain Map of Emerging Information and Communication Technologies in Health and Health Care. Princeton, NJ, The Robert Wood Johnson Foundation. 2003 5

6. an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, 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. (2001) J Med Internet Research 3(2) 6

7. Eysenbach’s 10 e’s. 1.Efficiency (avoid duplication, better communicaiton etc) 2.Enhanced quality of care 3.Evidence based medicine 4.Empower patients 5.Encourage shared decision making 6.Educate clinicians 7.Enable information transfer 8.Extend scope of care 9.Ethical challenges 10.Equity (access and benefit) 7

8. How would you characterise these definitions? 8

9. The Web and medicine/health Web 1.0: information transfer (tele-monitoring -medicine) Web 2.0: interactivity –connect patients to providers (B2C model) –connect patients to each other (online support groups) Web 3.0 ?????? 9

10. Understanding eHealth Research on health professional/services and patient/user responses to eHealth technologies Research on role of the Web in mediating health Health information transfer via the Web. Transforming professional–patient relationships –Coiera, E. (2003) The Internet's challenge to health care provision. British Medical Journal 312: 3 Impact of social media on support/networks –Loader, BD et al (2002) Medicine on the line? Computer- mediated social support and advice for people with diabetes. Int J of Social Welfare 11:53–65. New (?) representations of health 10

11. Health and illness context Demographic change developed world life expectancy from 40-80 in 200 years conditions associated with ageing e.g. arthritis, dementia long term conditions (chronic illness) e.g. diabetes Increased cost of health services Shift from repair to prevention / facilitate self care Access (remote and rural populations and the less mobile) 11

12. UK Policy context NHS Plan 2002 (modernisation) Wanless Report 2002 (recommends doubling of spending on ICT to fund ambitious targets) NPfIT 2002 (Connecting for health) - integrated care records service - electronic prescribing system - electronic appointment booking system - the IT infrastructure to support these systems. scrapped in Autumn 2011 Wanless Report 2007 (ICT implementation slow) 12

13. US context When doctors and hospitals use Health IT, it reduces errors, cuts paperwork, and lowers costs. Over the past 3 years, the Obama Administration has made it a top priority to make it easier for doctors and hospitals to adopt Health IT. We’re providing incentive payments to hospitals and eligible providers to adopt electronic health records and use them to improve patient care. We created 62 Health IT Regional Extension Centers around the country to help health care providers take advantage of those incentives. Already, more than 120,000 primary care providers, including over 70% of rural primary care providers in small practices, have registered to use those incentives. Kathleen Sebelius 21 February 2012 : http://www.whitehouse.gov/blog/2012/02/21/giving- doctors-and-hospitals-tools-they-need-provide-better-carehttp://www.whitehouse.gov/blog/2012/02/21/giving- doctors-and-hospitals-tools-they-need-provide-better-care 13

14. But –barriers to implementation –limited success –notable failures 14

15. Mair F, May C, Murray E et al (2009) Understanding the implementation and integration of E-Health Services http://www.sdo.nihr.ac.uk/projdetails.php?ref=08-1602-135 Methods: 1.Systematic review 2.Qualitative study of professionals (barriers and facilitators) 3.Case studies using qualitative and quantitative methods Choose and Book Picture Archiving Clinical Nurse Information System – using PDAs 15

16. Definitional problems (what is eHealth?) –Management systems (data storage and transfer); –communication systems (for users separated in space/time); –CDSS (rule based decision support); –Information resources internet access to information. Systematic reviews of implementation are misleading (methodological flaws and insufficient attention to the work required to bring systems into everyday use, or how eHealth systems impact on roles, responsibilities and tasks) 16

17. Barriers and facilitators 1. Patient benefits and clear purpose. 2. Collaborative working. 3. Standards a) universality, b) clinical risk, legality & safety. 4. Ease of use a) familiarity & ease to learn, b) efficiency and c) technical support. 5. Professional attitudes a) unity of purpose and b) sense of user empowerment & relationship with suppliers/designers. 6. Clear rationale. 7. Cost a) time, convenience & physical space and b) financial. 17

18. Choose and Book – variable implementation http://www.chooseandbook.nhs.uk/ well integrated in hospital care: ‘We have got it in as mainstream business processes. My consultants are used to it... it is becoming a way of life here…’ (CSI Chief Executive) poor integration in GP: ‘And again for people to say that a Choose and Book takes two minutes – it just doesn’t – it is two minutes if you are really lucky, if the wind is in the right direction on the right day. Even if those 2 minutes but still 20% of the common consultation … 20% that wasn’t there before.’ (CS1 GP Early Adopter and IT enthusiast). 18

19. Picture archiving & communication system (PACS) http://www.connectingforhealth.nhs.uk/systemsandservices/ pacs Fully normalized - highly integrated, enabled the organization to meet its goals more efficiently than the old system: ‘It [PACS] is firmly embedded. If you walk around this hospital two years on, the clinical team wouldn’t even stop to think about what’s they’re doing. It just, there’s not other way for them to get to look at the x-ray image. … No, no it’s truly embedded...’ (CS2 Hospital Chief Executive). 19

20. Mair et al conclusions Need for three way dialogue between designers, implementers and professional users Attend to 1.Context (national and local policy; championing and leadership) 2.Nature of the technology (usability; effects on interactions) 3.Impact on work, workload and training 20

21. Representations of health Pro anorexia sites Fox NJ, Ward KJ, O´Rourke AJ (2005) Pro-anorexia, Pharmaceuticals and the Internet: Resisting the Medicalisation of Body Shape. Sociology of Health and Illness 27 (7): 944-71. Hammersley M, Treseder P. (2007) Identity as an analytic problem: who's who in `pro-ana' websites? Qual Res 7: 283-300 Weight loss Fox NJ. et al. (2005) Expert Patients´, Pharmaceuticals and the Medical Model of Disease: The Case of Weight Loss Drugs and the Internet. Social Science and Medicine 60 (6): 1299-1309 21

22. Seale C. (2005) New directions for critical internet health studies: representing cancer experience on the web. SHI 27(4):515-40 Interpretive media text (content) analysis of two top Google- ranked UK sites http://www.breastcancercare.org.uk http://www.prostate-cancer.org.uk All references made to web site addresses in natioanla nd local UK newspaper articles up to the end of 2003 (hosted by Lexis-Nexis) (plus URL in- and outlinks) 22

23. Seale conclusions Gender differences in representation (parallels offline representations e.g. stereotypes of men as stoical and isolated, women managing complex relationships) Impact of search filters (reducing countervailing views) to create ‘a highly conventional media environment” 23

24. Recap What is eHealth? The Web and health/ medicine /illness Research on (Web) technology implementation in health services Research on the role of the web in mediating ‘health’ 24