1. Strategies for the Education of Diabetic Patients on the World Wide Web Part I
K C LUN
Associate Professor, Dept of Community Medicine
Director, WHO Collaborating Centre for Health Informatics
Director, Medical Informatics Programme
National University of Singapore

2. The Internet - a huge repository of health information
In recent years, the Internet has been making profound impacts on all fields of human activities. It is now widely recognized as one of the most important tools for information. A recent study showed that 60% of consumers in the USA obtain their health information on the Internet. This astounding finding has important strategic and business implications in the delivery of health and healthcares services.
A recent study shows that 60% of consumers in the USA get their health information from the Internet

3. Feb 99 Asian Edition of Businessweek
Number of Internet users in 11 Asian countries will hit 10 million by end 1999 and 30 million by 2002
The pervasiveness of the Internet is now spilling over to Asia where some of the world’s largest populations are concentrated. A study reported in the Feb 1999 Asian edition of Businessweek reported that by the end of 1999, there will be some 10 million Internet users in the 11 Asian countries surveyed. This number is expected to increase to 30 million by 2002.

4. Strategies for Diabetic Patient Education on the World Wide Web
Health information from Web Portals
Text-based e.g. Frequently-Asked Questions
Multimedia-based e.g. Health Education Videos
Newsletters and Electronic Journals
Discussion Groups, Interactive Forum and Support Groups
Virtual Patient
Distance Education
With the many World Wide Web tools now available, and, given the multimedia capability of this new information paradigm, there is now an array of strategies that can be implemented for health education on the Web. This presentation will focus on Web strategies for Diabetes Patient Education.

5. Health ONE: A strategic joint project between the NUS Medical Informatics Program and the National Computer Board
Health ONE is a multilingual, interactive multimedia health portal launched by the National University of Singapore in 1997 and funded by the National Computer Board. In this presentation, references will be made to Health ONE in the discussions of the various patient education strategies listed in the previous slide.
Connect to Health ONE

6. Health ONE reaches out to the public and healthcare professionals via interactive multimedia web applications as well as multilingualism to promote health and education
Health ONE is one of a few truly multilingual health portals in the world, with information available in English, Chinese and Malay. As a premier health portal on the broadband Singapore ONE network, it also provides services in audio and video formats.
Health One information available in English, Chinese and Malay in text, audio and video

7. Health information from Web Portals - Text-based Resource Materials
Health information portals on the Web are largely text-based because of bandwidth constraints. Often these information sites provide answers to Frequently-Asked Questions (FAQs) on disease information and its management. They also provide basic information on the disease, allow users to pose questions about the disease to an expert, provide an online forum for patient support and maintain links to other related Web resources worldwide.

8. Health information from Web Portals - Multimedia-based e. g
Health information from Web Portals - Multimedia-based e.g. Health Education Videos
In addition to providing its users with FAQs on diabetes, the NUS Health ONE project also carries multilingual video clips on diabetes and its management. Click on ‘Monitoring your Blood Glucose level’ to try.

9. Health information from Web Portals - Multimedia-based e. g
Health information from Web Portals - Multimedia-based e.g. Health Education Videos
Click on the top left-hand image to try a video clip in Chinese!

10. Newsletters and Electronic Journals
Web users can now access literally hundreds of medical newsletters and e-journals on the Internet. The American Diabetes Association (ADA) has a daily electronic web-baed newsletter, the ADA News Daily, on diabetes news and education.

11. Message Boards, Support Groups
Discussion groups, interactive forums and support groups are also popular Web resources that allow diabetic patients to share with others their experience with living with the disease. e.g., offers an electronic message board that allows diabetic patients to post questions to their medical panel and to interact with other diabetic patients.

12. New Paradigm in Patient Education: The Virtual Patient
using gaming technique to promote patient education
In 1998, Health ONE introduced the concept of virtual patient for the education of patients with Type I diabetes. The virtual patient helps diabetic patients to learn about the management of the disease through game-playing.

13. The Tamagotchi Electronic Pet
The Tamagotchi electronic pet inspired the development of the Virtual Patient for diabetic patient education.
Can this electronic virtual pet be usefully applied to medicine? .

14. Virtual patient modeled on the tamagotchi
Research Goal:
Build a website that allows users to learn management of a disease by looking after a virtual patient afflicted with a particular medical condition.
Proper management results in control of condition and eventually improvement.
Patients learn about their disease by looking after the virtual patient. Proper management will result in control of the condition and eventually improvement
Kasou Kanjya or Kkanjya
- Japanese for “Virtual Patient” .

15. Virtual patient modeled on the tamagotchi
Research Goal:
Build a website that allows users to learn management of a disease by looking after a virtual patient afflicted with a particular medical condition.
Improper management results in deterioration of patient’s condition.
Improper management of the virtual patient will result in deterioration of the patient’s condition leading to complications.
Kasou Kanjya or Kkanjya
- Japanese for “Virtual Patient”

16. The many faces of Kkanjya - an insulin-dependent diabetic
Changes in the patient’s condition are reflected in the variation in facial expression, using morphing techniques. Here, the virtual patient is fine.
I am OK but take good care of me

17. The many faces of Kkanjya - an insulin-dependent diabetic
Here, the virtual patient does not look too good!
Ouch! I need my insulin

18. The many faces of Kkanjya - an insulin-dependent diabetic
The virtual patient is improving. Good job!
My diabetes is under control.
Thank you for taking good care of me

19. Taking care of Kkanjya, the insulin-dependent diabetic
kclun
********
To play with the virtual patient, the user has to register with the system so that a password-protected account is created for him/her. The website runs with a back-end database to capture all of the user’s subsequent transactions relating to the management of the virtual patient.

20. Home Screen
This is the Home Page of the Virtual Patient displaying (a) the patient’s current health status, (b) his current caloric intake for the day, (c) number of units of insulin administered, (d) current blood sugar level and (e) his current score based on adherence to dietary limitation and strict adherence to his insulin regime.

21. Game Design Three levels of play (beginner, intermediate, advanced)
Scoring based on:
Patient’s adherence to dietary restrictions
Strict adherence to insulin regime
Score of 2 - caloric and insulin intake fall within normal range
Score of 1 - Outside the normal range but within the stipulated upper and lower bounds
Score of 0 - Outside the stipulated upper and lower bounds
Just like any other computer game, there are 3 levels of play with the Virtual Patient. Scoring is based on the patient’s adherence to dietary restrictions and strict adherence to insulin regime. The Score will determine the Virtual Patient’s facial expression.

22. Game runs on accelerated time clock
1 virtual day =
15 mins real-time
To speed up the management of the Virtual Patient, the game runs on an accelerated time clock (Internet time).

23. Logic engine scores player based on:
timely insulin injections
The game’s logic engine scores the player based on (1) timely insulin injections.

24. Logic engine scores player based on:
glucometer readings based on dietary
caloric intake
The game’s logic engine scores the player based on (2) glucometer readings based on dietary caloric intake.

25. Feeding Kkanjya
Feeding the Virtual Patient is done by simply clicking one of the meal buttons.

26. Looking after Kkanjya - your scorecard
The score card will determine the medical progress of the Virtual Patient.

27. Flow Chart Outcome User registration User login with password
Plays with virtual patient
Administers insulin
Feeds patient
Outcome
Store user’s login name,
password and play level, date
of last transaction
The Virtual Patient flow-chart.
Store user transactions
Store criteria and scoring system for each level of play
SQL database

28. The Health Education Module
Digital training videos delivered in real-time using streaming technology
Glucometer module:
calibration of glucometer
measurement of blood glucose
obtaining reading from glucometer
The Health Education module of the Virtual Patient educates diabetic patients on the proper use of the glucometer as well as administration of insulin. Try them!
Insulin module:
proper way to administer insulin using traditional fine needle
NOVOPEN III

29. Health Education Significance of the Diabetic Virtual Patient
Teaches the importance of medication compliance to patients
Educates patients and the public on the management of diabetes
Training videos teaches them on proper procedure to administer insulin and calibration and use of glucometer
Health Education significance of the Diabetic Virtual Patient is primarily to teach the importance of medical compliance and proper management of diabetes.

30. Strategies for the Education of Diabetic Patients on the World Wide Web
To be continued …
Please view Part II