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Consumer Health Information & Telehealth
- 1. INFO 648 – Healthcare Informatics ,Fall 2009 – M. Rogers, PhD Team 3 Johari Crews Andrea Kyer Titus Moolathara Gabriel Sirlopu Consumer Health Informatics and Telehealth drexel university
- 3. Definitions
- 7. Conceptual Framework for CHIS
- 10. Challenges: Economics and Privacy
- 12. Definition of Telemedicine Telemedicine involves the use of modern information technology, especially two-way interactive audio/video communications, computers and telemetry to deliver health services to remote patients ad to facilitate information exchange between primary care physicians and specialist at some distance from each other. (Bashshur, et al., 1997)
- 13. Telehealth: a broad term
- 14. Remote Monitoring Subset of telehealth Common practice in home health care Captures clinically relevant data in the patient’s home Focuses on management rather than diagnosis
- 15. Remote Interpretation Capture of medical data at one site and transfer to another for interpretation Radiographs Photographs Wave Form Advancement in technology increases the availability of these services.
- 16. Multi-media, real time interaction… Video-based Telehealth Mode of synchronized video-conferencing Three categories: Telepsychiatry Correctional Telehealth Home Telehealth Telepresence View situations and act on them Excellent collaboration method
- 17. Using the telephone again: 25% of all primary care encounters occur by telephone Improve cost control. Some insurance providers are reimbursing for email and text messaging. Reimbursing for telephone contact?
- 18. page 513 Figure 14.1ways to bridge the distance between patients and provider
- 19. page 513 Figure 14.1ways to bridge the distance between patients and provider
- 20. Consumer Health Informatics Modern consumers of healthcare experience an increased demand to participate in their care. Reflects a shift in paradigm from the patient being a silent recipient to active collaborator. The patient is now a case manager. Inexpensive access to information on health promotion, disease prevention and disease management.
- 21. Changing roles for Health Professionals Medical professionals have the following responsibilities to the field of Consumer Health Informatics Serve as sources for content Provide important guidance in moderating public electronic discussion groups and responding to patient’s electronic messages Act as an information broker and interpreter for patients
- 22. How do we present health-related information in a way that is easily understood by the average person? Can existing decision support systems be adapted for use by consumers, or do we need to build a new system from scratch? Challenges
- 23. NLM –Conceptual framework for consumer health information seeking
- 24. Consumer
- 26. Channel
- 27. Outcome
- 28. Environment
- 29. Information Quality: Who is watching the internet? Credentialing represents one approach to ensuring the quality of health information available to consumers. Three disadvantages: The challenge to ensure that every information element is tested and evaluated fully exceeds the resources available to do so. Leaves control of the authority for healthcare information in the hands of traditional care providers. Credentialing alone is inherently contradictory to healthcare consumerism.
- 30. How are consumers interacting with health information?
- 31. Online Search Behavior Readability Consumer Health Vocabulary a Cross-language information retrieval Research Methods in Use by the NLM
- 32. More seniors More chronic illness Greater need for healthcare $ With so many retirees, the national income decreases because there are fewer people working and earning. The not-too-distant future…
- 33. Telehealth can reduce healthcare costs Long term disease monitoring of patients at home currently represents the most promising application of telehealth technology for delivering cost effective quality care.
- 34. Challenges: Economics Licensure and Economics in Telehealth Licensure is frequently cited as the single biggest problem facing telemedicine Medical licensure is state-based Reimbursement Medicare: synchronous video is reimbursed only for rural patients Medicaid: 19 states provide coverage for sync video Few insurers: electronic messaging and online consultation Only services provided directly by humans are currently reimbursed by insurance
- 35. Challenges: Security Using the Internet for Consumer Health and Telehealth Applications will mean… Resources are widely available Data freely transmitted over the Internet raises security concerns The industry faces the challenge to ensure integrity and quality of the medical data transmitted over the Internet
- 36. On the bright side…
- 37. The Future… Wealth of public health information and provider-oriented information resources are available through the Internet Patients are now researching medical data Clinicians need to ensure to be prepared to answer all the patient’s questions based on their research Telehealth technology continues to grow due to the rapid advancement of technology Facilitating productive collaboration between patients, their caregivers, biomedical scientists, and information technology experts.
- 38. Has the use of Consumer Health Informatics helped the consumer or has it made health care more difficult to understand? Health information on the internet is too plentiful for anyone to realistically keep track of. Experiment by googling – try heavily advertised drugs as your search term; try searching a symptom or something overly broad like ‘healthy diet’. Share and discuss on the board. How can HIT professionals facilitate productive collaborations between patients, their caregivers, biomedical scientists, and information technology experts? “Be careful about reading heath books. You may die of misprint.“- Mark Twain Is it worthwhile to put records (general health information) into the hands of the consumer? Think about this as you read…
- 39. Baker, L. and Gollop, C., Initials. (2004). Medical textbooks: can laypeople read and understand them?. Library Trends, 53(2), Eysenbach, G. (2000). Recent advances: consumer health informatics. BMJ, doi: 10.1135/bmj.320.7251.1713 Pare, G. Jaana, M. and Sicotte, C. (2007). Systematic review of home telemonitoring for chronic diseases: the evidence base.Journal of the American Medical Informatics Association, 14(3), doi: 10.1197/jamia.M2270. Consumer Health Informatics & Telehealth –p.511-535 in Shortliffe, E. H. (2006). Biomedical Informatics. Health Informatics. [New York]: Springer Science+Business Media, LLC. Sullivan, F. and Wyatt, J., Initials. (2005). How Informatics tools help deal with patient problems. BMJ, doi: 10.1136/bmj.331.7522.955 Tse,T. Gemoets, D. and Rosemblat, G. (2004). Consumer health information seeking: a report to the board of scientific counselors. The Lister Hill National Center for Biomedical Communications, doi: LHNCBC-TR-2004-03 References
Notes de l'éditeur
- Complexity and collaboration in health care have made Telehealth and Consumer Health Informatics necessary. The patient needs a better understanding of their health diagnoisis and be to aware of new research and information. The patient needs to be an active participant.
- The definition of Telemedicine. Involves the use of modern information technology, especially two-way interactive audio/video communication, computers and telemetry to deliver health services to remote patients aids to facilitate information exchange between primary care physicians and specialist at some distance from each other.
- Telehealth and telemedicine have the ability to bring professionals and patients closer together. Telemedicine emphasizes the distance, especially the provision of care to remote or isolated patients and communities.
- Remote Monitoring is the subset of telehealth. Remote monitoring has become a common practice in home health care in the United States. It focuses on the capture of clinically relevant data in the patient’s homes or other locations outside of the medical facility. Remote monitoring focused on management rather than diagnosis. It is used to track parameters that guide management. Additionally, patients receiving remote monitoring experience lower average hospital readmission rates compare to regular patients.
- : Remote Interpretation involves the capture of images or other kind of data at one location and then transmitted to another location for interpretation. This medical data includes radiographs, photographs, or wave forms. The availability and capability of these processes continue to grow as technology advances.
- As its name clearly states, video-based telehealth consists of the form of sync video-conferencing. Telepresence involves systems that allow clinicians to not only view remote situations but also to act on them. This system is intended to provide the emotional/vivid impact as if the remote situation was taken place at the clinician’s location. It provides a good method of collaboration.
- Improve cost control by using the telephone for case management rather than more expensive technologies. Some insurance providers are reimbursing for email and text messaging. Will insurance companies pay for telephone contact?
- Rarely do consumers receive all their needs from a single provider. the consumer now must participate in their care for example share in decision making, self care and collaboration, this reflects the change in paradigm from classlical healthcare to modern healthcare. Acting as a case manager for themselves, the consumer now has to broker care from generalist, specialist and other healthcare workers. Increased availiablity of information allows for a better understanding of health promotion, disease prevention and management of chronic health problems
- Healthcare professionals have three different key roles:1. They serve as sources of content. 2. Provide important guidance in moderating public electronic discussion groups and responding to patient’s electronic messages.3. Information brokers and interpreters for patients, directing patients to relevant resources and using time in the clinical encounter to discuss observations, to help interpret the meaning and relevance of particular information, and to aid patients to translate information into behavioral changes in their lives.
- One challenge is to develop or adapt existing computer based decision support system for use by consumers. The greatest contribution of consumer health informatics research to the healthcare sector may be in the efforts to systematize and codify consumers needs, values, and preferences, in its research into how these variables influence outcome measures.
- This diagram is part of the National Library of Medicine’s 2004 report on Consumer Health Information Seeking. It’s not simple or pretty! The NLM acknowledges this, but they had to start somewhere. What this diagram does is provide a high level map of areas to be explored – we can develop a good plan of attack by investigating each of these components, and thinking critically about their interconnections:
- Consumer. Here is where we can see cognitive science in action. How we deliver health information depends on the audience. Systems need to be designed to meet the needs of consumers with different cognitive abilities. Another factor is the information or knowledge the consumer already has, even if it’s incorrect it will still have a significant effect on the way they evaluate new information they come across in their search. It’s not easy to admit everything you thought you knew was completely wrong, so if you can’t find information related to what you think you already know, you might simply lose motivation to continue searching.
- Left to their own googling, consumers will turn up thousands of formal and informal sources of health information. They will typically decide which ones to go with by going with their ‘gut’, just like any other online shopping experience – the qualities being considered are trustworthiness, credibility, availability, intrapersonal support provided, and the intended message.
- “Channel” refers to communication channel and covers a lot of ground. The level of interactivity can be unidirectional (an online video, pre-recorded) or bi-directional (online video chatting in real time). The modality can be any one or a combination of audio and visual means. Accessibility is an important consideration as well – it’s easy to take internet access and cell phone reception for granted until you’re in a rural area.
- As we’ve seen in other areas, measuring the actual effect of improved information access is notoriously difficult. If our research question is something along the lines of “Does consumer participation in health communication improve the quality of health care and does that improvement result in improved health?” what do we have that can be counted, measured, and tested?
- People do not seek health information in a vacuum — it is integrated into their lives. When does it come up, and what motivates it? By understanding the practical, everyday role of health information in a person’s life we can work toward designing systems that deliver where, when and how information is needed. iPhone apps are one area for on-the-go information that’s exploded recently, we’ve reviewed a few of these on our wiki and would love to hear from anyone who uses them.
- Credentialing represents one approach to ensuring the quality of health information available to consumers. It is most useful when the credential itself is accompanied by a statement indicating the perspectives and biases of those granting it.Inherent in the credentialing approach are three disadvantages:1. The challenge to ensure that every information element is tested and evaluated fully exceeds the resources available to do so.2. This approach leaves control of the authority for healthcare information in the hands of traditional care providers, reflecting both the expertise and the biases of established medical sources.3. Credentialing alone is inherently contradictory to healthcare consumerism, which empowers the consumer to make choices consistent with her own worldview.
- CHIS research wants to zero in on this particular part of the diagram, the interaction between consumers and online health information systems that may be mediated by various communication channels.
- These four areas are identified as methods being used to understand online health information seeking behavior. Researchers are able to look back on “artifacts” like web-traffic reports or log-file data and consider the nuts and bolts language issues they present. They can find which queries came up with zero hits and try to understand what the searcher might have been trying for; they can map technical terms and concepts to common everyday language; and they can explore ways to allow Spanish speakers access to the information. The question of Readability is very interesting – the average American Adult reads at a level below junior high school. How can the language used be adjusted to improve consumer comprehension but not distort the meaning or effectiveness?
- Chronic diseases have become major causes of death in almost all countries. The economic burden of chronic diseases is profound, accounting for 46% of the global burden of disease. The losses in national income for 2005 due to deaths from heart disease, stroke, and diabetes were estimated to be $18 billion in China, $1.6 billion in UK, $1.2 billion in Canada. In the United States 78% of all medical costs nationally is due to chronically ill patients.
- The patient management approach appears to be very well received and accepted by patients themselves. it allows them to participate in the process of care, improves their awareness and feeling of security, and ultimately leads to empowerment.There is an increasing need to identify patient management approaches that would ensure appropriate monitoring and treatment of patients while reducing the cost involved in the process. Economic challenges arise when we try to update reimbursement and licensure protocols to fit a new setting without geographic boundaries.
- Licensure is frequently cited as the single biggest problem facing telemedicine. Medical licensure in the U.S. is state-based, while telemedicine frequently crosses state and national boundaries. This is on-going issues that some states continue to deal with.Reimbursement is another factor that limits the growth of telehealth. In today’s field, Medicare only reimburses rural patients for synchronous video treatment, Medicaid only covers 19 states for synchronized video, and only a few insurers reimburse electronic messaging and online consultation. Bottom line, only services provided directly by humans are currently reimbursed by insurance
- More information is becoming publicly available on the Internet. The amount of consumers seeking for information over the Internet continues to grow. This demand increases the risk of privacy invasion, which is a major security concern for health information technology professionals. Subsequently, HIT professionals need to ensure the quality and integrity of this data.
- Medical education never ends, sharing and integrating information across the world promises a more efficient future for healthcare. Virtual environments have been useful training grounds for medical professionals, students, and health consumers. Some examples of this can be viewed in our wiki. Now better informed patients, medical records that inform and teach, and electronic sources of reliable, well presented information make it easier to make informed decisions on problems presented in primary care.
- Through the internet and private intranet, wealth of public health information and provider-oriented information resources are available to clinicians in practice. Additionally, patients are now conducting their own research and bringing questions to the practitioners. Practitioners need to be prepared to answer their questions and also allocate additional time to answer them adequately. Enhancement in technology continues to expand which magnifies the growth of telehealth practices. However, technology is not the only factor to allow its growth. A major social change would also need to be taken under consideration. An outstanding issue remains; it is the challenge of facilitating productive collaboration between patients, their caregivers, biomedical scientists, and information technology experts.