consumer health informatics & telehealth

HCI 111

By Dr. Khaled Ouanes Ph.D.E-mail: [email protected]

Twitter: @khaled_ouanes

Consumer Health

Informatics & Telehealth

By Dr. Khaled Ouanes Ph.D. - Twitter: @khaled_ouanes

Complexity and collaboration in healthcare have made Telehealth and Consumer Health Informatics

necessary.

HEALTHCARE COMPLEXITY AND COLLABORATION

The patients need better understanding of their health

diagnosis and to be aware of the new trends in research and information.

The patient needs to be an active participant.


●Complexity: the increasing need to understand health and disease.

●Collaboration: active participation between providers, patients, family members & society.


WHAT IS 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.

TELEMEDICINE?

It also facilitates information exchange between primary care physicians and specialists located at some distance from each other.

TELEMEDICINE?

TELEMEDICINE?

TELEMEDICINE= Medicine +Telecommunications

Technology

We can define it, then, as the use of electronic information and

communication technologies to provide and support healthcare

services when distance separates the participants.

TELEM

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term

•Excellent collaboration method

•Capture data at one site and interpret it at another

•video-conferencing between patients and providers

•Focuses on management rather than diagnosis

Remote Monitoring

Telemedicine:

Telepresence

Remote Interpretatio

n

TELEM

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term

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.

TELEMEDICINE HISTORY

TELEMEDICINE HISTORY

Telemedicine began as early as 1924, with the concept of a physician seeing his patient over the radio using a television screen.

The 1st wave of actual telemedicine programs started in the 1950s. We’re now witnessing the

3rd wave. Most programs that began in the 1960s-1980s no longer exist (Funding issues)

WHY TELEMEDICINE?

AccessProvide primary healthcare that would not be available otherwise.Eliminate expensive travel and isolation.Reduce need to move patients.

Telemedicine settings :RuralSchoolsClinicsHospitalsPrisonsNursing homes/ Assisted living

WHY TELEMEDICINE?

TH

E T

ELEM

ED

EC

INE

EC

OS

YS

TEM

Video conference systemCameras on each endTV screens/Computers on each endVarious medical peripheralsVideo connection T-1 line, Satellite, Phone line (POTS), Internet…

HOW DOES TELEMEDICINE WORK?

Rem

ote

S

ite

Hub Site

T-1

HOW DOES TELEMEDICINE WORK?

TELEMEDICINE AND TELEHEALTH: REDUCING THE DISTANCE BETWEEN THE

CONSUMER & HEALTHCARE SYSTEMS

Patients and providers quickly recognized that rapid electronic communications have the potential to:

1.Improve care by reducing the costs 2.Limit delays associated with travel 3.Direct communication among various

participants (patients, family members, primary care providers, specialists…)

Long distance careRemote monitoringAdvice regarding disease without moving Treatment follow-ups via telecommunications

MAIN BENEFITS OF TELEMEDICINE

CONSUMERISM, SELF-HELP, AND CONSUMER HEALTH

INFORMATICSPatients are important participant in health care. Patients participate in Health care by: •Self-monitoring •Evaluating•Choosing therapeutic strategies from acceptable alternatives•Implementing the therapies •Evaluating therapies effects

As a full partner in health promotion and disease management

consumers serve as their own case managers, brokering care from

generalists, specialists, and ancillary groups.

THE ROLE OF THE CONSUMER

Generally consumers receive their needed clinical services from different providers. Modern

Informatics tools, such as the electronic health record (HER),

provide an integrated record and communication service.


Consumers require access to this record so that they can contribute timely observations, monitor their own progress toward health, and

comprehend the plethora of clinical interventions available to them.


Applications of medical informatics technologies that focus on patients or healthy individuals as the primary users. Mainly, it:- Analyzes information needs of consumers- Develops, tests, and implements strategies to deliver health information to consumers- Integrates consumer preferences into HCIS

CONSUMER HEALTH INFORMATICS (CHI)

CHI CONTINUUM

DEGREE OF CONSUMER AUTONOMY

Provide information

Access to personal medical

information

Communicate with providers

Obtain education/ information/treatm

ent

Give/receive support

BRIDGING DISTANCE WITH INFORMATICS: REAL-WORLD

SYSTEMSThere are many ways to categorize CHI and Telehealth

resources, including classifications based on participants, bandwidth,

information transmitted, medical specialty, immediacy, health care

condition, and financial reimbursement.

BRIDGING DISTANCE WITH INFORMATICS: REAL-WORLD

SYSTEMS

DIRECT ACCESS TO HEALTH INFORMATION RESOURCES BY

CONSUMERSComputer technology can supplement clinicians’ teaching with more detailed information that can be referenced repeatedly by a patient privately at home. Consumer health informatics resources provide substantive & procedural knowledge about health problems & promising interventions.

Consumer health informatics resources originate from 2 major perspectives: Professional and

self-help.

HEALTH INFORMATION RESOURCES FOR CONSUMERS

Professional-developed CHI resources are those developed by healthcare clinicians and their organizations. Healthcare organizations (e.g. HMOs, managed-care companies, and group practices) develop information resources as a service to the patient populations that they are treating.


Self-help Consumer health informatics resources complement & augment those provided by the formal healthcare systems. A self-help perspective is generally more inclusive & comprehensive than a professional perspective. The information may address daily living concerns, lifestyle issues, content considered credible by medical authorities.


Many CHI resources represent a combination of professional and self-help perspectives. Web-based resources, (e.g. those provided by the Fred Hutchinson Cancer Research Center) provide pointers to other Web sites that represent professional or self-help perspectives


CONSUMER HEALTH NETWORKS & HEALTH-RELATED MESSAGINGComputer networks Provide patients with

access to information and offer the additional opportunity for individuals to connect with other people who share similar concerns and with their healthcare providers.Network-based consumer health services include both specialty and public access networks.

Examples of two specialty systems that have been heavily researched are:

The Computer LinkComprehensive Health Evaluation and Social Support System (CHESS)

CONSUMER HEALTH NETWORKS & HEALTH-RELATED MESSAGING

The Computer Link: A specialized computer network service for homebound patients and their caregivers.

CHESS: Targets the needs of people living with AIDS and women diagnosed with breast cancer.


Public access systems include the health related Usenet discussion

groups and the health forums available on CompuServe and

America Online.


The Forgotten Telephone 25% of all primary care encounters occur via the telephone. These include triage, case management, results review, consultation, medication adjustment and logistical issues.This can be partly traced to the fact that telephone consultations are not reimbursed by most insurance carriers.


Remote Monitoring Remote monitoring is a subset of telehealth focusing on the capture of clinically relevant data in the patients’ homes or other locations outside of conventional hospitals, clinics or healthcare provider offices, and the subsequent transmission of the data to central locations for review.


Several factors limit the widespread use of remote monitoring


1.EFFICACY: While these systems have proven

acceptable to patients and beneficial in small studies, few large-scale controlled trials have been done.

CONSUMER HEALTH NETWORKS & HEALTH-RELATED MESSAGINGFactors limiting the use of remote

monitoring

2. WHO WILL REVIEW THE DATA: Research studies have utilized specially trained nurses at centralized offices but it is not clear that this will scale up.


monitoring

3. MONEY: for most conditions, remote monitoring is still not a reimbursed activity.


monitoring

Remote Interpretation: Capture of images, radiographs (teleradiology), photographs (teledermatology, teleophthalmology, telepathology), or wave forms, such as ECGs (telecardiology). By far, teleradiology is the largest category of remote interpretation.


There are 3 categories of synchronous video Telehealth that stand in clear contrast to the general trend:1- Telepsychiatry2-Correctional Telehealth3-Home Telehealth


Telepsychiatry Psychiatry is the ideal clinical domain for synchronous video consultation. Diagnosis is based primarily on observing and talking to the patient. New York State Psychiatric Institute (NYSPI): responsible for providing expert consultation to mental health facilities and prisons throughout the state.


Correctional Telehealth Prisons tend to be located far from major metropolitan centers. They are then located far from the specialists in major medical centers. Transporting prisoners to medical centers is an expensive proposition.


Home Telehealth In 2002, American Telemedicine Association released new guidelines for Home Telehealth. Synchronous video is provided over Plain Old Telephone Service (POTS) connections.

In late 1990s, many believed that home broadband access would become ubiquitous and many vendors abandoned POTS-based systems in favor or IP-based video solutions.


Home Telehealth can be divided into 2 major categories:1-The 1st category: Telehome care: It is the telehealth equivalent of home nursing care. Involving frequent video visits between nurses & patients. It is viewed as a way to provide care at reduced costs. As with home nursing care, telehome care tends to have a finite duration (often focused on recovery from a

specific disease or incident).


2- The second category: centers on the management of chronic diseases. Compared with telehome care, this type of home telehealth frequently involves a longer duration of care and less frequent interactions. Video interactions tend to focus on patient education, more than on evaluation of acute conditions.


Healthcare professionals

play 3 key roles in CHI

ROLES OF HEALTH PROFESSIONALS IN CHI

1. Professionals serve as sources for content. Working in conjunction with software designers, clinicians provide relevant information on the nature & course of illnesses & expected treatment. Effective clinicians deeme as content experts should consider both physiological causes of disease and Socio-environmental causes & consequences of illnesses.


2. Professionals provide important guidance in moderating public electronic discussion groups &and responding to patients’ electronic messages.


3. Clinicians become information brokers and interpreters for patients, directing patients to relevant resources & using time in the clinical encounter to discuss observations, to help interpret the meaning & relevance of particular information, and to aid patients to translate information into behavioral changes in their lives.


CHALLENGES: SECURITY

Using the Internet for Consumer Health and Telehealth Applications will mean…

Resources are widely availableData 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

Better Primary

Care decisions

More accurate

secondary referrals

Un-necessary

spending is reduced

ON THE BRIGHT SIDE FOR HCI…

everyone with computer access can potentially communicate with experts around the world. We now have the tools to develop new healthcare models, wherein clinicians, community leaders, families, and friends collaborate to prevent illness, promote health, care for the sick, and develop and administer new therapies. This vision is no longer a pipe dream: We can do it today.

FUTURE DIRECTIONS

The challenge will be to facilitate productive collaborations between

patients, their caregivers, biomedical scientists, and information technology

experts.

FUTURE DIRECTIONS

HCI 111

By Dr. Khaled Ouanes Ph.D.E-mail: [email protected]

Twitter: @khaled_ouanes

consumer health informatics & telehealth

Health & Medicine