Emerging Technology - E-Health - Research Paper Example

Emerging Technology - E-Health Abstract This report is a discussion about a new technology in the healthcare sector, termed as E-Health. The technologies used for the networking of e-Health, which primarily include information and communication technology and telemedicine, are discussed in this report along with an introduction to electronic health records and E-Ten’s projects related to e-Health. Netlink, Netc@rds and Transcards projects have been discussed briefly to illustrate the role of e-TEN in the healthcare industry. The impact of internet on healthcare and telemedicine has been explained in order to achieve a better understanding of the subject. It has been clearly illustrated how the e-Commerce has improved the security and economic issues for the consumers. The way the relationship between the physician and the patient has been affected by the use of e-Health services has also been given a glance. British Columbia, Canada, has passed important legislation regarding e-Health which has been discussed along with the e-Health Code of Ethics. In the end, some major issues regarding the improvement of e-Health solutions and services have been discussed which include quality of the services, security and privacy of the e-Solutions, administrative simplification and the digital divide. Last but not the least, some website links have been quoted which would be of interest for e-Patients. In short, the whole issue of e-Health has been discussed in significant detail so that the readers get a better understanding of this efficient and interesting technology-based field. Keywords: e-Health, ICT, telemedicine, EHR, quality, security, internet, physician, e-Patient, legislation, project, service, record, information, communication, diagnosis, treatment Introduction In the simplest terms, e-Health (also written as eHealth) is defined as the health care practice which is carried out by making use of information technology and electronic procedures. e-Health is a newly emerging field which is rapidly leading towards the improvement of health care in the developing countries. This is such a broad term that there is no clear definition for it. Gunther Eysenbach (2001) has defined eHealth as follows: e-health is 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. E-Health provides services which let the doctors have an access to their patients’ data by maintaining their records and information about their diseases in databases and other e-Health tools, rather than using paper documents. They can assess the data, prepare prescriptions to be sent to the pharmacies via communication technology, get instant and accurate results from the laboratories directly, communicate with their patients on a regular basis no matter which part of the globe they live in, and give better suggestions regarding their health and lifestyle. On the other hand, the patients, here referred to as ePatients, can have access to doctors all around the world with the use of information and communication technology, telemedicine and e-Health systems (each of which will be described shortly), get diagnosis (known as remote diagnosis) and treatment regarding their diseases, and thus remain better informed about their problems in particular and health care in general. There are a lot of e-Health forums, softwares and weblinks on the internet which allow them to communicate with their doctors and with other fellow patients as well. If there is need for a patient to get in contact with a foreign doctor best suited for the treatment of his disease, or if his treatment can only be provided in some other country, then e-Health is there for him where, by using suitable e-Health systems, he can resolve his trouble. E-Health has a major contribution in solving the communication problem between the practitioners providing healthcare in remote areas and healthcare institutions in the city. E-Health brings the best healthcare providers in competition which enhances the quality of healthcare practice. It has created a trustworthy doctor-patient relationship as e-Health systems ensure the patients’ privacy. It has also made it possible to achieve online education about healthcare through online sources. It provides tools, known as e-Health tools which facilitate health services like diagnosis and treatment. These include electronic databases, mobile monitors, health portals, and many more. E-Health is also cost-effective as money is not spent on staffing and traveling resources. The European Union (EU) is the leader in the development of e-Health systems and tools. According to a rough estimate, EU has spent almost €500 million of research funding on e-Health since 1990 (Europa, 2009). Unfortunately, there are a lot of people out there who do not have access to computer and internet, or they have less knowledge about technological advances, and thus they cannot benefit from the services of e-Health, despite the fact that such people are the most deserving of getting proper healthcare. In short, E-Health not only acts as a platform where the health care providers, authorities and hospitals can work closer to each other, but also acts as a medium between the doctors and patients; a medium that is just in accordance with the latest technology and the modern era. E-Health is not merely a big step in the new technology, it is 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, 2001). Given below is the description of some very important terms related to e-Health. It is important to know them in order to better understand e-Health. Information and Communication Technology (ICT) This term combines in itself the characteristics of information technology (IT) and telecom. Most simply put, IT provides solutions to process the information while telecom provides solutions to transfer that information. Processing includes management of data (like computing, storage of data in databases, manipulation, protection and retrieval of data) and its networking. Transfer includes transmission of data from one place/desktop to other using communication techniques. Both technologies are collectively called information and communication technology (ICT). ICT is of primary importance in the field of e-Health. It has made it possible to provide faster, reliable, cost-effective and responsive solutions to mankind in the health sector. ePatients use ICT to have a better knowledge about their diseases and other issues. They can communicate with their physicians and fellow sufferers. Fieschi (as cited in Karsenti & Charlin, 2008) states that ICT has enabled the patients to be part of the health decision process who are constantly requesting to view and access the data about their disease contained in their medical records. Physicians use ICT systems to analyze and access their patients records and have a peer-to-peer communication. ICT provides tools and softwares for this purpose which will be discussed in the next pages. The European Union has funded roundabout 40 eTEN projects in the e-Health field which are based upon ICT (Europe’s Information Society, 2009). Telemedicine Telemedicine is the process that involves exchange of medical information between people/physicians/patients residing at different places through the use of technology. The information may be about patients and their medical histories, or it may be general information about medical issues and health care. When this information is shared with the use of electronic equipment, it is called telemedicine. Telemedicine has acquired great importance in e-Health as it provides faster and safer services both to the doctors and the patients. The main benefit of telemedicine is that it has made monitoring of distant patients possible. Now, patients do not have to go through the hassle of traveling to the physicians if they are living in remote areas. They or their physicians can discuss their illness and reports with the specialists in bigger cities through audio and video conferencing and make decisions collectively. This is called real-time or synchronous telemedicine. When one or both of the communicators are not present to talk and make decisions simultaneously, the situation is referred to as asynchronous telemedicine. In such a case, the details about the patient like his case history and reports are stored on the server and passed on to the specialist on the other end so that he may respond when he is available. This is also referred to as store-and-forward technique. E-Health Solutions E-Health solutions include the systems and softwares based on ICT for the use of physicians, medical authorities and patients to share and exchange medical information (Gibbons, 2008). These solutions provide incorporated electronic imaging, audio and video conferencing, accounting and billing procedures in addition to email and web access. There are a lot of companies out there who are providing perfect, secure, quick and reliable solutions which ensure better care quality to patients in low costs and well-organized administration. Some of the well-known e-Health solutions in market are: Patient Access Points, Physician Portals, Consumer Health Content, Datikor, and a lot more. Electronic Health Records (EHRs) These are also referred to as computerized patient records or electronic medical records. In simplest terms, An EHR is a longitudinal electronic record of a patient’s data. This data includes patient’s case history, details about his disease, his medications, demographic data and laboratory reports, any vaccinations and immunizations, billing and 3-D radiology images regarding the disease. An EHR plays a vital role in evidence based treatment and decision-making. EHRs are very quick as there is no need for any paper-work for documenting and sharing of the information and images. These enable access to the records even from distant areas by means of online networking. The drawback with EHRs is that these are quite expensive but once implemented, these tend to be very cost-effective. Microsoft and Google have also presented consumer-based EHRs which are to be used by the e-Patients. They can record, in these EHRs, their personal information like their case histories and all medical information related to their disease, for future reference or as a memorandum. This type of EHRs in not in common use as yet. Impact of Internet and e-Commerce on Healthcare and Telemedicine Healthcare is one of the many industries that have turned to the internet and e-Solutions to provide effective services to the users. Internet has eliminated communication hurdles, cross-cultural and linguistic issues. It has made it possible for the consumers to get acquainted with medical issues and healthcare services through e-Health websites, electronic journals and articles, healthcare forums and discussion boards, online support groups and the ongoing medical information. They can now gather information, general or specific, right at their desktops in the comfort of their homes. There is so much information available on the internet about illnesses and diseases that consumers or e-Patients tend to have almost the same knowledge as a physician. E-Patients or internet-savvy patients are the persons who use internet to collect information about health related issues, either for themselves or for other people they know (and in the second case, they are called e-Caregivers). Internet could not have done much without the involvement of e-Patients or power patients. This way, internet has changed the whole concept of health care. Now, one does not have to travel long distances to meet the specialists. Thanks to the information available on the internet, one can do self-diagnosis and get connected online with the best healthcare providers on the globe. There is less or no direct human interaction. Internet is the medium between the two end-users. With the introduction of peer-to-peer networking, a computer can serve as a server as well as a client. Technology has made internet available even on wireless and hand-held devices which has drawn a large population especially e-Patients to use the internet with great ease. Internet has also made the high-bandwidth multimedia capable of carrying out real-time audio and video conferencing (telemedicine) between physicians and patients especially in remote areas. Peter Angood (2001) states that “telemedicine over the Internet was practiced in one of the most remote areas of the world-Mt. Everest-demonstrating that it is possible to utilize all the latest healthcare telecommunications tools in even the most extreme of settings.” E-Commerce is the type of commerce that is carried out through the World Wide Web (www). Prior to the intrusion of e-Commerce, healthcare organizations faced multiple challenges in providing low-cost quality care to consumers. With the arising need of implementing technology-based systems to solve this problem, e-Commerce has played a vital role. Thanks to e-Commerce, the paper-based documentation system has been eliminated and replaced by cost-effective and reliable patient-centered databases. E-Commerce has made online purchases and inventory transfers possible which has benefited the organizations economically. Thus, both the internet and e-Commerce together serve as a platform for carrying out e-Health services in a modern fashion with improved quality. Impact of Internet and e-Health on Doctor-Patient Relationship How has the new technology-based system of e-Health affected the doctor-patient relationship? There is a mixed response to this question both by the physicians and patients. Surveys have been carried out to get a better knowledge of perspectives at both ends. Some patients find it beneficial to use the internet for information while others do not want to give it a chance. Some physicians find internet comfortable to be used as a medium for diagnosis and treatment while others prefer face-to face meetings with their patients. Internet has made e-Patients confident by giving them an opportunity of evidence-based decision-making. They are more aware of their illness than they used to be in the past. This fact has affected their relationship with their physicians both positively and negatively. According to Johnson and Ramprasad (as cited in Jacobson, 2007), “Internet is helping health consumers to become more empowered” than ever before because now they can make self diagnosis, make decisions about their treatment methods, get second opinion online and can question the physician about their treatment techniques and advice. They fully participate in the whole process. This is also referred to as Patient Empowerment, that is, “distribution of power between physician and patient” (Jacobson, 2007). Talking about the negative effects on physician-patient relationship from physicians’ perspective, some physicians find it irritating enough to deal with patients who are too informed about their illness or who bring their collected data from the internet with them when they visit their physicians which makes them feel less authoritative and uncomfortable. This way, the trust cannot be established between the patient and the physician, which is very important. Thus, patient empowerment is the most worrisome and frustrating fact for the physician. In addition to this, Ahmad et. al (2006) found out in their survey that physicians found it irritating and tedious to interpret the patients’ data on the internet using e-Health tools, plus the patients with low health literacy were often exposed to unreliable websites and forums which misled them and created problems when they met their physicians. In such a case, patient empowerment becomes problematic. But there are many physicians out there who believe that internet and the medical information available on it has greatly empowered their relationship with the consumers as they can have open discussions about health problems and lifestyles through discussion boards and forums where e-Patients do not hesitate to question or object to a physician’s opinion. As far as patients’ perspective is concerned, surveys report that some of them think that internet has made them more empowered and informed about their illness and that they feel equal to their physicians in decision-making, and this has positively affected their relationship with their physicians as their identity and disease information is kept private and secured. This enhances their trust with the doctor. Canada and the E-Health Law The Canadian province, British Columbia, presented in the 2008 Legislative Session: 4th Session, 38th Parliament, the legislation about e-Health and its services so that the consumers could benefit from e-Health’s secure and steadfast solutions right from the comfort of their homes. This legislation is named as E-Health (Personal Health Information Access and Protection of Privacy) Act that is basically about the security issue of the EHRs. The law clearly states that anybody, who is accessing the data stored in these electronic records either with the idea of adding information or retrieving information for any purpose, must have proper authorization. Moreover, the patients have access to the health information banks and retain the power of disclosing or not disclosing their personal information. The disclosure of information, such as for research purposes, would be the responsibility of the data stewardship committee specially designed for this purpose. The Canadian Press (as cited in Swartz, 2008) states that any person or organization violating the law will be fined $200,000 (Cdn.). E-TEN Projects For E-Health E-TEN is a European Community Program that is funding for the e-Services projects for European Union member states. E-TEN aims at the consistency, security and reliable access of the citizens’ clinical statistics both by the healthcare providers and the citizens. This is achieved by selecting the most appropriate health standards and technological networks and solutions that are in accordance with the EU policy. Projects are being completed in fields like e-Government, e-Learning, e-Inclusion and e-Health. These e-TEN projects have the aim of securing and improving the trans-European healthcare services. Three of the most important projects that are being carried out in the field of e-Health are Netlink, Netc@rds and Transcard projects. These projects will give rights to the mobile EU citizens’ to have an access to their medical information and EHRs through secure network. The Netlink Project The aim of the Netlink project is to provide latest technology-based secured network in the healthcare sector which should enhance healthcare quality for patients and simplify the communication and managerial procedures by introducing inter-operable smart data cards with built-in microprocessors, both for the patients and the professionals. The access to online servers will be made secure and easy-to-use for the practitioners. Netlink “will undertake the secretariat of the G8 Health Card Working Group in the next two years” (Netlink Project, 2002). The Netc@rds Project The purpose of the Netc@rds project is to examine the application of health smart cards or “European Health Insurance Card” (NETC@RDS, 2007, para. 1) instead of paper forms in EU member states. The insured citizens moving across EU can use these smart cards to prove their privilege to health care services. This project is divided into five phases (A1, A2, A3, B and C) with the time span starting from 2002 to 2010. The Transcard Project This project is referred to as Franco-Belgian project which started in May 2000 and aims at providing access to healthcare services to the citizens of France and Belgium. A great number of French and Belgian citizens would be able to use their health insurance cards or social security cards (Vitale for French and SIS for Belgian) to gain access to as many as eight hospitals located on the border of Thierache. e-Health Code of Ethics When e-Health services are brought into play, many ethical issues arise. There are various institutes that have put forth the Code of Ethics for the betterment of e-Health consumers. Some of these include Hi-ethics Alliance, Internet Healthcare Coallition and medCERTAIN. The aim of e-Health Code of Ethics is to enable the e-Patients to seek information online, interact with the physicians and fellow sufferers, and use e-Health services with full confidence without worrying about the disclosure of their personal information. Helga and Ahmad (2000) state that: The final Washington e-Health Code of Ethics sets forth guiding principles under eight main headings: candor; honesty; quality; informed consent; privacy; professionalism in online health care; responsible partnering; and accountability. The summary of e-Health Code of Ethics is as under: All medical information that is provided on the internet should be precise, current and self-explanatory so that the consumers may understand what they are seeking. The physician interacting with the patient should be honest and straightforward, and should deal with the patient in a candid fashion. The patient should also be honest with the physician. The patient’s consent should be considered before sharing, selling or disclosing his personal information. The consumer’s privacy should be maintained by blocking unauthorized access to his health records and personal data. The sale of e-Health services and goods should be made legal and reliable to avoid the risk of fraud. Major Issues Regarding E-Health Quality of E-Health Services Improved quality of e-Health solutions and services is one of the most important issues in the healthcare sector. Low quality results in insecure and less effective applications. Consumers are the best deciders and they always prefer the applications that they find dependable. Thus, quality is to be maintained by ensuring resource endorsement, authorization and by applying insignias and proper seals that will prove that the resource is in accordance with the quality healthcare principles. Though many quality assurance techniques are being used to ensure the quality and stay in pace with the competitive market, yet it has to go a long way. Guaranteed Security and Privacy The need for secure online networks initially arose when issues like computer viruses and internet fraud posed a threat to the security and privacy of data stored on online servers and health records. The consumers began to worry about their personal information so they had to be made sure that their data will not be affected or disclosed without their consent. So, Health Insurance Portability and Accountability Act (HIPAA) was put forth by U.S. Congress on August 21, 1996. Title II of HIPAA deals with the privacy issue of the consumer’s data and presents Privacy Rule which ensures fines and punishments for fraud and violation of the rule. The rule gives consumers the right to file complaints if they find anybody obtaining, selling or disclosing their information. This way, they can have their data protected and their communications confidential. Administrative Simplification Title II of HIPAA also deals with administrative simplification. It actually aims at simplifying burdens on the physicians and staff by bringing health information technology (HIT) tools in use such as EHRs. HIT tools help in eradicating enormous redundant information throughout the course of physician credentialing. These are also used to regulate patients’ credentials by generating identification cards that amass patients’ credentials on micro chips embedded in these cards. According to American Academy of Family Physicians (2009), administrative simplification can be achieved by “physician enrollment in public and private payers’ electronic funds transfers (EFTs)/payments and electronic remittance advice (ERA) statement programs”, which would result in enlarging the cash flow and would resolve the payment posting issues. Digital Divide Digital divide is defined as a gap between the consumers who have an access to computers and internet and those who do not use computers and internet due to reasons like computer illiteracy, lack of finances, not having access to computers at all or lack of interest in using the internet. The lack of access to information technology would result in lack of knowledge, more specifically, healthcare knowledge which would eventually keep people from using healthcare services. But efforts are being done in overcoming this digital divide by increasing health literacy and providing up-to-date medical information over the internet. Instances: E-Health and Life There can be various instances where e-Health can be applied to life. Consider a person who wants to quit alcohol. He browses the internet and gets advice through open forums and decision-support applications about the methods he should apply to quit alcohol. A newly pregnant woman surfs through the pregnancy websites to find information about her labor and parenting. An elderly woman with high blood pressure enters an online discussion board to discuss her illness with people who have this illness. A young boy who is conscious about his weight browses through healthcare websites and gets in contact with a fitness expert. In short, the services of e-Health can be applied in billions and trillions of ways to real life without having to travel to the specialist. E-Health Websites There are a lot of websites available over the internet created for e-Patients where they can find general or disease-specific medical information, material regarding herbs, supplements and vitamins, medical dictionary, information about tests and surgeries, and interactive health tutorials. Some of these are: cyberdocs.com, art-of-patient-care.com, cancerforum.net, coolnurse.com, transeworkers.com, just-add.com, just-arthritis.com, collectivemed.com, justschizophrenia.com, aids.org, justbreastcancer.com, and so on. Conclusion This paper was a discussion on the newly emerging technology, E-Health, which has promised high-quality and easily accessible health care services with low costs. The minimum the e-risks associated with using the e-Health services, the larger the number of e-Patients. There is a large population who seeks medical information online using broadband and wireless systems. The medical information sought over the internet is most often related to healthcare professionals, disease-specific websites, reviews about hospitals, cross-border medical facilities, health insurance, opinions and views of peers on online newsgroups or blogs. E-Health has made internet-savvy patients more eager and conscious about their health and illness. It has greatly affected the doctor-patient relationship where doctors tend to be a helpful guide for the patients and patients tend to be more empowered regarding their healthcare. Now, it is easier to get treatment using telemedicine technology even for remote patients. Technology-based tools have ensured the privacy and security of patient’s personal information which has brought a large number of consumers to use the internet confidently. Now, the patient can have the same information about his illness as his physician. E-Commerce has made cost-effective purchase and transfer of goods possible for healthcare organizations and practitioners. Thus, we can say that the internet, telemedicine and ICT based e-Solutions have greatly blessed the consumers with the most effective health care ever possible, and it has entirely changed the lifestyle and consumers’ perspective toward their health. References Ahmad, F., Hudak, P., Bercovitz, K., Hollenberg, E., & Levinson W. (2006). 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B.C. law secures e-health records. Information Management Journal. Retrieved from http://www.allbusiness.com/legal/constitutional-law-privacy- rights/11483826-1.html Read More