How Will E-health Affect Patient Participation in the Clinic - Essay Example

What is e-health? Advances in Information and Communication Technology or ICT have had a huge impact on the health industry. ICT-based tools were designed to make different healthcare services more efficient in terms of patient-health care provider interaction and data communication. Such tools also helped with the prevention, early diagnosis, and treatment of a disease. ICT tools and services created specifically for the health industry are also referred to as e-health. Examples of e-health tools and services are electronic health records, computer-assisted surgeries, health portals, decision support tools, telemedicine services, m-health or mobile health, and health knowledge networks. E-health is defined as “a new term used to describe the combined use of electronic communication and information technology in the health sector OR is the use, in the health sector, of digital data-transmitted, stored and retrieved electronically-for clinical, educational and administrative purposes, both at the local site and at a distance” (WHO Regional Office for the Eastern Mediterranean, 2003). When it comes to clinical purposes, e-health makes easy it to manage and update medical records, allows electronic prescribing of medications, and makes patient management less demanding. E-health also fosters learning. Patients can access information about their condition and treatment options. There are also online support groups for people with similar conditions through e-health. Doctors can also use e-health for their continuing medical education. ICT health tools can also be used for organizational purposes. Scheduling of appointments and monitoring of laboratory results are made easier with e-health. The development of e-health has made it possible for healthcare professionals to give and for patients to receive quality, effective, and efficient healthcare services. Through the use of various e-health tools and services, communication and health management are a lot quicker and easier. Information is easily accessible and there is less stress on both healthcare providers and patients. E-health tools allow healthcare providers to care for the patients based on each one’s individual needs, allowing them to give care that is patient-centered. For patients, e-health tools provide them with information regarding their condition and encourage them toward self-care. E-health has evolved a lot and many consider it to be an indispensable tool in the industry of healthcare. Laboratories rely heavily on computers for analysis and many diagnostic procedures require the assistance of a computer. Medical errors are also prevented with the aid of computers especially when it comes to dosage and medicine interaction (Silber, 2003). While the value of e-health in medical practice and patient care cannot be questioned, how does this affect the relationship between patients and doctors and the healthcare system in general? As computers and technology are becoming more and more prominent in the streamlining of healthcare services, there is a less need for face-to-face consultations between healthcare providers and patients. With computers acting as an intermediary for healthcare, how does it affect the connection between health care provider to health care provider and health care provider to patient? Does e-health lead to a more individualized healthcare system or does it tend to disturb the relationship between patients and healthcare providers, leading to an impersonal relationship focused more on the technical aspect of care? There is no doubt that e-health has come a long way. There have been many possibilities opened up by the development of e-health and many prospects are sure to come. E-health has many advantages but its full potential when it comes to healthcare cannot be reached if the wrong direction is taken. It must be understood by both healthcare providers and patients to make it work the best possible way. Patients and e-Health More and more patients are taking a more active role when it comes to caring for their health. E-health makes it possible for patients to look for medical information in the internet. A concern though is the reliability of the information. The internet contains a wide range of information on healthcare and it is easy to come across fraudulent ones. The ease with which one can make a website also adds to this problem. In the year 1996, the Geneva Ministry of Health created the Health On the Net (HON) Foundation to help consumers find dependable and relevant medical information. HON made use of M.A.R.V.I.N., a robot that searches different sites and documents on the internet based on particular fields of interest(Boyer, 2004 cited in Iakovidis, Wilson, Healy, 2004). Another internet watchdog is the Internet Healthcare Coalition. The Internet Healthcare Coalition was formed in the year 1997 with the aim to support quality online resources for health. The Coalition also aims to help people find reliable sources for healthcare (Mack, 2000). Physicians can also provide patients with quality healthcare sites. Proper healthcare information through the internet is crucial as anyone and everyone can access it. False information can be harmful to the health of consumers, especially to those who rely heavily on information they get from the net. Aside from sites containing healthcare information, consumers can also access healthcare call centers made possible with e-health. Healthcare call centers provide services such as physician referrals, scheduling of appointments, medical advice, nurse triage, assistance with case coordination, and web conferencing among others. There are many healthcare call centers to choose from, each one with different products and services offered. E-health has also made it possible for forums and online support communities to exist. The internet is a good place for discussing different health topics and you can get advice from different people in health forums. Online support communities also exist for those with health challenges such as cancer, psychiatric disorders, and ADHD. There are also online support groups for alcoholics, substance abusers, and victims of abuse. Support sites are helpful for patients as well as for friends and families of patients with health challenges. You can get information, tips, and advice from people who have had the same condition or experience as you in online support groups. You can also express your feelings freely without fear of being judged negatively. E-health services and tools have made it possible for patients to get healthcare without going to the doctor’s clinic. Through telemedicine, patients in remote and isolated areas are able to access efficient healthcare. Even those with debilitating conditions and the disabled do not have to worry anymore about going to the hospital for a medical consultation. Geographic location is no longer a barrier to getting healthcare services thanks to developments in e-health. Follow-ups can also be done through telemedicine, making it very convenient and cost-effective for patients. Home-based applications of e-health allow prompt and timely interventions to be done, improving the quality of care received by patients. E-health has also made it possible for hospital stays to be shorter and there is also a reduced need for emergency visits to the hospital. Patients do not need to stay anymore in the hospital for monitoring, as remote monitoring is a viable option. Remote monitoring is especially useful for patients with chronic conditions like asthma and diabetes. Healthcare professional are immediately alerted for changes in the patient’s condition and patients are able to participate in their own care by taking their own vital signs. Remote monitoring ensures that patients are able to regularly communicate with their healthcare providers. Examples of patient devices used in remote monitoring are pulse oximeter, blood glucometer, ECG recorder, and blood pressure monitor. Once the patient takes his or her vital signs, the results are transmitted to the healthcare provider, who will then determine the next course of action. Patients are also able to access their health records through e-health tools and services. In Boston, patients of Massachusetts General Hospital can access their electronic medical records through a web-based portal called Patient Gateway. Patient Gateway enables patients to schedule appointments, request prescriptions, and ask for referral authorization from their doctors. Information about health and medical conditions are also available at the site. Results of laboratory tests and other procedures can also be viewed. According to Chase (2010), allowing patients to access their health records helps reduce the chance of clinical errors as erroneous data can be corrected by the patient. It is also believed that this would strengthen the role of patients and doctors as partners in healthcare. While electronic health records have many benefits when it comes to patient care and management, there are also some consumers who are concerned regarding the privacy of medical records. In a case in Miami Valley Hospital (Sutherly, 2010), 200 hospital employees accessed the medical records of a vehicular accident patient whose crash happened to be caught on tape and viewed nationwide. Under the law, only those who are directly involved in the care of the patient may access the patient’s health records. Many considered what happened at the Miami Valley Hospital as a breach of the patient’s privacy. Patient privacy is paramount and electronic health records pose a threat to this privacy because of their easy accessibility. E-health also enables patient education through mobile health. A simple SMS message can inform consumers about available health services, diagnostic procedures, treatment options, and information about disease management. SMS messages are also more private and information about diseases that are taboo in some communities can be disseminated to patients without being obtrusive in any way. Examples of health campaigns done through SMS messaging are HIV/AIDS testing, measles prevention, and vaccine promotion. Numerous studies have shown that SMS message campaigns were more effective and influential compared to television and radio campaigns. SMS messaging is also a lot cheaper, making it one of the best options when it comes to cost-effective healthcare. Mobile health is especially useful for consumers who are living in remote and rural areas. Such areas rarely have clinics, have scarcity of healthcare providers, and have limited access to information regarding health. E-health enables those living in such populations make better decisions when it comes to their health. E-health, ultimately, helps patients and consumers take charge of their health. It empowers them to make informed decisions and to participate in their own care. Preventing, diagnosing, treating, and monitoring a disease is not just the responsibility of healthcare providers. Rather, it is a joint venture which involves both the healthcare provider and the patient. The different ICT health tools and services are designed to help patients achieve self-care. These also aim to strengthen the relationship between healthcare providers and patients and to establish trust between these two parties. By making healthcare more patient-centered, e-health helps improve the quality of care delivered to consumers and patients. Patients and consumers can easily access the internet or their mobile devices for healthcare information. From medications, to personal health records, scheduling of appointments, patient monitoring and other health information, e-health brings efficient and quality healthcare closer to a lot of people. Healthcare providers and e-Health E-health tools and services also have a great impact on healthcare providers. One of the conveniences brought about by e-health is the existence of electronic medical records, which greatly reduce the amount of time that healthcare providers usually spend on tedious paper work. Electronic medical records eliminate the need to handwrite each and every action done by the healthcare providers. The possibility of errors, especially when it comes to medications, is also greatly reduced with the use of electronic medical records. Poor handwriting and use of unstandardized medical terminologies used to be major issues in the use of paper-based medical records. These led to errors in delivering care, which in turn greatly reduced the quality of care given to patients. One of the most common errors is medication errors. Medication errors included incorrect dosage, drug allergies, and adverse drug reactions brought about by drug interaction. E-health tools such as electronic prescribing address this problem by ensuring that the correct dosage is given. The drugs currently taken by the patient are also checked against each other and the healthcare provider is immediately notified if there are possible drug interactions. The patient’s known drug allergies are also considered and the system provides alternative drug options. Electronic health records also allow healthcare providers to give patient-centered and evidence-based care. Data is captured at the moment of care and this data is integrated into the different sources of the clinical workflow. The data on the patient’s health records helps the healthcare provider on the clinical action to take. Data in the electronic health records also aid healthcare providers with decision making. Decision support systems help healthcare providers make prompt decisions and interventions in the face of an emergency. Such systems use the patient’s data, medical information from a database, and an inference engine to provide healthcare providers with relevant advice which is individualized to the patient’s needs and situation. E-health also allows healthcare providers to perform minimally invasive surgical procedures. With the use of computers and robots, surgery is faster and less invasive. Computer-assisted surgeries require imaging tools and other similar technologies to aid the surgeon with the procedure. Robotic surgery, on the other hand, involves robots which may or may not require an actual surgeon to do the surgery. Telemedicine is another e-health tool that allows medical professionals to communicate from different places. This is especially helpful for doctors who often travel or have patients in isolated areas as this allows them to see and care for their patients through other healthcare professionals with the aid of a video or audio feed. Telemedicine equipment also allows a doctor to diagnose a patient’s condition even if a physical exam is not done. Telemedicine is of great benefit to certain medical fields such as cardiology, dermatology, and radiology. E-health also provides medical professional with online sources for continuing medical education. Continuing medical education supports professional growth and ensures that medical professional are kept up-to-date on the latest advancements and research findings in the field of medicine. It also helps medical professionals gain new knowledge and skills which they can use to improve their practice. Data gathering is also possible through e-health tools and services. Healthcare professionals in the research field can definitely benefit from the ease through which they can collect data on different levels. Data can be collected on a community level, a national level, an international level, and a worldwide level with the help of e-health. This is especially helpful for public health programs as healthcare providers and policy makers need information to determine whether current health programs and policies are effective. Data gathered from specific areas can also help in the formation of new programs and policies. In the past, paper surveys were utilized to gather information. Now, mobile phones, smart phones, and PDA’s make the process of collecting data a lot easier and more consistent. The use of mobile technology is healthcare is also known as mobile health or m-health. Aside from remote data gathering as in the case of surveys, mobile health also allows healthcare providers to perform disease surveillance, carry out research trials, and monitor epidemic outbreaks. E-health tools are not only helpful in data gathering but in data analysis and processing as well. In Uganda, health workers were given PDA’s that were provided by the Ugandan Health Information Network to collect data. Health workers reported an increase in job satisfaction due to the efficiency of such technology. In addition, this method of data collection also turned out to be cost-effective with 25% reported savings (Vital Wave Consulting, 2009). E-health tools and services definitely make things a lot less demanding for healthcare providers. There are many benefits of e-health and the care delivered to patients is guaranteed to be efficient and of quality. An article by Steve Lohr (2008) which appeared in the New York Times, however, said that most doctors are not actually utilizing electronic health records. According to the New York Times, a report released online by the New England Journal of Medicine showed that less than one out of five doctors in the country have started using EHR’s. However, doctors who have actually started using electronic health records have reported improvement in patient care in terms of quality and timeliness. The delay in the adoption of this e-health technology is believed to be mainly economic. Majority of doctors who privately practice their profession do not have the funds to invest in electronic health records. However, the value of computerized records in improving the quality of care, reducing errors, and minimizing costs cannot be overlooked. While many healthcare providers are happy with the convenience brought about by e-health tools and services, the possible negative impact of e-health on healthcare professionals cannot be ignored. As healthcare technology continues to develop and advance, there is a lesser need for hospital visits and less face-to-face interaction between the patient and the healthcare provider. These in turn could degrade the role of healthcare professionals in patient care. Some healthcare professionals and hospitals may feel threatened with the rise of e-health, which could affect the development of this technology. In an interview conducted by Gary Finnegan from EurActiv (2009) with Dr. Tremblay, an e-health expert, Tremblay stated that e-health can make some of the clinical work obsolete which can make medical professionals resist such technology. Consumers can also be indifferent toward the use of e-health tools and services if these lack user-friendly characteristics. However, he believes that health professionals will be amenable to the use of e-health technology if they see that there are clinical benefits associated with it. The important thing is to help health workers and hospital administrators see and understand the advantages of e-health. Healthcare providers would not mind e-health so much if it improves clinical practice and patient care and if it did not interfere with their roles as professionals. Hospital administrators, on the other hand, are primarily concerned with the protection and growth of their organization and would not feel threatened by e-health if they see that it will support their cause. Patient and Healthcare Provider Interaction One of the most important aspects when it comes to patient and healthcare provider interaction is the establishment of a relationship and a trusting environment. In the past, face-to-face interaction in the clinical setting helped establish rapport and trust between the patient and the medical professional. Face-to-face interaction has always been an essential element in health care whether it involves patients and doctors, patients and nurses, or patients and other health workers. With the development of e-health tools and services, there is a reduced need for face-to-face interactions when it comes to healthcare. Patients do not need to go to the doctor’s clinic anymore for a consultation. Rather, they can do it through telemedicine. Patients do not need to go directly to a doctor if they are sick. Rather, they can go to health portals and look up information regarding their symptoms and get a diagnosis. Treatment options are also provided in health portals and patients can easily choose from the given options. Consumers also have the option of calling health call centers to get the information they need. E-health has also made it possible for doctors to diagnose a patient’s condition without being physically present. Telemedicine tools allow medical professionals to assess a patient even when they are miles apart. Doctors can also perform surgery without being there, as in the case of robotic surgery. Obviously, e-health offers a lot of benefits to patients, healthcare professionals, and the healthcare system in general. The convenience offered by e-health tools and services, the reliability of healthcare information, and the ease through which one can retrieve and organize information are hard to match. However, alongside the advantages of e-health are some disadvantages as well. A lot of changes have obviously happened with the dawn of e-health technology. As such, there have also been changes in the patient-doctor relationship and each one’s roles have become redefined. How exactly does e-health affect the relationship between the patient and the doctor? Does e-health enhance and strengthen the patient-doctor relationship or does it weaken the relationship, making patients more likely to consult the internet rather than a medical professional? A lot of people are now more computer-savvy. Millions of people have access to the internet and internet-based technologies. Just by typing a few keywords and clicking on the mouse, you have hundreds of sites at your disposal where you can get health-related information. Many patients use the internet to find the health information that they need rather than go to the doctor’s office. In a survey conducted by the Pew Internet and American Life Project in the year 2002, results revealed that there is a greater number of people who look for medical advice online than people who go to health professionals (Redwood, 2009). The effects of e-health tools and services on the relationship between doctors and patients are uncertain (OpenClinical, 2005). When it comes to e-health, many are concerned with how it will affect patient-doctor interaction and relationship especially when face-to-face interaction is greatly reduced. According to Iyer, Salam, and Gupta (2001 as cited in Khosrowpour 2001), receiving healthcare services entirely from the internet is not a sustainable option. Video and audio feeds are necessary when a patient and a healthcare provider communicate for it to become more personal. In this regard, e-health is viewed as a tool that will help develop a long term relationship built on trust. E-health is perceived as a means of support to the patient and serves as an assurance that the relationship with the doctor and the care provided does not end when the patient leaves the clinic. Interaction between the patient and the healthcare provider mainly involves exchange of information regarding diagnosis, treatment, medications, follow up care, and recovery from the disease. Iyer, Salam, and Gupta further explain that the internet can be used to strengthen the doctor-patient relationship when the physician provides interactive opportunities on his or her website such as virtual patient monitoring and virtual house calls. For Mandl, Kohane, and Brandt (1998), electronic communication, specifically e-mail, have the possibility to provide patients and healthcare providers with an opportunity for better interaction. E-mail can help build a connection between the patient and the medical professional and can promote the involvement of the patient with regard to documenting and managing their own care. However, Mandl, Kohane, and Brandt also stressed the importance of regulating technologies involving communication as it can lead to an opposite result and damage the relationship between the patient and the doctor. Lack of proper implementation policies with regard to communications technology can also lead to inconsistencies in health outcomes and make health care less accessible. For Baur (2000 as cited in Kirshner 2003), however, e-mail is perceived by some medical professionals and researchers to have a negative effect on the patient-doctor relationship. E-mail as a means of communication between patients and healthcare providers is seen as undermining the importance of an interactive communication which is vital for the development of a trusting and therapeutic relationship. The Health Insurance Privacy and Portability Act (HIPPA) states that patients must be able to view and modify their health records. Electronic health records are not only available to the healthcare providers but to patients as well. Patients are now able to easily access their health records through patient portals.. For Ross and Lin (2003 as cited in Kirshner 2003), allowing patients to access their health records improved the patient-doctor relationship as it allows patients to communicate more freely with their doctors. When patients are given the opportunity to view their health records through the internet, it gives patients a sense of control over their health which in turn builds trust in the patient-doctor relationship. According to Malone et al (2005 as cited in Robinson, 2008), the use of e-health can have a negative effect on the patient-doctor relationship, especially on the side of medical professionals. As patients have access to reliable and relevant healthcare information, some healthcare providers associated this with patient control issues and felt that e-health in this context was used as a means to double check the medical advice they give to their patients. Some healthcare providers were also concerned with how e-health led to changes in who was in control of the relationship. The patients are more knowledgeable about their conditions because of e-health technology and are able to ask more questions, which may be unsettling for some medical practitioners. For some doctors though, e-health technology actually helps strengthen the patient-doctor relationship. According to Ferguson (2000 as cited in Redwood, 2009), the relationship between the patient and the doctor is reinforced when these two parties are able to communicate on the same level. Healthcare information retrieved by patients from the internet help them understand their doctors better. Doctors find that e-health users took a shorter time to understand complicated medical information compared to those who did not utilize information on the internet. In Silber’s ‘The Case for eHealth’ (2003), publications relating to medical literature clearly showed an increase in the use of the internet for medical purposes by consumers. While consumers would like their physicians to provide them with information regarding reliable healthcare websites, they don’t bring it up during medical consultations because they are worried about the physician’s reaction. Physicians, on the other hand, fail to provide their patients with information regarding reliable healthcare websites because of failure to recognize the need of their patients for communication and information. For Blumenthal (2002 as cited in Redwood, 2009), even though doctors are gradually losing their role as the chief source of medical information, patients still trust the information and medical advice they receive from doctors more than they trust the information they get from the internet. There are several reasons why consumers do not accept the health information they get from the internet. On a Vividence survey reported by Scrip (2002 as cited in Redwood, 2009), 75% of the respondents refused to believe e-health information. The three main reasons for this disbelief are 1) information on the website seems commercialized and the site seems more concerned with selling a particular product rather than providing accurate and reliable information to consumers, 2) the source of the information provided on the website could not be established, and 3) consumers are unsure if the information provided is updated. There are different views regarding the effects of e-health services and tools on the patient-doctor relationship. There are always two sides to a story and e-health is no different. There are positive effects as well as negative effects on the relationship between patients and doctors. E-health can be perceived both as a threat and as an ally in the further development of healthcare. E-health and the Healthcare System E-health has the potential to change the healthcare system in a big way. This change can either be for the better or for the worse. The reaction of patients and healthcare providers to e-health is very important and plays a huge impact on the success or the failure of this technology. Acceptance of e-health is vital for this technology to flourish. However, if people turn out to be unresponsive to its use in healthcare, then e-health will fail to change the healthcare system. For Redwood (2009), trust is a vital factor in determining the future of e-health and the healthcare system. Trust between patients and doctors, between patients and the internet, and between doctors and information from e-health will be the basis of e-health’s fate in the healthcare industry. At present, there is a weak level of trust in healthcare because of the deteriorating relationship between patients and doctors. According to Illingworth (2002 as cited in Redwood, 2009), “trust is the scarcest of medical resources”./ There have been many concerns regarding the use of ICT-based tools and services in the field of healthcare. Among these concerns are lack of standards in e-health, violation of patient privacy, and lack of access to technology. In a study conducted by a German research firm Empirica on behalf of the European’s Commission’s Directorate General Enterprise and Industry which aims to investigate the present status of e-health standardization (Hoeksma, 2008), results showed that general use of e-health standards was lacking which led to problems in interoperability in the healthcare setting. The standards that were currently set in place were either copyrighted or inconsistent. One of the reasons why there is lack of e-health standardization is because IT managers in hospitals tend to place a higher priority on internal process functions rather than use of standards in e-health. Another barrier identified is the lack of financial motivation to use electronic means to exchange information. Another concern when it comes to e-health is the increased risk for violation of patient privacy. There have been many cases of breach of patient privacy in hospitals due to the accessibility of electronic health records like the case in Miami Valley Hospital (Sutherly, 2010). Many people feel that their privacy is not protected enough by healthcare establishments and this raises concerns over anonymity and confidentiality. Lack of access to technology is another problem in e-health. Not all people have the funds, skills, and access to computers and cannot use e-health efficiently. In a study conducted to investigate the barriers and catalysts to the implementation of e-health (King et al, 2010), lack of access to e-health technology was seen as a possible hindrance to e-health implementation. Computer literacy was also an issue. E-health can either serve as a bridge or a hurdle in the development of healthcare. It can improve the quality and efficiency of care and strengthen the relationship between the patient and the healthcare provider. It can also lead to more disparities in the healthcare industry and breakdown patient-doctor communication. The important thing is people involved, that is, the patients, healthcare providers, and organizations supporting e-health, understand their responsibility when it comes to the development of e-health to ensure that healthcare moves forward. Finnegan, G., 2009. Doctors cautious about ‘disruptive impact’ of eHealth. [online] EurActiv Network. Available at: < http://www.euractiv.com/en/health/doctors-cautious-disruptive-impact-ehealth/article-185671> [Accessed 15 November 2010]. Hoeksma, J., 2008. Call for common e-health standards. [online] Available at: < http://www.ehealtheurope.net/news/4293/call_for_common_e-health_standards> [Accessed 16 November 2010]. Iakovidis, I. Wilson, P. Healy, J.C., 2004. E-Health: Current Situation and Examples of Implemented and Beneficial E-Health Applications. Netherlands: IOS Press. King et al, 2010. 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Available at: http://www.daytondailynews.com/news/dayton-news/electronic-health-records-raise-fresh-privacy-fears-984037.html [Accessed 15 November 2010]. Vital Wave Consulting, 2009. mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World. [pdf] UN Foundation-Vodafone Foundation Partnership. Available at: < http://www.unfoundation.org/global-issues/technology/mhealth-report.html> [Accessed 14 November 2010]. WHO Regional Office for the Eastern Mediterranean, 2003. What is e-health?. [online] E-Health in the Eastern Mediterranean. Available at [Accessed 14 November 2010] Read More