INFORMATICS

AND THE
HEALTHCARE
INDUSTRY

Amy J. Barton
OBJECTIVES

•Define concepts of eHealth, telehealth, and mHealth.

•Explore applications of eHealth for healthcare, education, and research.

•Examine evidence on the impact of eHealth in health promotion and health maintenance.

•Analyze the transformational nature of eHealth within the healthcare industry.

•Discuss a telehealth case study.

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HISTORICAL CONTEXT OF E-HEALTH
•The rudimentary roots of telemedicine extend back to ancient times where simple forms of
distance communication, such as the use of light reflections and smoke signals were used to
relay messages about external threats, famines and disease.

•Long-distance communication evolved from these modest beginnings to systems such as the
telegraph, radio, and onward to advanced digital communication and communication systems
(Bashshur & Shannon, 2009).

•Telehealth applications have evolved from simple communications to sophisticated, pervasive,

and widespread systems in the home that make use of wireless, wearable, robotic, and multi-
sensorial technologies.

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THE CONCEPT OF E-HEALTH
•eHealth is an emerging field of medical informatics, ring to the organization and delivery of
health services and information using the Web and related technologies.

•In a broader sense, the term characterizes not only technical development, but also a new way
of working, an attitude, and a commitment for networked, global thinking to improve
healthcare locally, regionally and worldwide.

•eHealth technologies provide opportunities for customized and meaningful communication,

enabling patients to receive individually tailored information that can be viewed and responded
to at their convenience.

•Patients can also post their comments and advice to virtual communities (Neuhauser & Kreps,
2010).
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THE CONCEPT OF TELE-HEALTH
•The American Telemedicine Association (ATA) uses the terms telemedicine and telehealth
interchangeably.

•"Tele- medicine is the use of information exchanged from one site to another via electronic
communications to improve patient’s health status.

•Closely associated with telemedicine is the term telehealth, which is often used to encompass a
broader definition of remote healthcare that does not always involve clinical services" (ATA,
2010).

•Telehealth can be considered another component of the eHealth concept, with the difference
being around the delivery mechanisms, which can include live video conferencing, store-and-
forward systems.
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THE CONCEPT OF M-HEALTH
•Another component of Health is mobile felt (mHealth), which can be considered a delivery
mechanism for eHealth.

•mHealth typically refers to the use of a wireless communication device that supports public
health and clinical practices (Eytan, 2010; TBHome, 2010)

•mHealth is seen as a valuable tool as the digitization of health and wellness data increases.

•It is postulated that many tools will be required, as no single tool will serve all needs for all
people.

•As a result, there is a need to stop focusing on the technological components separately and
work toward aggregating these communication technologies in an integrated system
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E-HEALTH APPLICATIONS
•Telehealth has both clinical and non-clinical uses.

•Non-clinical applications include professional education healthcare administrative duties;

research; and the aggregation of health data, excluding patient-specific medical treatments and
decisions.

•Clinical uses include medical decisions involving patient care, diagnostics, and treatments.

•Clinical applications for telemedicine can be provided at the point of service or at another
location in the home for patients who may be home-bound, who reside in rural communities, or
who are living in correctional facilities.

•Telehealth is forging new relationships between patients and all types of practitioners
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IMPACT ON THE WEB

•Today, 85% of American adults (ages 18 and older) are using the Web; 70% of them access via broadband
connected at home, and 61% connect wirelessly to the Web via their laptop or 56 % with smart phone.

•A 2010 Pew Internet and American Life Project study indicates 89% of adults with no chronic diseases go online,
while only 72% of adults living with chronic disease are likely to access to the Web (Fox & Duggan, 2013).

•These findings are in line with trends in public health and technology adoption. Chronic disease is typically
associated with being older, African American, less educated, and living in a lower-income household.

•People living with chronic disease have complicated health issues and are disproportionately offline.

•Two online activities that are common among people living with chronic diseases are blogging and online health
discussions.

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CONSUMER ENGAGEMENT

•The National eHealth Collaborative (2012) developed the Patient

Engagement Framework to assist healthcare organizations in developing a
strategic plan to incorporate eHealth tools and resources as part of an
overall engagement strategy.
•The framework includes five phases

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CONSUMER ENGAGEMENT

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PERSONAL HEALTH RECORDS
•Personal health records (PHR) are maintained by the patient, in contrast to the medical
record that is maintained by providers at the various clinical agencies caring for the
patent.

•The PHR facilitates patient access to information about his/her health and healthcare
experiences.

•Use of a PHR encourages patients to track care encounters and collect relevant health
information to share in care management.

•Google Health is a Web-based personal health record.

•Users can build health profiles, import records from hospitals and pharmacies, share
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MANAGING HEALTH CONDITIONS AND
ACCESSING RESOURCES
•Electronic resources are being used increasingly to learn about and manage health
conditions.

•Health behaviors of adults with chronic conditions are notably different from those of
adults in general.

•Specifically, "when broad controlling for age, income, education, ethnicity, and over- all
health status, internet users living with one or more conditions are more likely than other
online adults to:
Gather information online about medical problems, treatments, and drugs.
Consult online reviews about drugs and other inter treatments.
Read or watch something online about someone else's personal health experience.
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WEARABLE AND PORTALE MONITORING SYSTEM

• Wearable and Portable Monitoring Systems.

• Remote patient monitoring, considered experimental a few years ago, is now maturing, with a
number of applications available.

• The VitalJacket is one example that utilizes microelectronics in a wearable T-shirt that continuously
monitors electrocardiogram waves and heart rate.

• A system available today from BodyMedia is a wear able monitoring system that focuses on weight
loss, health, and fitness.

• The Health Buddy System is a remote monitoring platform that provides a daily interface between
care coordinators and patients with chronic illnesses: this system has a proven track record over the
past decade. 14
TELENURSING AND DECISION SUPPORT TOOLS

• Telenursing broadening the role of nurses and advancing their value in the chain of
healthcare delivery to consumers in remote regions or to homebound patients.

• Home health nursing via visual communication is a technique that provides accessible care
and reduces both travel time and expense.

• Using videophones, the nurse and patient can establish a more personal relationship.

• Images can be transmitted interactively from the patient's home directly to attending
physicians, improving follow-up and treatment for things such as leg wounds.

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POSSIBILITY OF VIRTUAL WORLDS
• Possibility of Virtual Worlds. Web-based 3D virtual worlds are currently being investigated
as a potential tool to engage a variety of audiences in healthy behavior and lifestyle choices
regardless of location.

• These tools are also being used as a new educational method for the healthcare professions
that will help facilitate learning through inter active, collaborative learning environments
(Skiba, 2007).

• The 3D worlds are created online using a virtual persona, or avatar, which interacts with
other avatars in the online world.

• The Centers for Disease Control and Prevention (CDC) has established a Second Life island
where users can see streaming videos and access links to information on CDC.gov. 16
HEALTH PORTALS AND WEB 2.0
• Web 2.0 social networking sites such as Facebook, Twitter, YouTube, and MySpace are
proliferating.

• Health consumers feel empowered and now want to participate in decisions about their
health care.

• Support groups are using the Web as a new platform to organize, share experiences, seek
online counseling, and simply connect with others.

• Web sites are now being utilized by healthcare providers as a place to engage with
colleagues on clinical and non-clinical issues.

• Hospital portals can make appointments, renew prescriptions, and review are being
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developed where patients test results and their medical records online.
M-HEALTH APPLICATIONS
• The rapid and pervasive worldwide adoption of mobile cell phones is going to drive tremendous growth in
handheld healthcare over the next decade.

• Wireless communication technologies are forcing a transformation in how and where healthcare is delivered.

• The abilities to collaborate, share high-resolution images, and even have live broadcasting of surgeries are all
enabled by new technologies.

• Applications areas for mHealth include consumer education, emergency response systems, professional and
patient communications (e.g. text messaging. e-mail, social networking), health promotion and community
mobilization, and public and population health (Waegemann, 2010).

• mHealth will need to be integrated into the training of healthcare workers, so professionals have the knowledge
and skills required to use the technology safely and effectively (Ganapathy & Ravindra, 2008).

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IMPACT OF E-HEALTH APPLICATIONS
• Web-based educational programs are changing the way consumers and healthcare providers
learn.

• These programs continue to proliferate, providing the opportunity for interactive learning
and simulations with the ability to have multi-user discussions and presentations in a
collaborative learning environment.

• Faced with limited funds nursing schools now have the ability to form partnerships and
share their resources via the virtual classroom.

• Technological innovations, such as video streaming and virtual reality 3D displays, are
providing more sophisticated formats in which to deliver educational materials

• The role of the nurse as a patient and consumer educator in the digital age is evolving as 19
ELECTRONIC DATA EXCHANGE
• Advances in eHealth the growing use of electronic health records have contributed to the realities of
health data exchange.

• During the 1990s, hospitals attempted to create community health information networks to share
information at the community level. However, concerns for patient privacy, the high costs of system
implementation, and access to information by competing organizations prevented widespread use and
acceptance of this innovation (Thornewill, Dowling, Cox, & Esterhay, 2011).

• In the United States, the federal government took a leadership role in health information exchange
when the National Committee for Vital and Health Statistics published a report titled "A Strategy For
Building a National Health Information Infrastructure in 2001. This report indicated that such a
capability would improve response in individual and public health emergencies
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 PAYMENT REFORM THROUGH MEANINGFUL
USE
• The HITECH Act also introduced the concept of "meaningful use."

• The idea was that not only should providers use electronic records within their
practices, they should make use of the information available to enhance patient care
outcomes.

• Per statute, a provider must demonstrate meaningful use by (1) use of certified EHR
technology in a meaningful manner such as e-prescribing; (2) that the certified EHR
technology is connected in a manner that provides for the electronic exchange of
health information to improve the quality of care; and (3) in using this technology,
the provider submits to the secretary information on clinical quality measures and
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RESEARCH OPPORTUNITY
• Much is written on how eHealth applications may help provide care for an aging population, improve
care in rural areas, and decrease healthcare disparities in the United States and increasingly around
the world.

• There is an increasingly important need to look at the impact of eHealth applications on the care
relationship and how these applications affect outcomes (McGowan, 2008; Merrell & Doarn, 2010).

• There is a need to study symptom management an effectiveness of "distant" clinical assessments to

identify standardized best practices.

• The effectiveness of electronic communication methods as avenues to provide healthcare will need to
be researched.

• Nursing research will need to adapt to this ever-evolving landscape of technologies 22

TRANSFORMING EMERGENCY
PREPAREDNESS
•
AND RESPONSE
During a disaster situation, the use of telehealth technology would allow clinicians to provide
healthcare services remotely.

• A locally based network of clinicians linked via modern communication would help reduce major
disruptions in healthcare.

• Protocols need to be developed for mobile communication devices before disasters so they can be
rapidly deployed to provide routine care, triage, and shelter-in-place medical care (Ackerman, 2010;
Bloch, 2010).

• Advanced wireless electronic technologies are the quickest vehicles to communicate needs during
emergency situations.

• State, federal, and international emergency efforts have not evolved as rapidly as these new
technologies. 23
E-HEALTH CHALLENGES AND ISSUES

• Innovations in eHealth do not come without challenges and issues that healthcare
professions must address.

• As the transformation of healthcare moves toward patient centric models, the

healthcare professionals must resolve some key challenges and issues.

• These issues concern on legal, ethical, and public policy arenas.

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LICENSURE
• The lack of infrastructure for interstate licensure was a key impediment to the growth of
telehealth.

• The U.S. Congress contracted with the Center for Telemedicine Law for a background paper
concerning telehealth licensure issues in early 1997 (Telemedicine Report to Congress).

• Alternative approaches to licensure outlined in that report include consulting exceptions,

endorsement, mutual recognition, reciprocity, registration, limited licensure, national
licensure, and federal licensure.

• Additionally, in 2010, the Centers for Medicare and Medicaid Services (CMS) proposed a
rule that would allow a streamlined credentialing and privileging process for physicians and
practitioners providing telemedicine services. 25
 ETHICAL ISSUES
• The predominant ethical issues concerning telehealth are privacy, confidentiality, and security.

• The following definitions have been set forth by the American Society for Testing and Materials
Committee E31 on Healthcare Informatics, Subcommittee E31.17 on Privacy Confidentiality, and
Access (1997):

 Privacy. "The right of individuals to be left alone and to be protected against physical or
psychological invasion or the misuse of their property. It includes freedom from intrusion or
observation into one's private affairs, the right to maintain control over certain personal information,
and the freedom to act without outside interference.“

 Confidentiality. The "status accorded to data or information indicating that it is sensitive for some
reason, and therefore it needs to be protected against theft, disclosure, or improper use, or both, and
must be disseminated only to authorized individuals or organizations with a need to know." 26
ETHICAL ISSUES
Data Security. “The result of effective data protection measures; the sum of measures that
safeguard data and computer programs from undesired occurrences and exposure to
accidental or intentional access or disclosure to unauthorized persons, or a combination
thereof; accidental or malicious alteration; unauthorized copying; or loss by theft or
destruction by hardware failures, software deficiencies; operating mistakes; physical damage
by fire, water, smoke, excessive temperature, electrical failure or sabotage; or a combination
thereof.

System Security. "Security enables the entity or system to protect the confidential information
it stores from unau theorized access, disclosure, or misuse, thereby protecting the privacy of
the individuals who are the subjects of the stored information" 27
 EMERGING ISSUES AND CHALLENGES
• For all the possibilities it presents, eHealth does come with challenges including privacy concerns,
equity across populations, and the need to define a new type of relationship between the patient and the
healthcare provider (Eysenbach, 2001).

• Other issues include integration and networking interoperability, and usability.

• Finally, there is the challenge to determine what impact these new technologies will ultimately have on
patient outcomes.

• Further, reimbursement for telehealth interventions and a positive cost-benefit ratio are necessary
before providers can consider adopting technological innovation into their practice environments.

• Health systems may want to fund programs if telemedicine visits prevent trips to congested emergency
departments.
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REGULATING OF M-HEALTH APPLICATIONS

• Medical device be used as an accessory to a or transform a mobile platform into a regulated

medical device. Specifically:
Mobile applications that are an extension of one or more medical device(s) or displaying,
storing, analyzing, or transmitting patient-specific medical device data
Mobile applications that transform the mobile plant. form into a medical device by using
attachment display screens, or sensors or by including functionalities similar to those of
currently regulated medical devices
Mobile applications that allow the user to input patient-specific information and through the
use of formulas or processing algorithms, output a patient specific result, diagnosis, or
treatment recommendation to be used in clinical practice or to assist in making clinical
decisions (Barton 2012b. p.2).
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 PUBLIC POLICY

• The American Telemedicine Association (2014) outlined guidelines to "advance the

science, to assure uniform quality of service to patients, and to promote reasonable
and informed patient and provider expectations."

• These guide lines include administrative, clinical, and technical recommendations

designed to provide a safe, quality, telehealth experience.

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CONCLUSION

Without a doubt, eHealth applications will proliferate in the future.

Healthcare professionals need to seize the opportunities made possible by
advanced technologies and create powerful and human-centered
applications to facilitate consumers' full participation in health and
wellness. To evolve this process, healthcare professional need to be
actively involved in resolving challenges, shaping public policy, and
evaluating health outcomes.
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