E-HEALTH PRESENT AND FUTURE Ramona Mayer EBG MedAustron GmbH, Wiener Neustadt, Austria.

E-HEALTHPRESENT AND FUTURE

Ramona MayerEBG MedAustron GmbH, Wiener Neustadt, Austria

eHealth . . .

"eHealth is the single-most important revolution in healthcare since the advent of modern medicine, vaccines, or even public health measures like sanitation and clean water”

Silber D. The case for eHealth. (Presented at the European Commission'sfirst high-level conference on eHealth May 22/23 2003.) European Institute of Public Administration 2003.

From medical informatics to eHealth

Classical Medical Informatics – stand alone era (1970+)

Health Telematics – early telecom days (1985+)

eHealth – Web era (1995+)

Pervasive and ubiquitous eHealth - ambient intelligence era (2005+)


Classical Medical Informatics – stand alone era (1970+)

Systems for the storage, retrieval, sharing and optimal use of biomedical data, information and knowledge

Health Telematics – early telecom days(1985+)

Regional health care networks Remote diagnosis and telemedicine applications Decision Support Systems


eHealth – Web era (1995+) Internet based applications and services Medical content for prevision Intranets for health service management

Pervasive and ubiquitous eHealth - ambient intelligence era (2005+)

Health knowledge infrastructure Wearable and implantable systems Biomedical informatics for personalized health Health GRIDs

eHealth

mHealth

Health knowledge management

Electronic Medical Records

Telemedicine

Consumer Health InformaticsVirtual healthcare teams

eCardiology

eRadiology

„eHealth“…

eHealth encompasses a range of services that are at the edge of medicine/healthcare and information technology

e-health encompasses much of medical informatics, but has to prioritise the delivery of clinical information, care and services rather than the functions of technologies

No development of basic technology, but development of beneficial applications

for patients physicians care facilities health care insurance companies etc

EC definition of eHealth

“….the use of modern information and communication technologies to meet needs of citizens, patients, healthcare professionals, healthcare providers, as well as policy makers"

http://europa.eu/

WHO definition of eHealth

"eHealth is the cost-effective and secure use of information and communications technologies in support of health and health-related fields,

including health-care services health surveillance health literature health education, knowledge and research"

(World Health Organization , Ninth plenary meeting, 25 May 2005 - Committee A, seventh report)

5 Steps of eHealth

Information

Communication

Interaction

Transaction

No information

Stage 4

Stage 3

Stage 2

Stage 1

Effi

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Level of process orientation

Low

Hig

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Low High

Integration

Stage 5Electronic Patient Record

Electronic Health Record

Electronic diabetes diary

Steps of eHealth…

Step 1 - Information Providing information for patients or doctors e.g. via

the web (information in one direction), Medical databases like PUB MED

Step 2 - Communication (action) The exchange of information between two people

involved (patient - doctor, doctor - doctor...) without direct and current reaction of the communication partner (e.g. on-line diabetes diary)

Step 3 - Interaction (action + reaction)

Exchange of information or dates between people involved with immediate reaction of the communication partner (e.g. telemonitoring, telesurgery…)

Steps of eHealth…

Step 4 - Transaction Electronic handling of a complete (treatment)process (“All

or nothing”)

Step 5 - Integration (e.g. Electronic health record - EHR)

Electronic health biography – central documentation for all health relevant data from birth to death

Information

Communication

Interaction

Transaction

No information

Stage 4

Stage 3

Stage 2

Stage 1

Effi

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Low

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Integration



DIAB-MEMORY

Providing information for patients or doctors e.g. via the web

(information in one direction)

Step 1 – Information


Provider of the information Publishing companies, authors Provider of medico technical equipment Pharmaceutical companies Health insurance companies Physicians and health care professionals …

Information medium Print media CD, DVD, … Computer network / Internet

Recipients Physicians Patients Family members …

Internet


Physicians Medical literature

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db= PubMed

Medical database (z.B. Drug informaton systems) http://www.druginfosys.com /…

Patients Health advisor

http://www.netdoktor.at/

Dictionary of medical terms http://www.medterms.com/ …

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db

http://www.druginfosys.com/

http://www.netdoktor.at/

http://www.medterms.com/

http://www.medterms.com/


Health on the Web

Estimated ~ 20,000 health websites Used by 98 million adults

75% of people who have web access Average of 3.3 times per month

More than consult doctors each day


Health on the Web

Pro Correct information

can lead to more knowledgeable and less anxious patients

more participatory health decisions

Con Misinformation

can lead to confused patients Bad decisions, false hope, harm

Information

Communication

Interaction

Transaction

No information

Stage 4

Stage 3

Stage 2

Stage 1

Effi

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vice


Low

Hig

h

Low High

Integration



Communication = ActionThe exchange of information between two people involved

(patient - doctor, doctor - doctor...) without direct reaction of the communication partner

(e.g. online diabetes diary)

Step 2 – Communication


Diabetes-diary allows to document the blood glucose values enables the physician to access the data adjust the insulin dosage accordingly

The patient can communicate with the physician online save time and unnecessary office visits.

from: http://www.diabetes-diary.com/

Step 2 – Communication Online diabetes diary

From: http://www.diabetestagebuch.de/


Step 3 - Interaction

Information

Communication

Interaction

Transaction

No information

Stage 4

Stage 3

Stage 2

Stage 1

Effi

cien

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nd q

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Low

Hig

h

Low High

Integration




Interaction = action + reaction

Exchange of information or data with immediate reaction of the communication partner (e.g. telemonitoring,…)


Telemedicine

Most useful when Specialist services are in very high demand or patients are extremely isolated

( Antarctica or remote communities in Australia, Africa and Alaska)

Telemedicine encompasses any medical activity

involving an element of distance (R. Wootton)

Online versus store-and-forward Functional

Telecardiologye Teleradiology Telesurgery Teledermatology Telecare (homecare)

Action Telemonitoring Second opinion Telediagnosis etc…

Multimedia (Text, Audio, Image, Video, Augmented Reality)

Step 3 - Interaction Telemedicine

1. Live telemedicine via videoconference2. Store-and-forward telemedicine –

transmit for assessment offline Typical telemedicine interaction: store

and forward followed by live interaction

Data types Text ( e.g. patient's notes) Images (e.g. x-ray, CT, etc) ( Telemedicine often relies

on images)

Step 3 - Interaction Telemedicine

1. Patient with an implant with home monitoring function

2. CardioMessenger sends a SMS daily and additionally in the case of an event

3. Automatic data processing at the service centre

4. Physician with secure internet access

Step 3 - Interaction Telemonitoring

www.biotronik.com

Quelle: http://www.chili-radiology.com/


Teleradiology

Step 4 - Transaction

Information

Communication

Interaction

Transaction

No information

Stage 4

Stage 3

Stage 2

Stage 1

Effi

cien

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nd q

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Low

Hig

h

Low High

Integration




Transaction Electronic handling

of a complete (treatment)process (“All or nothing”)

For example : Austria

Rollout until end of 2005 Electronic handling of a complete (treatment)process

Includes: On the reverse side = EHIC - European Health

Insurance Card Digital signature

At present the ecard cannot be used at: Private medical practice Other contractual partners (e.g. optician, midwife, …)

Step 4 – Interaction Electronic health card

Step 4 – Interaction Electronic health card

Administrative dataEHIC - European Health Insurance Card

e-medication

Health care provider index

Patient recordPhysician letter

√

}W

ork in progress

Step 5 - Integration

Information

Communication

Interaction

Transaction

No information

Stage 4

Stage 3

Stage 2

Stage 1

Effi

cien

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nd q

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Low

Hig

h

Low High

Integration




Electronic health biography

= central documentation for all health

relevant data from birth to death

Central data repositoryor

Local data repositories + central index

Case record (e.g. under discussion in Germany)or

Live long electronic health record

Any combination is under discussion in countries across Europe!!

Step 5 - Integration

E-health in different environments

for example:General HospitalIon beam facilityeHealth on the EU-level

eHealth in a general hospital Administration

Billing Hospital information system (HIS) Procurement Logistic

Medical data Radiological images and findings Lab- Information System Discharge letter Teleconference etc…

Step

1 -

3

Clinicians are very busy and under constant pressure to perform !

They will NOT change their behaviour, unless the new workflow is clearly more efficient on a personal and individual level !

Sulivan2002; Holzinger & Errath 2004

Usability …..

For an interface to be a success it must provide

the right functionality at the right place at the right time and in the right form

from the user's point of view!Holzinger 2000

Concrete project: Platform for the planned co-operation between the Ion beam Research

and Treatment centre MedAustron in Wiener Neustadt, Austriaand Hungarian hospitals

MedAustron eHealth services Provided services

Accept patient information Accept medical findings Accept radiological images and findings

Provide RT planning information Dose information Plan details

Provide medical reports

Scenario IPatient referral without pre-irradiation

Possible data inputfrom referring hospital

Patient base data Medical relevant

data Histological data Surgical report Other findings

CT/MRI/PET-CT/US

Available data output from MedAustron

RT planning documents Applied dose

Medical report

Teleconference

Scenario IIPatient referral with pre-irradiation


Patient base data Medical relevant data

Histological data Surgical report Other findings

CT/MRI/PET-CT/US RT plan + applied

doseAvailable data output

from MedAustron

RT planning documents Applied dose Sum dose

Medical report

Scenario IIIPatient referral with pre-irradiation


Patient base data

Medical relevant data Histological data Surgical report Other findings

CT/MRI/PET-CT/US

RT plan + applied dose Available data output from MedAustron

RT planning documents Applied dose Sum dose

Medical report

Step 5


1 2

34

eHealth for RegionsA network for transnational co-operation

Aim Support of an innovative process by building a

platform for the exchange and generation of ideas for co-operation

Provision of experiences and knowledge about the specific challenges of transnational collaboration in the field of eHealth among the network partners

Finally the co-operation should be run by the partner themselves!

eHealth for RegionsCo-operation fields and pilots (examples)

Personal information medical sticks Developed for patients with chronic diseases, who

are often travelling in European neighbouring countries on business or vacancies

Objectives To improve the cross-border medical service, esp. for

travelling pts. with chronic diseases

To support physicians with information treating foreign patients

To omit unnecessary examinations of patients USB sticks are prepared with structured medical information based on

the

European emergency health card

Partners: Denmark, Finland, Germany, Lithuania, Norway, Poland, Sweden

Step 1

eHealth for RegionsCo-operation fields and pilots (examples)

Ferries with Tele ECG at the Baltic Sea

Objectives A better health care support for travelling citizen to reduce time from symptoms to treatment

TT Line transports 2000 to 4000 passengers every day between

Trelleborg (Sweden) and Travemünde or Rostock (Germany) First aids room equipped with a transtelephonic ECG

recorder ECG transmitted to multilingual server of telemedicine

centre in Bad Segenberg (Germany) routed from there to co-operating cardiac centres in a readable format

Step 2

Summary : eHealth =

„ … in a broader sense, characterizes not only a technical development,

but also a new way of working, an attitude, and a commitment for networked, global

thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.”Eysenbach G. What is e-health? J Med Internet Res 2001;3(2):e20,

adapted by Pagliari et al. 2005

Challenges…

National legal regulations and obligations AND: Legal and ethical implications of using health

information technologies which may result in harmful effects in certain cases are not yet clear...

Safety (data integrity and completeness) Data security and protection

System developers need to employ quality and safety assurance methods to avoid clinical risks and legal liability

Interoperability Implementation and integration of eHealth systems into care processes

are constrained by insufficient levels of systems interoperability (though moves to ensure standardisation in many current e-Health implementation programmes will reduce this)

Acceptance (availability and usability)

5 Steps of eHealth

Information

Communication

Interaction

Transaction

No information

Stage 4

Stage 3

Stage 2

Stage 1

Effi

cien

cy a

nd q

ualit

y of

ser

vice


Low

Hig

h

Low High

Integration



Electronic diabetes diaryModerate progress

Used in daily practice

Accelerated progress

Summary

eHealth is not able to solve the problems of

the health and social systems

BUT

the problems of the health and social systems cannot be solved WITHOUT

eHealth

...working together towards an ehealthy future

E-HEALTH PRESENT AND FUTURE Ramona Mayer EBG MedAustron GmbH, Wiener Neustadt, Austria.

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Transcript of E-HEALTH PRESENT AND FUTURE Ramona Mayer EBG MedAustron GmbH, Wiener Neustadt, Austria.