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PDF Download Review Paper IMIA Yearbook of Medical Informatics 2005: Ubiquitous Health Care Systems. Haux R, Kulikowski C, editors. Stuttgart: Schattauer; 2004. p. 157-164. N. M. Lorenzi Review Vanderbilt University Nashville, Tennessee E-Health Strategies Worldwide USA Abstract: Healthcare worldwide is in a state of constant change. The multitude of changes require creative solutions that range from restructuring healthcare to provide better services to the effective use of information technology (e-health). Both are daunting tasks in any individual organization let alone on a national or international level. To completely cover the many e-health initiatives worldwide would require a more compre- hensive document than is possible within this article. Therefore, this article represents a sample of the e-health efforts that are occurring simaltenously throughout the world. E-health Definition world with such dazzling applications puter and telecommunications tech- as surgical procedures performed by nology across all economic sectors There are a number of definitions of remote-controlled robotic devices, the was fueled by the ease of communica- e-health. The following two definitions transmission of digitized medical im- tion, transactions and information gath- reflect the most prominent definitions. ages and biological signals, and the use ering through this new medium. Con- • “The application of the Internet of real-time teleconsultation. Many sumers were intrigued by the ability to and other related technologies in clinical and administrative information gather information from a variety of the healthcare industry to improve and communication technology appli- sources and to make purchases quickly the access, efficiency, effective- cations are available in healthcare or- using a variety of shopping tools. Entry ness, and quality of clinical and ganizations. Most organizations have into this new world to establish a web business processes utilized by the goal of a fully integrated informa- site could be achieved by acquiring a healthcare organizations, practitio- tion system for the benefit both indi- domain name and a webpage, at a ners, patients, and consumers to viduals and their organizations. nominal cost. From chat groups to improve the health status of pa- Given what is occurring, E-Health is individual web pages, the sharing of tients.” (Healthcare Information not only a realistic and viable concept health information also grew rapidly, and Management Systems Soci- it is also the underlying support struc- and often without quality controls [4]. ety (HIMSS))[1]. ture for the changes that are mandated During this same period, many health • E-health is health’s version of e- or required to support the complex care organizations increased their in- commerce: that is, conducting health care systems in the world today. vestment in the technical infrastruc- health business electronically. E- E-Health will continue to evolve driven ture for healthcare was increased to health is the combined use of elec- by technology and the need of consum- meet the new challenges of managed tronic communication and IT in the ers (patients) for health care informa- care and financial pressures. Clini- health sector, both at the local site tion and services. There will be con- cians who had used computers in their and at a distance for clinical, edu- tinuous development of new and inno- academic training demanded the same cational and administrative pur- vative techniques and the consumers’ ease of access to on-line reference poses [2]. (patients’) needs will only increase the materials. As new tools, such as radi- need to access to healthcare informa- ology Picture Archive Communica- tion and services. tions Systems (PACS), laboratory and Introduction During the last 12 plus years the electronic medical record systems were explosive growth of the worldwide introduced, physicians expected to have Over the past few years, telecom- Internet has exceeded the expecta- current information available at their munications-mediated health interven- tions and imagination of the technology fingertips wherever they were – at tions have made headlines around the industry [3]. The expansion of com- home, in the office, at the hospital. IMIA Yearbook of Medical Informatics 2005 157 Review Paper The competing demands for instant 3. Evidence based - e-health inter- health may deepen the gap be- access to information and transactions ventions should be evidence-based tween the “haves” and “have- as well as the increased availability of in a sense that their effectiveness nots”. People, who do not have the technical equipment supported rapid and efficiency should not be as- money, skills, and access to com- growth of the information delivered sumed but proven by rigorous sci- puters and networks, cannot use through various web services. Just entific evaluation. Much work still computers effectively. As a result, about every company connected with has to be done in this area. these patient populations (which health care saw the benefit of using 4. Empowerment of consumers and would actually benefit the most technology to fill the demand for im- patients - by making the knowl- from health information) are those mediate healthcare information. edge bases of medicine and per- who are the least likely to benefit There is an unfortunate issue in sonal electronic records accessible from advances in information tech- this new direction and that is that some to consumers over the Internet, e- nology, unless political measures companies are adding “e-” to old solu- health opens new avenues for pa- ensure equitable access for all. tions. Many new initiatives remain tient-centered medicine, and en- The digital divide currently runs unproven. It will take time to know ables evidence-based patient between rural vs. urban popula- which solutions will be successful. Stra- choice. tions, rich vs. poor, young vs. old, tegic goals and needs must be the 5. Encouragement of a new rela- male vs. female people, and be- focus of our e-health systems and not tionship between the patient and tween neglected/rare vs. common the vendors or suppliers’ business health professional, towards a true diseases. models. partnership, where decisions are made in a shared manner. 6. Education of physicians through E-Health World Review What is the “E” in E-Health? [5] online sources (continuing medical education) and consumers (health In order to better understand the e- According to Gunther Eysenbach, education, tailored preventive in- health initiatives that are taking place the “e” in e-health does not only stand formation for consumers) worldwide, we surveyed a number of for “electronic,” but implies a number 7. Enabling information exchange International Medical Informatics As- of other “e’s,” which together perhaps and communication in a standard- sociation members. We are grateful best characterize what e-health is all ized way between health care es- for those that responded and they are about (or what it should be).. tablishments. future recognized in the Acknowl- 1. Efficiency - one of the promises 8. Extending the scope of health edgement section of this article. of e-health is to increase efficiency care beyond its conventional bound- in health care, thereby decreasing aries. This is meant in both a geo- costs. One possible way of de- graphical sense as well as in a The Asia-Pacific Area creasing costs would be by avoid- conceptual sense. E-health enables ing duplicative or unnecessary di- consumers to easily obtain health Australia agnostic or therapeutic interven- services online from global provid- The NSW Department of Health tions, through enhanced communi- ers. These services can range from will begin prototyping its new elec- cation possibilities between health simple advice to more complex tronic health records project this month care establishments, and through interventions or products such a in what is believed to be the first, wide- patient involvement. pharmaceuticals. scale online patient information data- 2. Enhancing quality of care - in- 9. Ethics - e-health involves new base of its type in Australia. Dubbed creasing efficiency involves not forms of patient-physician inter- “Healthelink”, the project has received only reducing costs, but at the same action and poses new challenges $19.4 million in funding for five years time improving quality. E-health and threats to ethical issues such and started “well before” the national may enhance the quality of health as online professional practice, in- HealthConnect project came into be- care for example by allowing com- formed consent, privacy and eq- ing, according to assistant director of parisons between different pro- uity issues. electronic records strategy for infor- viders, involving consumers as ad- 10. Equity - to make health care more mation business solutions at NSW ditional power for quality assur- equitable is one of the promises of Health Joanna Kelly. “Healthelink was ance, and directing patient streams e-health, but at the same time there born out of a review of health in NSW to the best quality providers. is a considerable threat that e- where a major recommendation was 158 IMIA Yearbook of Medical Informatics 2005 Review Paper that NSW move towards electronic for sick patients incapable of traveling Japan health records which dovetails well to the nearest medical centre or hospi- Japan has a significant number of into the national network,” Kelly told tal. When the nurse is unable to diag- initiatives to create a national electric Computerworld. “We’re literally days nose a given ailment on-site, the tech- health record. They envision involving away from developing and prototyping nician takes a digital photo, which can many physicians and others belonging the electronic health records system then be transmitted via a wireless to different hospitals to share informa- which will go live in September. The Internet connection to a doctor at a tion. One approach includes using a prototyping will be finished by the end medical institution, such as the Harvard Web-cgi-SQL database. However, of the year.” Healthelink’s first imple- Medical School for instance [8].
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