Health in the Information Age Rita Espanha and Gustavo Cardoso

< Answer>

Why Health and Information ?

< answer>

What does the Internet say to us?

A research on YouTube

9s of Dr. House

Sounds familiar ?

the notion that Internet doesn’t really help us with nothing important ?

A few minutes of Google

the people in this audience ?

The same testimonials …

but not in English ?

The answer may also lie in the media, but it’s not enough.

Why?

Because we have to look at...

< People >

Doctors

Nurses

Pharmacists

Patients

</ people >

< Institutions >

Hospitals

Public and Private

Medical Centers

Primary Care Institutions

Pharmacies

</ Institutions>

< Content>

Internet Pages

Blogs

Search Engines

</ Content >

It’s of all these things that this study is about

< Health in the Information Age>

goal

To analyze in what way Information and Communication Technologies are appropriated in the health field :

by users and professionals, in the context of the network society, in Portugal

to question

(1)

How can Internet be used in communication and to provide health information ?

(2)

What tell us the experiences of consumption and information technologies use by health professionals?

(3)

Which is the value and impact of Internet in the public health campaigns?

(4)

Which other communication technologies are valued and used?

Health Professionals

1000 Doctors by postal survey

1000 Nurses by postal survey

160 Pharmacists by online survey

Internet use 77% of Doctors 63.7% of Nurses

Internet use in professional practice 92,4% of Doctors 80,9% of Nurses

< doctor >

diagnose evaluation with Internet resource 52,3%

prescription of therapeutic measures 46,4%

prognosis evaluation 32,7%

therapeutic measures execution 19,5%

36,1% ( yes frequently + yes sometimes ) Recommend Internet websites to patients

the online consulting of information may lead to questioning the doctors knowledge ? Very much:24,9% Quite:49,5%

I agree with a single patient record accessible by me through the Internet 53% ( totally agree )

interaction remuneration with clinical purposes Email (45,5%) ;Telephone (39,5%) Cell phone (38,2%); SMS (31,8%) Chat (23,3%)

</ doctor >

< nurse >

usefulness for professional practice Very useful : 55,3% Useful : 40,4%

Internet information, improves autonomy and quality of life > 80% of opinions

I agree with a single patient record accessible by me through the Internet 54,3% ( totally agree )

</ nurse >

< pharmacist >

would you use, in your professional practice, if it was possible… Reception of prescriptions by email: 81,4%

would you use, in your professional practice, if it was possible… Reception of users direct requests: 71%

would you use, in your professional practice, if it was possible… Sending SMS to remind to take the medicines: 87,6%

importance of Internet contents in the health field Portuguese : 61,7% English : 90,5% ( relevant and very relevant)

</ pharmacist>

Patients and Health

2000 users by presencial survey

< users >

< perceptions and uses of the National Health System >

Where to go with a non urgent health problem ? Doctor of the National Health System: 71,5% Pharmacist: 18,2% Doctor (private system): 3,5%

… and with an urgent health problem? Public hospital Emergency service: 48,7 Health emergency center : 46,4% Doctor: 2,4% Private hospital emergency service: 1,4%

</ perceptions and uses of the National Health System >

procura de informação na Internet Source: INE/UMIC, Survey to the Use of Information and Communication Technologies by Families 2002 - 2007. * Individuals between 16 and 74 years old which have used the Internet in the first trimester of the year. Search in the Internet about health

Would you like to use online medical services 9,5% ( doctors appointments, tests appointments, occasional doubts, medical prescriptions )

telephone support (help lines) 95,8% never used (who did use…pediatric questions 73,2%)

stating that the doctor never dissuaded them from looking for information online 96%

when dissuaded … Risk of self-diagnose: 40,9% Lack of knowledge: 30,8%

8,4% Percentage of those that got their doctors cell phone number

60,8% used 54,1% got an answer 6,2% were contacted after leaving a message

</ users >

Professionals Users

(1) mediation arrive to the health field

(2) is part of professionals and users routines

(3) but is not part of…

(3) public health policies

(3) health field science teaching integration

(3) protocols of professional practice in the relation user/health professional

What has changed supremacy of network morphology over action

what is still to be changed? structural practices of the actors

Health contents on-line: Google, www and Blogs

80 general websites about health in Portuguese

Information fundamentally institutional

formal contents are more frequent (institutional, descriptive, functional)

than contents about “health” and “illness”

We find sites with health related information and content

but with no communication processes or services with a higher interaction level

but with no communication processes or services with a higher interaction level

Contrary to what happens in Catalonia

Contrary to what happens in Catalonia

where the interactivity levels are quite higher compared with the Portuguese experience

but where the presence of institutional websites is lower

55 Health blogs in Portuguese

They are built from the selection and comment to a given event or news

proceeding from other sources and standing out only a part of this information

General information blogs and diaries prevail

“ Online practices” through blogs are practically non existent

In spite of...

The majority of blogs being kept by health professionals (78,2%)

And amongst these, the majority being kept by doctors (45,5%)

The interactivity is very limited

In “Hans Oh’s Health Blog” http://blog.hansoh.com/2005/04/26

Health Care Institutions and Information Technologies: Organizational Changes and Autonomy

6 case studies

Different information systems and different uses

70 Interviews

Institutions in several regions of the country

6 different stories

The medicine circuit and patients computer management

Intranet and institutional websites

External electronic prescriptions and Local Health Units

Telematic Health Network (THN)

SONHO, SINUS, SAM and SAPE and RisPac (names of several informational systems at use in the National Health System, for administrative and clinic purposes)

A reading proposal…

OIT Model (Organization, Impacts and Technology )

There are many variables guiding in a positive and negative way

the Information Systems implementation processes

which determinate simultaneously

changes in the organization forms of the institutions

and in the autonomy processes of users and professionals

Some common features

(1)

Growing use of ICT’s applied to health

(2)

Tendency to an implementation and need of applications and information systems

which will optimize care processes given to the community

Whether clinical care or administrative quickening

(3)

Non existence of a generalized network concept in the National Health System

Programs and projects disruption

(4)

Doctors are the most resistant group

To the use of information applications/systems

Some General Conclusions

The analysis of health information systems

Sends us to 3 analysis units

(1)

Organizations and their management models

(2)

Health care professionals

(3)

Information and software physical and technological networks

leading to The need to articulate the 3 analysis units in a way that we have

Network Organizations, i.e.

More flexible and adaptable to change

And professionals who will increasingly value ICT’s

Leaving the expectation that these values will be more expressive in the future

In a global context where:

Internet is rising as an alternative

to more traditional methods of obtaining health information

Constant flows of information

encourage citizens to be more responsible for their own and their families health

In a context of generalized health information

the use of communication and information technologies is fundamental

To the promotion of individual autonomy in the health field

The incentive of Internet use in this context

Depends actively

(1)

On the type of available contents

(2)

the quality and credibility of contents

(3)

The ease in using and understanding available contents and resources

Which gives a central role to the health care professional

And health care institutions

In developing the concept of “informed citizen”

Even because :

</ answer >

< more questioning >

In November 2005, at the Royal Society of Medicine, Prof. Andrew Webster was discussing…

The promise

tertiary 1m hospital admissions secondary - over 11m hospital admissions primary – 360m GP consultations self care – 90% of health care events FAST, ACCESSIBLE INFORMATION E-TRANSACTIONS TELECARE

Information age health care INDIVIDUAL SELF-CARE CARE BY FAMILY AND FRIENDS CARE BY SELF-HELP COMMUNITY HEALTH PROFESSIONALS AS FACILITATORS HEALTH PROFESSIONALS AS PARTNERS HEALTH PROFESSIONALS AS AUTHORITIES

Doubts

(1)

Limits of e-health: what is possible to be ‘offered’ in e-health?

(2)

What implies e-health – in particular for health care professionals?

(3)

Implications of the future e-health services offer: new segmentation and new exclusions?

</ doubts >

?