Health and Multimedia


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  • eHealth Suggests an end to the medical monopoly of medical information, transformation of role to now include teaching the patient how to filter information to get accurate knowledge Concern that disparities may be reproduced or even increased by availability of info on a medium that not all can access Will the new consumerism cause medicine to adapt, or dig in its heels? Even if the existing medical information hierarchy is reproduced on the Internet, it doesn ’ t mean that consumers will accept it Both the orthodox and the unorthodox can occupy space on the internet
  • The overwhelming majority of ppl continue to believe that the information they obtain is reliable (86%) and report that they were successful (89%) in their search; Just under half (47%) of ppl have discussed the information they obtained online with their doctors; virtually half (49%) have gone online to look for information as a result of discussions with their doctors.
  • Carey ’ s Transmission (sender-receiver) vs ritual models (interaction, participation, interactions of symbols)
  • Classroom situation: teachers being challenged in classroom Students check up the facts in the internet Feeling threatened? Co-teaching? Supplement taking?
  • Enhancing consumer involvement in health care, Bradford W. Hesse, PhD Chief, Health Communication & Informatics Research Branch, National Cancer Institute (2009)
  • Health and Multimedia

    1. 1. eHealth & Multimedia <ul><li>June 7, 2010 </li></ul><ul><li>Nancy Chen, Nan Zao & Yujung Nam </li></ul>
    2. 2. Overview <ul><li>eHealth </li></ul><ul><ul><li>The rise of the internet health information undercuts the carefully established hegemony of the medical profession as the gatekeepers to expertise and knowledge </li></ul></ul><ul><ul><li>Medicine can now be seen through various debates as taking a role as guardian of public safety , moving its gatekeeper function onto the web, e.g. “Quackwatch”, Hardey, M. (2008) </li></ul></ul><ul><li>Multimedia Technology for Health and Social Services include </li></ul><ul><ul><li>changing role of the patient in health care </li></ul></ul><ul><ul><li>Internet health information seeking </li></ul></ul><ul><ul><li>social networking for health </li></ul></ul><ul><ul><li>medical simulation and training </li></ul></ul><ul><ul><li>games for health </li></ul></ul><ul><ul><li>Telemedicine </li></ul></ul><ul><ul><li>digital divide issues in access to health information. </li></ul></ul><ul><ul><li>Costs of development and dissemination </li></ul></ul><ul><ul><li>Need to develop culturally appropriate content </li></ul></ul><ul><ul><li>Information overload </li></ul></ul>
    3. 3. Source:
    4. 4. eHealth and the Role Patient To increase people’s health decision-making competencies and promote health, (1) how should we reconceptualize ‘patient,’ and (2) consider the effects of decision-making environments??
    5. 5. Reconceptualizing ‘Patient’ <ul><li>New: Health Citizen </li></ul><ul><li>Bi-directional decision-making </li></ul><ul><li>Wellness-centered </li></ul><ul><li>Focus on social determinants of health </li></ul><ul><li>Emphasize interaction & participation </li></ul><ul><li>Old: Patient </li></ul><ul><li>Uni-directional influence </li></ul><ul><li>Illness-centered </li></ul><ul><li>Focus on patient compliance </li></ul><ul><li>Transmission (or instrumental) model of communication </li></ul>
    6. 6. Sillence et al. (2007), “ How do patients evaluate and make use of online health information? ”
    7. 7. eHealth and the Role of Physician <ul><li>How does Internet use affect the degree to which people believe physicians are the sole source of expert medical knowledge? </li></ul>
    8. 8. <ul><li>Threats to control occur when clients increase access to and understanding of professional knowledge base </li></ul><ul><li>In health care contexts, threats have occurred when: </li></ul><ul><ul><li>Internet has led to increased transparency of physician work </li></ul></ul><ul><ul><li>Specialization of medicine has undermined individual MDs as omniscient sources </li></ul></ul><ul><ul><li>Alternative health movement has grown </li></ul></ul>
    9. 9. eHealth and the Role of Media <ul><li>How can new media better support people’s health needs? </li></ul>
    10. 10. Motivational Needs & Media Need Definition Examples of how new media can support need Autonomy Perceiving that one’s actions stem from internal sources <ul><li>Self-help tools, e.g., online smoking cessation </li></ul><ul><li>Personal health records w/ reminders & status reports </li></ul><ul><li>Health portals </li></ul><ul><li>Connective journalism that links to resources </li></ul><ul><li>Ubiquitous health care in consumer-friendly locations </li></ul>Competency Gaining mastery over skills & talents <ul><li>Functional health literacy </li></ul><ul><li>Information prescriptions from physicians </li></ul><ul><li>Skill augmentation, e.g., online meal planners </li></ul>Relatedness Gaining sense of respect & belonging from valued others <ul><li>Health advocacy groups </li></ul><ul><li>Networks of care, e.g., </li></ul><ul><li>Shared communities of knowledge </li></ul>
    11. 11. <ul><li>Barbara Johnston, M.S.N. </li></ul><ul><li>Executive Director of the Medical Board of California </li></ul><ul><li>Neil A. Solomon, M.D. </li></ul><ul><li>Founder & President of NAS Consulting Services </li></ul><ul><li>Clinical Director of the California Quality Collaborative </li></ul>Telemedicine in California: Progress, Challenges, and Opportunities
    12. 12. Telemedicine <ul><li>Definition: The use of telecommunications and information technologies to provide health care remotely </li></ul><ul><li>Modes of delivery: </li></ul><ul><li>Real-time communication (synchronous) </li></ul><ul><li>Store-and-forward systems (asynchronous) </li></ul><ul><li>Digital, audio and visual </li></ul><ul><li>Goal: To increase access to health care by transcending the boundaries of time and space with technologies, thus reducing health disparities, especially for rural and underserved populations </li></ul>
    13. 13. History <ul><li>Late 1950s: </li></ul><ul><li>First cited telemedicine application pertains to the use of a two-way closed-circuit TV system in the psychiatric setting in 1959 (Perednia & Allen, 1995). </li></ul><ul><li>NASA has been developing and applying telemedicine to monitor its astronauts’ health during missions since the Agency’s inception. </li></ul><ul><li>Early 1970s: Applications developed by NASA began to be applied to rural areas in the U.S. and developing countries. </li></ul>
    14. 14. In California <ul><li>Early 1990s: Proponents for telemedicine began to grow because it’s perceived as a solution for: </li></ul><ul><li>Widening disparities in health care, especially in rural areas </li></ul><ul><li>An aging population with greater health care needs </li></ul><ul><li>A rising shortage of health professionals: By 2015, California will face a shortage of 17,000 doctors, many in rural areas </li></ul>= Medically underserved areas Source: Office of Statewide Health Planning
    15. 15. Some successful programs in CA <ul><li>Telestroke Program at UC San Diego : Effectiveness in correct diagnosis evaluated with a randomized control group study published in Lancet </li></ul><ul><li>Central California teleophthalmology Network : A license-free software, Eyepacs, was developed by UC Berkeley and used to evaluate retinal scans of diabetic patients remotely to prioritize patients for treatment </li></ul><ul><li>Kings View Telepsychiatry program </li></ul><ul><li>Sutter Health’s eICU </li></ul>
    16. 16. Barriers to wider adoption of telemedicine <ul><li>Technology </li></ul><ul><li>High costs for purchasing equipment </li></ul><ul><li>Complexity of operating equipment </li></ul><ul><li>Slow data transmission due to the lack of high-speed Internet connections </li></ul><ul><li>Regulation: Telemedicine sessions could involve multiple parties in more than one state, and it might be unclear which state laws regarding licensure and malpractice coverage apply under such circumstances </li></ul>
    17. 17. Barriers to wider adoption of telemedicine (cont.) <ul><li>Financing </li></ul><ul><li>Resistance from Insurers concerned about rising service volumes and therefore increasing costs resulting from telemedicine </li></ul><ul><li>Reluctance from individual practices to adopt because the business model is unproven, and the costs of implementing the technology and altering practice routines can be high </li></ul><ul><li>Large integrated systems (e.g. VA and Kaiser Permanente) which manage health care and costs concurrently, constitute a financially viable model for telemedicine </li></ul>
    18. 18. Barriers to widespread adoption of telemedicine (cont.) <ul><li>Provider issues </li></ul><ul><li>Resistance to change as it requires disruption to traditional practices, learning of new skills, costs for acquiring new equipment, and time to work out how to bill for telemedicine encounters under different reimbursement schemes </li></ul><ul><li>Concern over erosion of patient-provider relationship and quality of care </li></ul><ul><li>Patient issues: </li></ul><ul><li>1. Telemedicine technologies may raise some privacy, confidentiality and security problems for patients </li></ul>
    19. 19. Concluding remarks & future trends <ul><li>More thorough analyses of existing programs are needed to demonstrate if a business case can be made for telemedicine </li></ul><ul><li>Lessons from early programs - both successes and failures - and personal experiences of early adopters need to be collected and applied to new ventures </li></ul><ul><li>Regulators, payers, providers, and consumers need to work together to determine how to prioritize the use of investment capital to roll out telemedicine services and to develop the relationships and financing mechanisms necessary to sustain telemedicine ventures </li></ul>
    20. 20. Health Care Unplugged: The Evolving Role of Wireless Technology Richard Adler, MBA Principle of People & Technology
    21. 21. The wireless revolution <ul><li>The explosive growth of cell phones </li></ul><ul><ul><li>“… a personal, portable, multipurpose, multimedia computing and communication device (p.5)” </li></ul></ul><ul><li>Cell phone networks </li></ul><ul><ul><li>Text & still images; downloadable music, ringtones, & videos; web-surfing </li></ul></ul><ul><li>Demographics of U.S. Cell phone users </li></ul><ul><ul><li>Age is related to the usage of cell phones and the use of more advanced cell phone features </li></ul></ul><ul><li>Related technologies </li></ul><ul><ul><li>Short- & medium-range digital networks, sensors, and batteries </li></ul></ul>
    22. 22. Wireless health care applications <ul><li>Cell phones are </li></ul><ul><ul><li>Personal, ubiquitous, connected, increasingly intelligent </li></ul></ul><ul><ul><li>Pervasiveness and low cost </li></ul></ul><ul><ul><li>Well-suited for delivering health care application, particularly for supporting the treatment of chronic diseases </li></ul></ul><ul><li>The demographic imperative </li></ul><ul><ul><li>Aging population & increasing occurrence of chronic disease  urgent need for better tools to monitor patients’ health status and help manage their health </li></ul></ul><ul><ul><li>Caring for patients with chronic conditions=$$$  Better chronic disease care could produce substantial cost savings </li></ul></ul>
    23. 23. Wireless health care application (cont.) <ul><li>The emergence of wireless health care </li></ul><ul><ul><li>Developed in foreign countries, relatively new, limited evidence regarding effectiveness </li></ul></ul><ul><li>Types of applications </li></ul><ul><ul><li>Applications that monitor physiological functions </li></ul></ul><ul><ul><li>Applications that provide information and feedback directly to patients, encouraging them to pay attention to and take a more active role in managing their health </li></ul></ul>
    24. 24. Types of Wireless Health Care *C=current use, F=future use. SENSOR PLACEMENT INFORMATION FLOW COMMUNICATION TYPE Portable Wearable Implantable Upstream Downstream 2-way Data Text Multimedia 2-way video Physiological Monitoring Cardiac C C C C C Glucose C F C C Vital signs C C F C C Patient Communication and Support Appointment reminders C C Health education & promotion C F C F F Patient compliance C C Patient engagement C C C F F Patient consultations C F
    25. 25. Glucophone <ul><li>Already used in South Korea, received FDA approval in June 2006. </li></ul><ul><li>The patient places a small sample on a test strip, inserts the strip into a reader integrated into the phone’s battery pack, and views the results on the phone’s screen. </li></ul><ul><li>The results are also sent automatically to an online medical management database and can be forwarded to a personal physician, family member, or caregiver. </li></ul>
    26. 26. 3G Doctor <ul><li>Launched in the United Kingdom in late 2006 </li></ul><ul><li>Enables patients to consult with physicians using the video capacities of advanced 3G phones </li></ul><ul><li>Patients complete a Web-based “instant medical record” . The participating physicians can access the data at the time of the video consultation ($50). A written report summarizing the doctor’s recommendations is available for download. </li></ul>
    27. 27. Issues & Implications <ul><li>Health industry issues </li></ul><ul><ul><li>Uncertainty about reimbursement </li></ul></ul><ul><ul><li>Unproven benefits </li></ul></ul><ul><ul><li>Health system not configured to use wireless applications </li></ul></ul><ul><ul><li>Privacy and security </li></ul></ul><ul><li>Technological issues </li></ul><ul><ul><li>Potential information overload </li></ul></ul><ul><ul><li>Lack of standards </li></ul></ul><ul><li>Cell phone market issues </li></ul><ul><ul><li>Incomplete coverage </li></ul></ul><ul><ul><li>Network fragmentation </li></ul></ul><ul><ul><li>The mismatch factor </li></ul></ul>