2. Application Areas: Consumer Use of
Computers for Health
Information seeking – health matters is a common use
of computers by patients and consumers. By searching
multiple sites and looking for commonality in the
content, they are able to discern the accuracy of the
information.
Communication and support - Electronic mail continues to be the “killer app”
of the Internet. Many e-mail users find it particularly useful for health-related
matters. Online support groups can provide a indispensable, even life-saving
resource to patient and families. Members of the group sometimes share
information about the latest research, treatments, and clinical trials that may
not be common knowledge.
Personal health records - Many keep their own personal
health records, both for themselves and for their family
members. Consumers can buy a personal health record
application in any software store, loading the program
onto their own computer, and storing their record there.
3. Decision Support - A broad range
of decision –support applications
is available to the interested
consumer. Some applications are
straightforward decision trees that
offer advice for follow-up
depending on the information
entered.
Disease management -
Technological support for joint
patient-provider collaboration in
disease management is a
promising application area.
Interactive voice response system
has been used successfully to
monitor patients with conditions
such as obsessive-compulsive
disease, hypertension, asthma and
others.
4. Issues in Consumer Computing for
Health
Variability in Quality of Information
Available to Consumers
Lack of Security in Internet-based
Transactions
Uneven Accessibility Across Age, Ethnic,
and Socioeconomic Groups
Educational and Cultural Barriers
Physical and Cognitive Disabilities
5. Areas of Nursing
Expertise that can
be Applied to
Consumer/Patient
Computing
THE NURSE INFORMATICIAN’S ROLE IN CONSUMER AND PATIENT
COMPUTING
6. Informaticians who are nurses bring unique skills to the area
of consumer informatics by virtue of their professional
education in nursing. Among these skills:
Deep
expertise in
patient
education
Cultural
Diversity in
the workforce
and a
strong ethic
of cultural
sensitivity
Strong
background in
both patient-
and
community
focused
research
Strong heritage
of patient
advocacy and
patient
empowerment
7. Special Considerations in Designing
Applications for Patients and Consumers
- Lay versus
professional
nomenclature
- General
literacy and
health literacy
Nurse Informaticians
have designed
applications for health
professionals to use
should be aware of the
special considerations
required in applications
for consumers and
patients. These special
considerations include:
9. Some Research Areas Related to
Consumer and Patient Computing
Ferguson (2002) refers to the “terra incognita of online consumer health.”
He recommends, among other topics, investigation the dynamics of online
support communities sometimes contribute to formal medical research.
Gustafson (2004) advocates for various levels of evaluation
studies of e-health systems based on the type of service
offered.
Schwitzer (2002) believes that there has been in adequate
evaluation of the merits of one type of decision support over
another in multimedia decision-support application.
Greenberg, D’Andrea and Lorence (2004) advocate research into
search technologies to help consumers to search ore effectively
and to evaluate the quality of what they find.
Kaplan and Brennan noted 3 particular areas of research: (1)
defining whether the user is a patient, consumer or client and
whether the definition s make a difference and whether the term
might change with circumstances; (2) determining how the roles
of the patient and healthcare providers are changing and (3)
examining what the term empowerment means.
10.
11.
12. Finally Health-Related Decision Making is
complex because it generally involves more
than a single person. Two key groups must be
considered: the family members of the
person facing a health crisis or in need of
health information and the healthcare
delivery team
13. • Health Care Decision Making Is
challenging because it involves
uncertainty, taxes human information
processing capabilities, deals with
subject matter that is unfamiliar to the
involved person, and there are multiple
constituencies that must be served.
Health Care Decision
Making:
• It advocates that patients are best
able to determine which values
should govern their care. Shared
decision making is also known as
relationship or collaboration decision
making which empowers patients to
choose among the options available
to them in consultation with their
clinician using their personal values to
frame the choice among alternatives.
Shared- decision
making and Informed
Choice
14. Patient Preferences
Attention to patient preferences as an input
into health-care decision making is rooted in
the application of decision theory to
understand personal choice. Neumann and
Morgenstern (1964) first proposed that the
personal values and attitudes that drive
individual choice could be understood through
mathematical formulations.
15. Two Main Branches of Decision
Theory
Decision Analysis: It helps in choosing one
course of action from several when the most
desired strategy depends, in part, on the
knowledge of the costs, benefits, and
probabilities of the resolution of the outcomes
of that strategy.
Multiattribute Utility Theory (MAUT): This
provides a way to establish a quantitative
expression of an individual’s value with respect
to a given set of alternatives, with preferences
for a given health outcome being expressed as
a score on the weighted sum of the entities
and their relatives weights.
17. Computer Technology and Patient
Decision-Making
- computerized surveys and instructional
programs available on the WWW
walked the patient through classic
decision analytic methods to help them
clarify their preferences.
Envisioning Treatment Options
-The technology-based Shared Decision-
Making Program ( SDP ) was developed within
a framework and designed for use in the clinic
setting to aid patients facing complex
treatment choices.
18. Linking Preferences with Treatment
Decision- The Department of Family
Practice at the Medical College of
Virginia, Virginia Commonwealth
University designed HealthTouch , a
computerized health information
system for health promotion and
disease prevention for use in
primary care.
Efficacy of Decision Aids
- Decision for providing information
regarding treatment options and
health states leading to the
elicitation of patient preferences
have been developed to provide
assistance to patients who are facing
complex healthcare decisions.
19. Points of Decision Support System
Intervention :
- It has been introduced at several
types of intervention points. The most
commonly deployed system are those
that are used when a patient has
entered an acute phase of a disease.
An emerging application of computer-
based DSS is in the area of chronic
disease management.
Acute Disease Decision Support
System:
- Acute Disease Decision Support System
DSSs that are employed in the support of
acute disease states typically are narrowly
focused on supporting the patient by
providing for their informational and
preferences determination needs regarding
a single episode of treatment choices.
