This document discusses the concept of eHealth (internet and health) from several perspectives. It defines eHealth and explores its potential benefits, including increased efficiency, quality of care, evidence-based practices, and patient empowerment. Challenges like equity and ethics are also addressed. Real-world data on internet usage for health purposes is presented. Overall the document provides an overview of the emerging field of eHealth.

1. Sociedad Red y Salud Francisco Lupi áñez (flupianez@uoc.edu) Profesor Universitat Oberta de Catalunya Estudios de Ciencias de la Información y Comunicación

2. Aproximaci ón a la Sociedad Red Internet y Salud eSalud - eHealth Realidad empírica - Fuentes de información Conclusiones Índice

3. “ Algo está cambiando, se dijeron Adán y Eva a la salida del paraíso”

4. Sociedad Red : forma espec ífica de estructura social identificada por la investigación empírica como característica de la Era de la Información. Estructura social: forma de organización humana en sus relaciones de producción/consumo, experiencia y poder expresadas a través de la interacción del marco cultural. Era de la Información : período histórico en el que la sociedad realiza sus diferentes actividades en un paradigma tecnológico constituído sobre una base microelectrónica de tecnologías de la información y la comunicación y la genética (Era Industrial -- electricidad) Aproximación a la Sociedad Red - Definición Castells, 2000; 2001; 2002

5. - Nueva estructura social Configurada en torno a redes. Crisis de la familia patriarcal y de las burocracia del Estado. - Nueva cultura Medios de comunicaci ón de base electrónica. Proceso de globalización. - Nueva econom ía Centrada en la producción de conocimiento como creación de valor. Global y formada por redes. - Nueva política Procesos de poder: batalla de las ideas y las imágenes. - Sociedad de redes Superación de la organización jerárquica y vertical. Flexibilidad, adaptabilidad y capacidad de reconfigurarse. Aproximación a la Sociedad Red - Rasgos Castells, 2000; 2001; 2002

6. Aproximación a la Sociedad Red Visión utópica Visión distópica REALIDAD EMPÍRICA Katz & Rice, 2001

7. Aproximación a la Sociedad Red 2 Intervenciones 12 Comentarios

8. Aproximación a la Sociedad Red Contenidos Direcci ón postal Teléfono Fax Email Lista de distribuci ón

9. Internet Medio de comunicaci ón, de interacción y de organización social que se articula tecnológicamente como red de redes de ordenadores capaces de comunicarse entre ellos. En este sentido, la World Wide Web (www), el correo electrónico, los foros de discusión, la transferencia de archivos, las dispositivos móviles (PDA, WAP, GPRS) son diferentes aplicaciones integradas en Internet Salud Estado de completo bienestar físico, mental y social, y no solamente la ausencia de afecciones o enfermedad. La salud implica que todas las necesidades fundamentales de las personas estén cubiertas: afectivas, sanitarias, nutricionales, sociales y culturales. Internet y Salud Castells, 2001; OMS

10. eSalud - eHealth OMS Connecting for Health. Global Vision, Local Insight. Report for the World Summit on the Information Society (2005) The use of information and communication technologies (ICT) for health, or ‘eHealth’, today represents one of the key instruments for health care delivery and public health. eHealth. Tools & Services. Needs of the Member State2006 Survey about Health care, Policy and Strategy, Education and Information

11. eSalud - eHealth Europe Better healthcare for less money: eHealth is the major challenge facing Europe's healthcare systems. It could potentially become the third largest industry in the healthcare sector. ICT for Health (also known as eHealth) describes the application of information and communications technologies across the whole range of functions that affect the health sector, from the doctor to the hospital manager, via nurses, data processing specialists, social security administrators and - of course - the patients.

13. eSalud - eHealth Journal of Medical Internet Research What is e-health? (1) e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.

14. eSalud - eHealth Journal of Medical Internet Research What is e-health? (1) 1. Efficiency - one of the promises of e-health is to increase efficiency in health care, thereby decreasing costs. One possible way of decreasing costs would be by avoiding duplicative or unnecessary diagnostic or therapeutic interventions, through enhanced communication possibilities between health care establishments, and through patient involvement. 2. Enhancing quality of care - increasing efficiency involves not only reducing costs, but at the same time improving quality. E-health may enhance the quality of health care for example by allowing comparisons between different providers, involving consumers as additional power for quality assurance, and directing patient streams to the best quality providers. 3. Evidence based - e-health interventions should be evidence-based in a sense that their effectiveness and efficiency should not be assumed but proven by rigorous scientific evaluation. Much work still has to be done in this area. 4. Empowerment of consumers and patients - by making the knowledge bases of medicine and personal electronic records accessible to consumers over the Internet, e-health opens new avenues for patient-centered medicine, and enables evidence-based patient choice. 5. Encouragement of a new relationship between the patient and health professional, towards a true partnership, where decisions are made in a shared manner. 6. Education of physicians through online sources (continuing medical education) and consumers (health education, tailored preventive information for consumers)

15. eSalud - eHealth Journal of Medical Internet Research What is e-health? (1) 7. Enabling information exchange and communication in a standardized way between health care establishments. 8. Extending the scope of health care beyond its conventional boundaries. This is meant in both a geographical sense as well as in a conceptual sense. e-health enables consumers to easily obtain health services online from global providers. These services can range from simple advice to more complex interventions or products such a pharmaceuticals. 9. Ethics - e-health involves new forms of patient-physician interaction and poses new challenges and threats to ethical issues such as online professional practice, informed consent, privacy and equity issues. 10. Equity - to make health care more equitable is one of the promises of e-health, but at the same time there is a considerable threat that e-health may deepen the gap between the "haves" and "have-nots". People, who do not have the money, skills, and access to computers and networks, cannot use computers effectively. As a result, these patient populations (which would actually benefit the most from health information) are those who are the least likely to benefit from advances in information technology, unless political measures ensure equitable access for all. The digital divide currently runs between rural vs. urban populations, rich vs. poor, young vs. old, male vs. female people, and between neglected/rare vs. common diseases. In addition to these 10 essential e's, e-health should also be * easy-to-use, * entertaining (no-one will use something that is boring!) and * exciting

16. eSalud - eHealth Journal of Medical Internet Research What is e-Health (2): The death of telemedicine? What Is eHealth (3): A Systematic Review of Published Definitions What Is eHealth (4): A Scoping Exercise to Map the Field What Is eHealth (5): A Research Agenda for eHealth Through Stakeholder Consultation and Policy Context Review What Is eHealth (6): Perspectives on the Evolution of eHealth Research

17. Realidad empírica – Fuentes de información Fuente: INEbase. Instituto Nacional de Estadística en Encuesta sobre Equipamiento y Uso de Tecnologías de la Información y Comunicación en los hogares 4,02% 5,27% 4. Buscar consejos de salud de un médico 0,18% 0,20% 3. Solicitar una receta al médico 1,46% 1,00% 2. Concertar una cita con el médico u otro personal sanitario 25,82% 28,13% 1. Buscar información relacionada con la salud (enfermedad, nutrición, etc) Cataluña 2004 España 2004 Item (usuarios de Internet)

18. Realidad empírica – Fuentes de información Statistical Indicators Benchmarking the Information Society (SIBIS) EUROBAROMETER 58.2 European citizens and sources of information about health eUser Project (eHealth) e-Business W@tch eHealth Pew Internet Project World Internet Project

19. CURRENT, CHANGING PRACTICES & USES STAKEHOLDERS SYSTEMS & INFRASTRUCTURE APPLICATIONS OUTCOMES AND CONSEQUENCES AT VARIOUS LEVELS FOR STAKEHOLDERS ASSESSMENT, EVALUATION POLICY, LEGISLATION, REGULATION, ECONOMICS ANEXO 1. Rice, R. (2001). The Internet and Health Communication: A framework of Experience. In: Rice, R. & Katz. J. The Internet and Health Communication. Experiences and Expectations (pp 1- 46). London: Sage Publications. Education Continuing medical education Testing Consultation Support Clinical trails Diagnosis Analyses Interaction Collaboration Information flows Online Support Online Communications Campaigns E-commerce Search and retrieval Records Images Patients Physicians Health care professionals Insurace companies Resources Social Networks Administrative and technical support Customers Referrals Suppliers and purchaser commercial organizations Web Nacional Information Iniciatives Telemedicina Community Health Information Network Privacy Authentication Intellectual property Access Quality Equity Efficacy Educational practice Personalization Barriers Trust Rewards and peer evaluation Health outcomes Institutions Knowledge communication Economic structures Markets Individual Family Community Organization Industry

20. Conclusiones Internet se esta configurando como un “espacio” de referencia para los temas relacionados con la búsqueda de información sobre la salud. Comienzan a esbozarse cuestiones que van más allá de la búsqueda de información y que están relacionados con procesos de interacción más complejos y que afectan a todo el sistema sanitario Salud  flujos de información

21. Muchas gracias por su atención Francisco Lupi áñez (flupianez@uoc.edu) Profesor Universitat Oberta de Catalunya Estudios de Ciencias de la Información y Comunicación