The role of e-health and consumer health informatics for evidence-based patient choice in the 21st century

Abstract

Consumer health informatics and e-health [ie, electronic health information and services available over networks such as the Internet1,2 and related technologies such as digital TV/WebTV, wireless media such as Web-compatible mobile phones and personal digital assistants (PDAs)] are emerging trends that will redefine health care in the 21st century. The desire of (most) consumers to assume more responsibility for their health care and a growing desire of health professionals to fully realise the potential of the patient and their families coincide with the emergence and increasing availability of interactive information accessible to consumers. These developments are further fueled by cost-saving pressures in health systems and the hope that giving consumers more information and power could increase the quality of care (eg, by avoiding unnecessary or duplicate interventions) and save costs by fully realizing the self-help potential of the patient and his family. Information technology and consumerism are synergetic forces that together promote an “information age health care system,” where (ideally) consumers can use information technology to access information at home and control their own health care and thereby utilize health care resources more efficiently.3 This paper focuses on the opportunities and challenges of e-health and related developments for the concept of evidence-based patient choice (EBPC).4 Evidence-based patient choice is a paradigm at the intersection of evidence-based medicine (EBM) and patientcentered medicine and is one important pillar for modern health care. Patient-centered medicine and evidence-based medicine are closely linked concepts. Both emphasize that it is not the authority of the doctor that justifies a particular clinical intervention. EBM argues from the scientific standpoint that the evidence for the intervention’s effectiveness must be the foundation of selecting an intervention (emphasizing the “science” of medicine), and patient-centered medicine argues from a humanistic standpoint that patients should play a central role in decisions about health care, stressing the fact that patient preferences must be incorporated into clinical decision making. Two requirements have to be met to enable EBPC: objective, unbiased information must be available to the patient, and the patient must have the power and opportunity to choose. While the latter depends on several factors, including the individual patient (not all patients are actually able or willing to make health-related decisions) and the physician (who sometimes fail to give patients a choice) and also the structure and organization of the health system, information and communication are the basic requirements for evidence-based patient choice rests. The remainder of this paper deals with electronic means to deliver this information and to facilitate patient choice. I will explore how the Internet changes access to information for consumers and will discuss how consumer health informatics can help to canalize the patients’ demand for information to information and integrate high-quality and relevant information in the informed decision-making process.