E-health Initiatives Research Articles

Internet and patient empowerment in individuals with symptoms of an eating disorder: A cross-sectional investigation of a pro-recovery focused e-community

IntroductionMany individuals with eating disorder problems seek information and support online. There are however numerous websites that promote eating disordered behaviors. The website and e-community ‘Proud2Bme’ was developed as a healthy alternative for pro-eating disorder websites, providing a safe, positive, and pro-recovery focused environment. It offers a wide array of information and personal stories, as well as platforms for interaction such as a forum and chat. The first aim of this study was to investigate whether, and to what extent, empowering processes and outcomes are experienced by participants on Proud2Bme. The second aim was to examine correlates of empowering processes and outcomes. MethodsParticipants (n=311) were recruited via an online survey on Proud2Bme. Correlations were examined and T-tests and ANOVAs were conducted. ResultsExchanging information, finding recognition, and sharing experiences were the empowering processes most often reported by participants. The most pronounced empowering outcome was feeling better informed. To a smaller degree, increased help-seeking behavior, increased optimism and control over the future, and increased confidence in treatment and the relationship with the therapist were reported. Lower levels of general empowerment, younger age, and more interactive usage patterns of the website were positively associated with the experience of empowering processes and outcomes. DiscussionOffering a platform where individuals can share their experiences and find recognition might be one of the most important ingredients for successful e-health initiatives aimed at improving patient empowerment. Moreover, in the field of eating disorders specifically, such initiatives offer a healthy alternative to the harmful and negative effects of pro-eating disorder websites.

Diffusion of e-health innovations in 'post-conflict' settings: a qualitative study on the personal experiences of health workers.

BackgroundTechnological innovations have the potential to strengthen human resources for health and improve access and quality of care in challenging ‘post-conflict’ contexts. However, analyses on the adoption of technology for health (that is, ‘e-health’) and whether and how e-health can strengthen a health workforce in these settings have been limited so far. This study explores the personal experiences of health workers using e-health innovations in selected post-conflict situations.MethodsThis study had a cross-sectional qualitative design. Telephone interviews were conducted with 12 health workers, from a variety of cadres and stages in their careers, from four post-conflict settings (Liberia, West Bank and Gaza, Sierra Leone and Somaliland) in 2012. Everett Roger’s diffusion of innovation-decision model (that is, knowledge, persuasion, decision, implementation, contemplation) guided the thematic analysis.ResultsAll health workers interviewed held positive perceptions of e-health, related to their beliefs that e-health can help them to access information and communicate with other health workers. However, understanding of the scope of e-health was generally limited, and often based on innovations that health workers have been introduced through by their international partners. Health workers reported a range of engagement with e-health innovations, mostly for communication (for example, email) and educational purposes (for example, online learning platforms). Poor, unreliable and unaffordable Internet was a commonly mentioned barrier to e-health use. Scaling-up existing e-health partnerships and innovations were suggested starting points to increase e-health innovation dissemination.ConclusionsResults from this study showed ICT based e-health innovations can relieve information and communication needs of health workers in post-conflict settings. However, more efforts and investments, preferably driven by healthcare workers within the post-conflict context, are needed to make e-health more widespread and sustainable. Increased awareness is necessary among health professionals, even among current e-health users, and physical and financial access barriers need to be addressed. Future e-health initiatives are likely to increase their impact if based on perceived health information needs of intended users.

Teleradiologie – Update 2014

Due to economic considerations and thanks to technological advances there is a growing interest in the integration of teleradiological applications into the regular radiological workflow. The legal and technical hurdles which are still to be overcome are being discussed in politics as well as by national and international radiological societies. The European Commission as well as the German Federal Ministry of Health placed a focus on telemedicine with their recent eHealth initiatives. The European Society of Radiology (ESR) recently published a white paper on teleradiology. In Germany §3 section 4 of the Röntgenverordnung (RöV, X-ray regulations) and DIN 6868-159 set a framework in which teleradiology can also be used for primary reads. These possibilities are already being used by various networks and some commercial providers across Germany. With regards to cross-border teleradiology, which currently stands in contrast to the RöV, many issues remain unsolved.

Electronic health in ghana: current status and future prospects.

The health-care system in Ghana is similar to those in other developing countries and access to health services for remote communities is extremely limited. In July, 2010, the Government of Ghana launched the national e health strategy. A number of international organizations have initiated various pilot projects, including disseminating and collecting data, education initiatives and telemedicine. In addition, several institutions and organizations are dedicated to the promotion of e-health and a range of Web-based health consultancy services have begun. The main objective of this study is to provide an overview of eHealth activities in Ghana. It was a daunting task, not least because of the need to gather information on eHealth projects and initiatives in Ghana, as there is no existing repository of such information. Through literature search in Africa journals online, Hinari, Medline, Google.com, Journal of Telemedicine and e-Health, Journal of Telemedicine and Telecare, Journal of Medical Internet Research and Interaction with eHealth experts, followed up with some of the authors' for directions to other projects, and following the references in some articles. A total of twenty-two (22) pilot projects have been identified in Ghana. Mobile devices in use range from PDAs to simple phones and smart phones. The key findings of this research are that there are about 22 eHealth project at various stages of implementation in Ghana. Some of these projects have wind up and others are still being implemented. Mobile devices in use range from PDAs to simple mobile phones and smart phones. Most of the projects have been donor initiated. Data collection started in March 2010 to June 2013. Although eHealth seems to have a limited role in Ghana at present, there is growing interest in the opportunities it may offer in terms of improving the delivery and access to services, especially in remote locations. Recommendations for further research are provided.

Warding off fraud [electronic medical records security

The healthcare industry is under attack, with imposters, fraudsters and cyber-criminals pretending to be people they are not to acquire personal patient data. But the ID theft clampdown has begun. The migration to electronic medical records is an important transition for the healthcare industry. Not only is it aimed at making healthcare more efficient and improving the quality of patient care, but the concept ties in with other e-health initiatives that can take advantage of emerging technology to improve the quality of patient care. Electronic medical records have received a good deal of attention in recent years, and not necessarily for the most positive reasons. Whilst the UK's NHS and the USA's Obama administration have encouraged healthcare organisations to invest heavily in electronic healthcare records, it has become increasingly clear that there is a need to guard against playing into the hands of cybercriminals.

Co-Creation With TickiT: Designing and Evaluating a Clinical eHealth Platform for Youth.

BackgroundAll youth are susceptible to mental health issues and engaging in risky behavior, and for youth with chronic health conditions, the consequences can be more significant than in their healthy peers. Standardized paper-based questionnaires are recommended by the American Academy of Pediatrics in community practice to screen for health risks. In hospitals, psychosocial screening is traditionally undertaken using the Home Education, Eating, Activities, Drugs, Depression, Sex, Safety (HEEADDSS) interview. However, time constraints and patient/provider discomfort reduce implementation. We report findings from an eHealth initiative undertaken to improve uptake of psychosocial screening among youth.ObjectiveYouth are sophisticated “technology natives.” Our objective was to leverage youth’s comfort with technology, creating a youth-friendly interactive mobile eHealth psychosocial screening tool, TickiT. Patients enter data into the mobile application prior to a clinician visit. Response data is recorded in a report, which generates alerts for clinicians, shifting the clinical focus from collecting information to focused management. Design goals included improving the patient experience, improving efficiency through electronic patient based data entry, and supporting the collection of aggregated data for research.MethodsThis paper describes the iterative design and evaluation processes undertaken to develop TickiT including co-creation processes, and a pilot study utilizing mixed qualitative and quantitative methods. A collaborative industry/academic partnership engaged stakeholders (youth, health care providers, and administrators) in the co-creation development process. An independent descriptive study conducted in 2 Canadian pediatric teaching hospitals evaluated the feasibility of the platform in both inpatient and ambulatory clinical settings, evaluating both providers and patient responses to the platform.ResultsThe independent pilot feasibility study included 80 adolescents, 12-18 years, and 38 medical staff-residents, inpatient and outpatient pediatricians, and surgeons. Youth uptake was 99% (79/80), and survey completion 99% (78/79; 90 questions). Youth found it easy to understand (92%, 72/78), easy to use (92%, 72/78), and efficient (80%, 63/79 with completion rate < 10 minutes). Residents were most positive about the application and surgeons were least positive. All inpatient providers obtained new patient information.ConclusionsCo-creative design methodology with stakeholders was effective for informing design and development processes to leverage effective eHealth opportunities. Continuing stakeholder engagement has further fostered platform development. The platform has the potential to meet IHI Triple Aim goals. Clinical adaptation requires planning, training, and support for health care providers to adjust their practices.

How Using ANT Can Assist to Understand Key Issues for Successful e-Health Solutions

Globally in healthcare, the focus is on designing and implementing national e-health solutions in an attempt to address key challenges that are plaguing healthcare delivery. However, despite the initial euphoria and notwithstanding the significant investments made, to date, many of these e-health solutions have yet to prove their success or have been complete failures. This paper presents the findings from an exploratory study that examined e-health initiatives in five countries Australia, China, Germany, UK and US to understand why these e-health solutions have not as yet delivered the promised results. The paper proffers Actor-Network Theory (ANT) as an appropriately rich theoretical lens that can be used to assist in the understanding of key issues for successful e-health solutions.

Telehealth and Telenursing Perception and Knowledge Among University Students of Nursing in Poland

Telehealth and telenursing are becoming the new reality in studying nursing. Little is known whether undergraduate nursing students receive adequate education on telenursing for patient care. The aim for this study was to evaluate the knowledge and attitude of nursing students toward telenursing. Students of nursing faculties from medical universities in Poland were invited to complete a survey about telehealth and telenursing. The survey was conducted utilizing a Web-based surveying platform ( www.mini-ankiety.pl ). We surveyed 308 undergraduate students of nursing faculty-291 females (94%) and 17 males (6%)-from medical universities in Poland. There were 116 students in their first year (course) (38%) and 96 students each in the second and third years (31%). Most of the students (220 [71%]) in the study group were in the age range from 20 to 23 years. The accurate definition of telemedicine was identified by 251 (82%) respondents. The definition of telenursing was recognized properly by 230 (75%) respondents. Of the students, 207 (67%) would anticipate telenursing service implementation into the national healthcare system, and 214 (69.49%) would appreciate the addition of telenursing classes to the curriculum. Students from a few universities showed significantly higher willingness to introduce telenursing classes into nursing curriculum and the intention to use telenursing services in their future nursing practice. The difference among universities could be influenced by regional e-health initiatives. This study has shown the rise of trust in technology along with the increase in the year of nursing study. The current generation of university students of nursing seems to be well educated in medical informatics and technology use. They are better prepared for and open to information society membership, including the practice of telehealth. The advancement in university education has an influence on positive attitudes toward telenursing and may become a milestone in the development of e-health in Poland.

Health Care Provider Adoption of eHealth: Systematic Literature Review

BackgroundeHealth is an application of information and communication technologies across the whole range of functions that affect health. The benefits of eHealth (eg, improvement of health care operational efficiency and quality of patient care) have previously been documented in the literature. Health care providers (eg, medical doctors) are the key driving force in pushing eHealth initiatives. Without their acceptance and actual use, those eHealth benefits would be unlikely to be reaped.ObjectiveTo identify and synthesize influential factors to health care providers’ acceptance of various eHealth systems.MethodsThis systematic literature review was conducted in four steps. The first two steps facilitated the location and identification of relevant articles. The third step extracted key information from those articles including the studies’ characteristics and results. In the last step, identified factors were analyzed and grouped in accordance with the Unified Theory of Acceptance and Use of Technology (UTAUT).ResultsThis study included 93 papers that have studied health care providers’ acceptance of eHealth. From these papers, 40 factors were identified and grouped into 7 clusters: (1) health care provider characteristics, (2) medical practice characteristics, (3) voluntariness of use, (4) performance expectancy, (5) effort expectancy, (6) social influence, and (7) facilitating or inhibiting conditions.ConclusionsThe grouping results demonstrated that the UTAUT model is useful for organizing the literature but has its limitations. Due to the complex contextual dynamics of health care settings, our work suggested that there would be potential to extend theories on information technology adoption, which is of great benefit to readers interested in learning more on the topic. Practically, these findings may help health care decision makers proactively introduce interventions to encourage acceptance of eHealth and may also assist health policy makers refine relevant policies to promote the eHealth innovation.

Implementation of a successful electronic wound documentation system in rural Victoria, Australia: a subject of collaboration and community engagement

To describe the steps needed for a successful implementation of an e-health programme (the Mobile Wound Care system) in rural Victoria, Australia and to provide recommendations for future e-health initiatives. Wound care is a major burden on the health care system. Optimal wound care was found to be impeded by issues that included the limited access to health care providers, incomplete and inconsistent documentation and limited access to expert review. This study trialled the use of a shared electronic wound reporting and imaging system in combination with an expert remote wound consultation service for the management of patients with chronic and acute wounds in Gippsland. The trial sites included four rural Home and Community Health Care providers. Considerable effort was put into designing a best practice e-health care programme. There was support from managers and clinicians at regional and local levels to address an area of health care considered a priority. Various issues contributing to the successful implementation of the wound care project were identified: the training model, quality of data collected, demands associated with multiple sites across a vast geographic region, computer access, hardware and computer literacy.

Telecommunications and health information for culturally and linguistically diverse communities: A community survey

Enabling universal access to high quality health information is challenging in multicultural Australia, where low proficiency in English can hinder access to information services. eHealth initiatives may potentially facilitate better access to health information for minority cultural groups. However, the extent to which ehealth initiatives are inclusive for culturally and linguistically diverse groups remains under-explored. A community survey was conducted to explore the extent to which members of a culturally and linguistically diverse community living on a public housing estate in Melbourne?s North, and the health professionals providing local community health services, currently used telecommunications in relation to health information. The community survey findings indicated relatively low levels of access to telecommunications in homes on the housing estate and infrequent use of the Internet to access health information. Health professionals used telecommunications for some forms of communication with patients but not others. The findings of this study have implications for the accessibility of electronic health information for culturally and linguistically diverse groups.

Is there and do we need evidence on eHealth interventions?

The proliferation of information and communication technology (ICT) is transforming the healthcare, as an information-intensive sector, in a way that has never been witnessed before. The use of ICT in health or eHealth has the potential to improve the quality of health services, improve access to services and reduce cost. Huge investments in eHealth initiatives have been made by many countries based on this potential. A body of evidence is being developed to show the value of eHealth. Research and evaluation in eHealth should be comprehensive and not only limited to technology. There is a need for more research in this area using a multidisciplinary approach and teams.

Is the biggest security threat to medical information simply a lack of understanding

Connecting Australian health services and the e-health initiative is a major focus in the current health environment. Many issues are presented as key to its success including solving issues with confidentiality and privacy. However, the main problem may not be these issues in sharing information but the fact that the point of origin of such records is still relatively insecure. This paper highlights why this may be the case. Research into the security of medical information has shown that many primary healthcare providers are unable to create an environment with effective information security. Numerous factors contribute to this complex situation including a trustful environment, the resultant security culture and the capability of individual healthcare organisations. Further, the growing importance of new directions in the use of patient information is considered. This paper discusses these issues and positions them within the complex environment that is healthcare. In our current health system infrastructure, the points of origin of patient information are our most vulnerable. This entwined with progressively new uses of this information expose additional security concerns, such as re-identification of information, that require attention.

Biometrics to play wider role in e-health

Remote health monitoring solutions are increasingly combining biometric health measurements with biometric identification of patients. At the same time the advance of low cost and cloud-based platforms are making e-health devices more affordable and accessible. The US has recently implemented the Medicare 30-Day Readmission Rule, penalising hospitals that readmit patients within 30 days of discharge, further driving e-health initiatives.

Enhancing Participation in Personally Controlled Electronic Health Records

The introduction of a Personally Controlled Electronic Health Record (PCEHR) system is central to Australia's key e-Health initiatives. This comes at a time when recent research efforts world-wide, report consumer concern about the security and privacy of information accessible via the Internet. Research into possible solutions has been ongoing for decades with Anonymous Credentials recognised as a possible solution. Our study examines whether the use of Anonymous Credentials can address these concerns and enhance participation in the PCEHR system. Preliminary analysis seems to indicate that this is the case, with the sample investigated displaying high levels of concern with security and privacy issues of both the PCEHR system and web based identification as a whole. Additionally enhancement of participation in the PCEHR, by introduction of anonymous credentials is found to be supported amongst respondents.

Impacts of Electronic Government Legislation and Initiatives on Community Health and Electronic Health Literacy

The electronic information the US government provides to the public on health issues may impact how the public protects itself from large scale diseases, illnesses and chronic conditions that are both self-inflicted as well as environment-based. This paper primarily focused on analyzing past research and survey data on linking electronic health literacy to electronic government legislation and perceptions of quality, confidence, and security of information in government. The study first applies a logistic regression on 2007 HINTS survey data analyzing the level of trust in government that impacts interest and access to e-health data. The paper then describes how the US has made efforts in improving e-health literacy through various pieces of e-government and e-health (as well as non e-health) legislation. Finally, focus was on state and federal e-health initiatives: mobile health programs or resources, health information exchanges, and state and privately funded health information technology centers, RHIOs. This shows how perceptions of government and government action may impact health literacy and access to e-health information in the community going forward.

Customer Empowerment in Healthcare Organisations Through CRM 2.0: Survey Results From Brunei Tracking a Future Path in E – Health Research

IntroductionThe idea of customers' empowerment in healthcare emerged in response to the rising concern that customers or patients should be able to play a critical role in improving their own health. In traditional healthcare practices, a patient is the recipient of care as well as medical decisions. However, a paradigm shifthas taken place - that is, a change from patients who merely receive care to those who actively participate in their healthcare. This change emerged in the 1960s and has spread throughout the entire healthcare industry as a social movement characterised by the right to act based on informed choice, active participation, a self-help perspective, and full engagement in critical processes (Kieffer, 1984).Traditionally, healthcare providers have made most of the decisions on treatments. Indeed, the lack of participation of patients in healthcare processes was the main obstacle to the empowerment of patients as customers. Nevertheless, there will always be circumstances in which patients choose to hand over responsibility for decisions about their healthcare to providers due to the difficulty in selecting available options or the time needed to understand the health problem and the options. However, this does not undermine the proposition that customers' empowerment will promote efficiency and that decisions should also be made from the perspective of customers (Segal, 1998).The utilisation of information and communications technology (ICT), especially the Internet, in the healthcare sector is frequently referred to as electronic health or e-health. The main purpose of e-health is to improve healthcare management for the mutual benefit of patients and healthcare providers. One important aspect of e-health is how to manage relationships between a healthcare provider and its customers (patients) in order to create greater mutual understanding, trust, and patient involvement in decision making. Therefore, healthcare organisations are implementing Customer Relationship Management (CRM) as a strategy for managing interactions with their patients (Anshari & Almunawar, 2012). The recent Web technology (Web 2.0) facilitates customers to generate contents to accommodate both patienthealth provider and patient-patient interactions. CRM enriched with the Web 2.0 (also called CRM 2.0) provides the capability for the intensive interactions mentioned above (Anshari, Almunawar, & Low, 2012). Besides, it can be considered a technology and strategy at the same time, raising hope for the advancement of e-health initiatives around the world.The main goal of this paper is to introduce a promising future research direction which may shape the future of e-health systems. In this paper, we examine customers' expectations concerning the process of empowerment through CRM 2.0 to make customers more proficient in dealing with their own healthcare issues. A preliminary survey regarding empowerment in e-health services was conducted in Brunei Darussalam (Brunei). The Internet density in Brunei is high with over 75 percent of the population having access to the Internet, and there is a very narrow digital divide in Brunei (AITI, 2010). Internet literacy in Brunei is high, and so are people's expectations to be empowered through e-health. However, it has to be noted that the development of e-health in Brunei is still in its infancy. The future developments within the scope of e-health services in Brunei should therefore significantly focus on patients' empowerment as one of the important features required by the people. The rest of this paper is organised as follows: the following section presents the background of the study, followed by the research methodology. We then discuss the results of the study in relation to a CRM 2.0 model we propose based on this investigation.Study BackgroundMany researchers have discussed the issue of empowerment in healthcare organisations. For instance, empowerment can be analysed from the perspective of patienthealthcare provider interactions (Dijkstra, Braspenning, & Grol, 2002; Paterson, 2001; Skelton, 1997; van Dam, van der Horst, van den Borne, Ryckman, & Crebolder, 2003), or from the point of view of the patient alone (Anderson et al. …

A fuzzy taxonomy for e-Health projects

Evaluating the impact of Information Technology (IT) projects represents a problematic task for policy and decision makers aiming to define roadmaps based on previous experiences. Especially in the healthcare sector IT can support a wide range of processes and it is difficult to analyze in a comparative way the benefits and results of e-Health practices in order to define strategies and to assign priorities to potential investments. A first step towards the definition of an evaluation framework to compare e-Health initiatives consists in the definition of clusters of homogeneous projects that can be further analyzed through multiple case studies. However imprecision and subjectivity affect the classification of e-Health projects that are focused on multiple aspects of the complex healthcare system scenario. In this paper we apply a method, based on advanced cluster techniques and fuzzy theories, for validating a project taxonomy in the e-Health sector. An empirical test of the method has been performed over a set of European good practices in order to define a taxonomy for classifying e-Health projects.

Telemedicine experience in the Brazilian Amazon

Introduction: The development of telecommunication technologies and the diffusion of its eHealth applicability have enabled the implementation of a wide range of telemedicine systems, supporting clinical practices in different regions of the world. Distant and poorer areas of the globe, often characterized by difficult access and hazardous environments, are those that can most benefit from availability of remote consultations. This is due to the high costs associated with the transportation of specialized health teams and medical equipment between major cities and small villages, sometimes essential for the provision of adequate health care. Brazil is a country of continental dimensions with socioeconomic inequalities and uneven distribution of specialized health care, making it an ideal environment for establishment of eHealth initiatives. Objective: The main objectives were (1) to develop an efficient method for acquiring and delivering patient medical information in remote areas using local Internet and (2) to assist urban and Indian populations in the Brazilian Amazon presenting with skin lesions and cardiovascular diseases. Methodology: Ethical approval was granted by the research and Ethics Committees of PUCRS, Porto Alegre, Brazil. The project comprised: (1) triage and patient interview; (2) digital ECG and skin picture acquisition; (3) data management, storage and transmission; (4) delivery of expert second opinion based on development of a secure and confidential communication system between the receiving and delivering sites. Upon internet availability, the system was programmed to connect to the Microgravity Centre’s main server and to synchronise all collected data. Specialist health professionals accessed this server and the electronic patient records via a secure application installed on personal computers. Patient information, images, and exams were analysed by health specialists at the delivering site, and an opinion and treatment suggestion was offered. Cases that proved inconclusive were due to a lack of available information or the need for further laboratory exams. The opinions were secured in an encrypted PDF envelope and returned to the receiving site, where final diagnosis and treatment remained the responsibility of the local health team. Results: Telecardiology (n=98): 59 (60.2%) normal ECGs, whilst 39 (39.8%) were altered, showing arrhythmias, conductive alterations and signs of ventricular hypertrophy. No patients presented signs of acute ischemia. In teledermatology (n=110): 57 (51.8%) patients did not present any skin disease. Among the patients with dermatological problems (n=53; 48.2%), the most common diagnoses were eczema, pityriasis versicolor, tinea, onychomycosis, and superficial mycosis. In five patients, the dermatologist suspected a cancerous lesion and recommended further investigation.

A “design-pattern”-based approach for analyzing e-health business models

BackgroundWhile many e-health initiatives and projects were launched in the last couple of years, a large number of them failed or are prone to fail. These initiatives either missed to articulate a clear value proposition to patients or lacked a sustainable profit generation formula. PurposeA core problem is the difficulty to understand and express the business logic behind e-health services in today's complex environment. Therefore, it is the aim of this study to provide appropriate means to analyze and explain business logics of e-health service provisions. MethodsThe study is of ethnographic nature, since business logics were studied in their social and cultural context. Furthermore, insights were gathered from a thematic literature review on business models in the healthcare sector. ResultsBased on the “design pattern” concept applied in architecture and software engineering, three distinct examples of archetypical design solutions of successful business models are discussed. ConclusionsExplanations of the different, isolated business logics can help to increase the understanding of value creation and revenue mechanisms. Findings of this study provide e-health marketers with a tool set to develop more sustainable business models. They facilitate further research on innovation and experimentation with different business model designs.