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Internet and Medicine: 10 years after. From the network's perspective Marc Nyssen Medical Informatics dept. Vrije Universiteit Brussel Belgium. Internet and Medicine: 10 years after. From the network's perspective Technology Institutes Medical profession Schools/universities
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Internet and Medicine: 10 years after From the network's perspective Marc Nyssen Medical Informatics dept. Vrije Universiteit Brussel Belgium
Internet and Medicine: 10 years after From the network's perspective • Technology • Institutes • Medical profession • Schools/universities • Where do we come from? - trends • Patients • Conclusions
Internet and Medicine: 10 years after From the network's perspective What is the network 's perspective? • health sector consist of computers connected to me • hospital computers activate medical staff to produce data • general practitioners are prompted to produce messages with patient data • Pharmacists spend their spare time discussing with representatives • I produce a lot of administrative messages to keep Ministries and medical insurance institutions busy • distance education, Ehealth research and E-med-commerce
Technology • 10 years ago: first web browsers (mosaic, ...) • Internet bad reputation • Ad-hoc dial-up network services • E-mail : most widely spread and used service • Little or no encryption
Technology • Now: large connectivity fraction • Internet • Permanent connectivity not far away • Wireless: wap, bluetooth, IEEE802.11 a/b, gprsUMTS • E-mail : most widely spread and used service • Little or no encryption
Technology 10 years ago: first web browsers (mosaic, ...) • No tables • No frames • No javascript • No Java ...
Technology From static to dynamic web pages Database driven web servers Java Public key encryption XML ssh/sftp replacing telnet/ftp E-mail sender authentification required! (smtp)
Institutes • Authoritative centers • Karolinska Institute • NIH • DG Information Society Unit C4: eHealth • Medline (pubmed, medlineplus) • Several others
Institutes • Karolinska Institute • Institut Pasteur
Institutes • DG Information Society Unit C4: eHealth
Institutes • Medlineplus
Institutes Pubmed
Portal sites • Medical portals After the Internet bubble ... just a few examples • Medscape • Medwebplus • Medical Martix • Promedmail
Portal sites Medscape
Portal sites Medwebplus
Portal sites Medical matrix
Portal sites Promedmail (Jack Goodall)
Portal sites EHTO
Societies Societies
Societies Conferences
Publications Journals • IEEE TITB (2003-) • Electronic Healthcare (2001-)
Publications Journals
Publications • On-line
Publications pubmed searches on “Internet AND medicine”
Ethics • HON (Healtcare On the Net) http://www.hon.ch • Internet Healtcare Coalition http://www.ihealthcoalition.org
Ethics • HON code of ethics • Authority, complementarity, confidentiality, attribution, justifiability, transparancy of authorship, transparancy of sponsorship, honesty inadvertising • Ehealth Code of Ethics • Candor, honesty, quality, informed consent, privacy, professionalism, responsible partnering, accountability
Medical profession • General Practitionner • Hospitals • Specialists • Para-medics • From “cards” to servers • Large nationwide projects
Medical profession General Practitionner • Electronic health record • Medication databases • Communication of lab results • Communication with GP's (group practice/guard) • Communication with hospitals • Communication with specialists
Medical profession Hospitals • patient “administration” • communication with health insurance bodies • technology oriented departments • local network(s) • communication with referring GP's • communication with patients??? • teamwork: who can access what?
Medical profession Specialists • Very different needs • Common: “patient administration” • Financial administration + reporting • Mini-clinics and group practices
Medical profession Para-medics, health workers “at large” • Tele-follow-up of patients • Access to at least part of medical record • Nursing record • Physical therapist's record
Medical profession From “cards” to servers? • Social security card (national, European) • Diabetes card • Minimal health record -> summary health record • Big brother : example in Spain • Centralized vs. distributed health records
Medical profession Nationwide projects (amongst many others) • Denmark: electronic prescription • Belgium: • “kruispuntbank sociale zekerheid” • Electronic passport • Telematics commission – labeling of her • UK: masterplan for NHS
Medical profession Nationwide projects (amongst many others) • Hygeia Crete
Medical profession Nationwide projects (amongst many others) • Keneya Blown (vestibule de la santė) Mali
Schools/universities • E-learning • Computer literacy • E-health programs • Master after master “management of health data” • Need for an European master program in eHealth?
Standards bodies • Internet Society (IETF) • WWW Consortium • CEN • HL7 • IEEE
Where do we come from?Where do we go to? Trends... • Basic connectivity • New protocols? • New models? • Client-server • Peer-to-peer • Distributed systems • Huge parallelism (grid?)
Patients/public Finally widely available to the public at large • Remote diagnosis • New medication announcements • Distance pharmacy • Distance education/certification • Accurate medical information and councelling
Patients/public Useful health tricks
Patients/public Distance pharmacy
Patients/public New medication:
Patients/public Distance education/certification: effortless diploma
Patients/public Finally widely available to the public at large missing: “super portal” combining all of these!
Patients/public Informative sites: patients are most concerned!
Conclusions • Medical Internet applications become established • Most required technologies are available • Diversity of medical systems • Quality labels and interoperability • Privacy • Few completely new ideas • Complex application “standards” • Missing level between research and deployment • Political drive exists but for the right motives?
References • Resource Book of IST Projects relating to Health (September 2002 Edition), Directorate B, Unit B1, European Commission , Information Society Directorate General • E-Health in Belgium and in the Netherlands, Proceedings of MIC2002, Roger France, Hasman, De Clercq, De Moor eds., IOS Press, ISBN 1 58603 313 1 • Information and Communication Technologies and Poverty Reduction in Sub Saharan Africa, Richard Gerster, Sonja Zimmermann, Gerster Consulting, October 2003 • Yearbook of Medical Informatics 2003, IMIA & Schattauer GmbH, ISBN 3-7945-2263-X • Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions, Eysenbach G, Powell J, Englesakis M, Rizo C, Stern A. BMJ. 2004 May 15;328 • Ethical challenges of medicine and health on the Internet: a review, Dyer KA., J Med Internet Res. 2001 Apr-Jun;3(2)