Welcome and Introduction

1. Welcome and Introduction Dr Claudia Pagliari Senior Lecturer in Primary Care Division of Clinical and Community Health Sciences

2. Apologies

3. Aims of the half day • To pool information about ongoing eHealth research in the University • To explore opportunities for multidiciplinary collaboration • To share ideas about possible funding • To plan for the future of the Edinburgh eHealth Research Network

4. What is eHealth?

5. Relatively new concept emerging post 2000 eHealth-specific publications over time (Pagliari et al, 2004, 2005)

6. What journals do ehealth articles appear in? • Information technology in medicine: 207 (95*) • Clinical: 77 • Medical education: 3 • Finance-related: 7 • Legal: 4 • Health Services related: 61 • Others: 28 (*After excluding hits due to journal title)

7. What topics are covered in eHealth papers?

8. How is eHealth being defined? • Multiple definitions • Variable scope • Very wide e.g. “something to do with computers, people & health” • Very narrow e.g. “the healthcare industry’s component of business over the internet”

9. Content analysis of definitions • Functions – Most cover multiple medical informatics applications for facilitating management & delivery of health care (e.g. data storage & exchange, CDSS, patient-provider interaction, education, telemedicine, public health information etc). Some narrower (e.g. e-business, consumer informatics, telemedicine) Common theme = communication. • Technologies – Most specify networked digital technologies (Internet) • Stakeholders - Providers & organizations; patients & citizens; all. • Geographical focus– Single organizations -> healthcare systems -> worldwide • Conceptual breadth– Technologies; place or function of eHealth in the modern world (e.g. patient-provider roles); changes required for implementation (cultural & organisational factors), benefits

10. Working definition • “e-health is an emerging field of medical informatics, referring to the organisation and delivery of health services and information using the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a new way of working, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.” [Eysenbach, 2001, adapted]

11. The scope of research within HI/eH • People and organisational factors • individual and group behaviour of health care personnel in their interaction with information and information technologies • Health care delivery & quality factors • Facilitating clinical care and evidence based medicine e.g. decision support • Providing information & services for patients • Health outcomes & health status • Public health factors • Epidemiology, population health, public engagement • Technological factors • Systems, hardware, software, networks • Information factors • Data issues e.g. standards, nomenclature, data management, security and confidentiality • Management & policy factors • Diffusion of innovations, effectiveness & QM, change management, ethics & legislation

12. Relevant disciplines • Social sciences • psychology, sociology, social anthropology • Computer sciences • Software engineering, artificial intelligence • Health sciences • Clinical medicine, nursing, allied health care • Management sciences • Business, organizational theory, management theory

13. Multidisciplinary collaboration needed!

14. Sample projects

15. ECCI & NPfIT (SEHD) • Origins • ECCI programme/ NHSS IM&T (eHealth) Strategy • Scope • Processes /issues for programme implementation, technology adoption, perceived outcomes & barriers. Policy implications. • Methods • Key respondent interviews, measurement of implementation indicators, stakeholder surveys, participative evaluation • Key findings • Programme evolved though various stages & difficulties (human, organisational, technical) • Wide regional variations linked to existing baselines & cultures • Dependence on SCI • Gradual implementation of most deliverables, although not in original programme timescale (Pagliari et al, 2003, 2005a,b)

16. Scoping the eHealth landscape (SDO) • Origins • NHS needed a steer on R&D commissioning & eHealth policy • Methods • Traditional & innovative reviews to chart definitions, place of eHealth, issues for implementation, evidence of effectiveness • Key messages • No consensus definition of eHealth, all aspects of HI represented but increasing focus on internet technologies • Key areas:Electronic Medical Records/Systems, Telemedicine and telecare; Decision support, the Internet • Systematic reviews suggests need for more RCT evidence but experts caution that this may not always be appropriate • Areas with greatest potential: • Applications: Tools for chronic disease management; tailored patient information and personal health records; flexible consulting (e.g. email). • New technologies: Wireless Computing, Grid Computing, Broadband, DTV (Pagliari et al, 2004, 2005)

17. SCI-DC consumer informatics (DUK) • Origins • National SCI-DC system being rolled out • Previous research highlighted patient engagement issues • DARTS at centre of MCN, but no patient-focused elements • Patient empowerment through electronic tools has great potential for chronic disease management • Proposed scope • Formative R&D • Focus - information/education, decision aids, social support • Methods • Scoping – reviews, survey, focus groups etc • User-centred design & usability testing with patients and clinicians • Pilot in practice & evaluate uptake & subjective impact (Pagliari et al, 2004)

18. Text messaging for adolescent diabetes - “Sweet Talk” (DUK) • Scope • Psychosocial intervention (social support, reminders, goal setting) using text messaging, for teenagers with diabetes • Methods • RCT of TM intervention embedded within RCT of IIT • Findings • Iterative, user-centred design led to good uptake. Intervention improved patients’ self-efficacy & adherence (Franklin et al, 2003, 2005)

19. e-mail consultations (DLHCC) • Scope • Intervention - 3 email accounts - Repeat prescriptions, appointment booking, clinical queries (triaged) • RQs – GP attitudes, usage, patient satisfaction, nature of e-interactions, impact on workload • Methods • Initial GP survey, qualitative analysis of interactions, user survey • Key findings • GPs reported little e-consulting & uncertainty over legislation. Intervention had high perceived value for patients, appropriate usage, no perceptible impact on practice workload. (Neville et al., 2004 a,b)

20. Other eHealth projects Lothian Primary Care Database Project • Variations in and predictors of coding behaviour • Validity/meaning/value of codes • Large-scale intervention study to improve coding • Epidemiological studies using the high quality data • Pilot observation shows use of diagnostic codes in Lothian PC has changed in response to new GP contract. Mobile ‘phone technology for asthma • Mobile ‘phone technology for prompting self-monitoring & feeding back measurements • Attitudes to mobile technology for asthma self-monitoring & feedback, experiences of pilot (benefits/barriers etc) logistics Attitudes to records access • Public & patient attitudes. Challenges faced by ethics committees

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