e-health Present and future

1. e-healthPresent and future Ramona Mayer EBG MedAustron GmbH, Wiener Neustadt, Austria

2. eHealth . . . "eHealth is the single-most important revolution in healthcare since the advent of modern medicine, vaccines, or even public health measures like sanitation and clean water” Silber D. The case for eHealth. (Presented at the European Commission's first high-level conference on eHealth May 22/23 2003.) European Institute of Public Administration 2003.

3. From medical informatics to eHealth Classical Medical Informatics – stand alone era (1970+) Health Telematics – early telecom days (1985+) eHealth – Web era (1995+) Pervasive and ubiquitous eHealth - ambient intelligence era (2005+)

4. From medical informatics to eHealth Classical Medical Informatics – stand alone era (1970+) • Systems for the storage, retrieval, sharing and optimal use of biomedical data, information and knowledge Health Telematics – early telecom days (1985+) • Regional health care networks • Remote diagnosis and telemedicine applications • Decision Support Systems

5. From medical informatics to eHealth eHealth – Web era (1995+) • Internet based applications and services • Medical content for prevision • Intranets for health service management Pervasive and ubiquitous eHealth - ambient intelligence era (2005+) • Health knowledge infrastructure • Wearable and implantable systems • Biomedical informatics for personalized health • Health GRIDs

6. mHealth Electronic Medical Records eHealth eCardiology Telemedicine eRadiology Consumer Health Informatics Virtual healthcare teams Health knowledge management

7. „eHealth“… eHealth encompasses a range of services that are at the edge of medicine/healthcare and information technology e-health encompasses much of medical informatics, but has to prioritise the delivery of clinical information, care and services rather than the functions of technologies No development of basic technology, but development of beneficial applications for patients physicians care facilities health care insurance companies etc

8. EC definition of eHealth “….the use of modern information and communication technologies to meet needs of citizens, patients, healthcare professionals, healthcare providers, as well as policy makers" http://europa.eu/

9. WHO definition of eHealth "eHealth is the cost-effective and secure use of information and communications technologies in support of health and health-related fields, • including health-care services • health surveillance • health literature • health education, knowledge and research" (World Health Organization , Ninth plenary meeting, 25 May 2005 - Committee A, seventh report)

10. 5 Steps of eHealth Electronic diabetes diary

11. Steps of eHealth… • Step 1 - Information • Providing information for patients or doctors e.g. via the web (information in one direction), Medical databases like PUB MED • Step 2 - Communication (action) • The exchange of information between two people involved (patient - doctor, doctor - doctor...) without direct and current reaction of the communication partner (e.g. on-line diabetes diary) • Step 3 - Interaction (action + reaction) • Exchange of information or dates between people involved with immediate reaction of the communication partner (e.g. telemonitoring, telesurgery…)

12. Steps of eHealth… • Step 4 - Transaction • Electronic handling of a complete (treatment)process (“All or nothing”) • Step 5 - Integration (e.g. Electronic health record - EHR) • Electronic health biography – central documentation for all health relevant data from birth to death

13. Step 1 – Information • Providing information for patients or doctors • e.g. via the web • (information in one direction) DIAB-MEMORY

14. Step 1 – Information • Provider of the information • Publishing companies, authors • Provider of medico technical equipment • Pharmaceutical companies • Health insurance companies • Physicians and health care professionals • … • Information medium • Print media • CD, DVD, … • Computer network / Internet • Recipients • Physicians • Patients • Family members • …

15. Step 1 – Information • Physicians • Medical literature • http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db= PubMed • Medical database (z.B. Drug informaton systems) • http://www.druginfosys.com /… • Patients • Health advisor • http://www.netdoktor.at/ • Dictionary of medical terms • http://www.medterms.com/ • …

16. Step 1 – Information Health on the Web • Estimated ~ 20,000 health websites • Used by 98 million adults • 75% of people who have web access • Average of 3.3 times per month • More than consult doctors each day

17. Step 1 – Information Health on the Web Pro • Correct information • can lead to more knowledgeable and less anxious patients • more participatory health decisions Con • Misinformation • can lead to confused patients • Bad decisions, false hope, harm

18. Step 2 – Communication • Communication = Action • The exchange of information between two people involved • (patient - doctor, doctor - doctor...) • without direct reaction of the communication partner • (e.g. online diabetes diary) Electronic diabetes diary

19. Step 2 – Communication Online diabetes diary Diabetes-diary allows • to document the blood glucose values • enables the physician to access the data • adjust the insulin dosage accordinglyThe patient can • communicate with the physician online • save time and unnecessary office visits. from: http://www.diabetes-diary.com/

20. Step 2 – Communication Online diabetes diary

21. Step 2 – Communication Online diabetes diary From: http://www.diabetestagebuch.de/

22. Step 3 - Interaction • Interaction = action + reaction • Exchange of information or data with immediate reaction of the communication partner (e.g. telemonitoring,…) Electronic diabetes diary

23. Step 3 - Interaction Telemedicine Most useful when • Specialist services are in very high demand • or patients are extremely isolated ( Antarctica or remote communities in Australia, Africa and Alaska) Telemedicine encompasses any medical activity involving an element of distance (R. Wootton)

24. Step 3 - Interaction Telemedicine • Online versus store-and-forward • Functional • Telecardiologye • Teleradiology • Telesurgery • Teledermatology • Telecare (homecare) • Action • Telemonitoring • Second opinion • Telediagnosis • etc… • Multimedia (Text, Audio, Image, Video, Augmented Reality)

25. Step 3 - Interaction Telemedicine 1. Live telemedicine via videoconference 2. Store-and-forward telemedicine – transmit for assessment offline • Typical telemedicine interaction: store and forward followed by live interaction Data types • Text ( e.g. patient's notes) • Images (e.g. x-ray, CT, etc) ( Telemedicine often relies on images)

26. Step 3 - Interaction Telemonitoring Schaubildtitel 2. CardioMessenger sends a SMS daily and additionally in the case of an event Schaubildtitel 1. Patient with an implant with home monitoring function 4. Physician with secure internet access 3. Automatic data processing at the service centre www.biotronik.com

27. Step 3 - Interaction Teleradiology Quelle: http://www.chili-radiology.com/

28. Step 4 - Transaction • Transaction • Electronic handling • of a complete (treatment)process • (“All or nothing”) Electronic diabetes diary

29. Step 4 – InteractionElectronic health card • For example : Austria • Rollout until end of 2005 • Electronic handling of a complete (treatment)process Includes: • On the reverse side = EHIC - European Health Insurance Card • Digital signature • At present the ecard cannot be used at: • Private medical practice • Other contractual partners (e.g. optician, midwife, …)

30. Step 4 – InteractionElectronic health card } Patient record Physician letter Health care provider index Work in progress e-medication √ Administrative data EHIC - European Health Insurance Card

31. Step 5 - Integration Electronic health biography = central documentation for all health relevant data from birth to death Electronic diabetes diary

32. Step 5 - Integration • Central data repository or • Local data repositories + central index • Case record (e.g. under discussion in Germany) or • Live long electronic health record Any combination is under discussion in countries across Europe!!

33. E-health in different environmentsfor example: General HospitalIon beam facility eHealth on the EU-level

34. eHealth in a general hospital Administration • Billing • Hospital information system (HIS) • Procurement • Logistic Medical data • Radiological images and findings • Lab- Information System • Discharge letter • Teleconference • etc… Step 1 - 3

35. Clinicians are very busy and under constant pressure to perform ! They will NOT change their behaviour, unless the new workflow is clearly more efficient on a personal and individual level ! Sulivan2002; Holzinger & Errath 2004

36. Usability ….. For an interface to be a success it must provide • the right functionality • at the right place • at the right time • and in the right form from the user's point of view! Holzinger 2000

38. E-health in different environmentsfor example: General HospitalIon beam facility eHealth on the EU-level

39. Concrete project: Platform for the planned co-operation between the Ion beam Research and Treatment centre MedAustron in Wiener Neustadt, Austria and Hungarian hospitals

41. MedAustron eHealth services • Provided services • Accept patient information • Accept medical findings • Accept radiological images and findings • Provide RT planning information • Dose information • Plan details • Provide medical reports

42. Scenario I Patient referral withoutpre-irradiation Possible data inputfrom referring hospital Available data output from MedAustron • Patient base data • Medical relevant data • Histological data • Surgical report • Other findings • CT/MRI/PET-CT/US • RT planning documents • Applied dose • Medical report

43. Teleconference

44. Scenario II Patient referral withpre-irradiation Possible data inputfrom referring hospital Available data output from MedAustron • Patient base data • Medical relevant data • Histological data • Surgical report • Other findings • CT/MRI/PET-CT/US • RT plan + applied dose • RT planning documents • Applied dose • Sum dose • Medical report

45. Scenario III Patient referral withpre-irradiation Step 5 Possible data inputfrom referring hospital Available data output from MedAustron • Patient base data • Medical relevant data • Histological data • Surgical report • Other findings • CT/MRI/PET-CT/US • RT plan + applied dose • RT planning documents • Applied dose • Sum dose • Medical report 1 2 Electronic Health Record 4 3

46. E-health in different environmentsfor example: General HospitalIon beam facility eHealth on the EU-level

47. eHealth for RegionsA network for transnational co-operation Aim • Support of an innovative process by building a platform for the exchange and generation of ideas for co-operation • Provision of experiences and knowledge about the specific challenges of transnational collaboration in the field of eHealth among the network partners • Finally the co-operation should be run by the partner themselves!

48. eHealth for RegionsCo-operation fields and pilots (examples) Personal information medical sticks • Developed for patients with chronic diseases, who are often travelling in European neighbouring countries on business or vacancies Objectives • To improve the cross-border medical service, esp. for travelling pts. with chronic diseases • To support physicians with information treating foreign patients • To omit unnecessary examinations of patients USB sticks are prepared with structured medical information based on the European emergency health card Partners: Denmark, Finland, Germany, Lithuania, Norway, Poland, Sweden Step 1

49. eHealth for RegionsCo-operation fields and pilots (examples) • Ferries with Tele ECG at the Baltic Sea Objectives • A better health care support for travelling citizen • to reduce time from symptoms to treatment TT Line transports 2000 to 4000 passengers every day between Trelleborg (Sweden) and Travemünde or Rostock (Germany) • First aids room equipped with a transtelephonic ECG recorder • ECG transmitted to multilingual server of telemedicine centre in Bad Segenberg (Germany) routed from there to co-operating cardiac centres in a readable format Step 2

50. Summary : eHealth = „ … in a broader sense, 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 G. What is e-health? J Med Internet Res 2001;3(2):e20, adapted by Pagliari et al. 2005