Lectures eHealth 2024 - Lecture 1 16-04- E-health: the intersection of medical informatics, public - Studeersnel (2024)

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E-Health (EBM204A05)

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Rijksuniversiteit Groningen

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Lecture 1 16-04-E-health: the intersection of medical informatics, public health andbusiness, referring to health services and info delivered or enhancedthrough the internet and related technologies.  Main aim is to improve healthcare  Has big impact on different groups in society o Citizens o Professionals in research and practice o Hospitals, academia and public health o Helath-related businesses o governmentsCommon practices: - Mhealth or mobile health (monitor and manage) - Telehealth or telemedicine (interaction with a professional) - Technology (applied technology systems)Diseases commonly treated with eHealth: - Menthal issues - Cancers - Problems with food - diabetisConceptual model of eHealth:Health in our hands  personal, accessible, empowering, integrated indaily settings, selfgenerated health goalsInteracting for health  Bridge temporal and geographical limits, time-saver, remote care, early triageData enabling health  Safer, higher quality, prediciting & preventingdiseases, data-driven careDigitization of healthcare: Positive Negative Care quality Difficulty – adoption and impementation of IS Prevent medical errors Integration of different IS Improve clinical communication Health information exchange

technical issuesStreamline care coordination High costs  implementation andmaintenanceAutomate care process Data securityConnect providers privacyCost saverThe building blocks of eHealth are:Scoping ehealth in EU regionHealth information system reforms (riding the eHealth wave):

• Countries build on their national foundations for eHealth to deliverpublic health and healthcare services
• Global understanding of the role of eHealth to achieve universalhealth coverage
• Recognize the need for eHealth natinal policies, strategies andgovernance
• Need for a coordinated appproach to plan, implement, evaluate, andsustain eHealth59% of EU countries have national HER systems, funding is the mostimportant barrier to HER system implementation.Estonina was the first country to implement HERSocial media is used by people to learn about health. Is this only positive? No, false information for example.Also there is the use of Virtual health communities/platforms  globalconversations on health  connecting patientsFor countries to take steps to:
• Strengthen their exisiting national eHealth foundations
• Accelerate activities for future development and adoption of eHealthRecommendations are:
• Political commitment
• Dedicated national eHealth strategies
• Legislation of HER
• Guidance on national telehelth implementation

specialist availiable at any time tech enought to know if it can benefit or be dangerous in healthcareLecture 2 – 23-04-Design, development and implementationNPfT failure because:

• Overambitious design
• Initiative was not trusted by doctors
• Project marred by resistance
• Inappropriateness of a centralized authority making top-downdecisions
• Lacks adequate end user engagementImportance of design processDesigners do have some blind spots  like context. Even if they are verynicely designedDifferent design approaches
• Human centered design
• Design thinkingo Key element in both is that they start with the user.o Stepwise and interactive
• Ideas framework  person centeredALT promise: improve quality and length of life, relieve pressure onincreasingly stretched health and .... Key misfit  deign x medical condition x need x ability to use theALT (what do they need and are capable of)ARCHIE framework (article 5) helps guide designers of technologies. The 6principles were mentioned in lecture. Even if eHealth proved to be user centered, the design still has to fitin a whole ecosystem/context in order to be successful andimpactful!Holistic framework (CeHRes roadmap)  combines the overall process. Context and stakeholders are important. Difficulties to realize eHealth in practice:o Investorso Healthcare systemso Stakeholders (patients, caregivers, healthcare, providers)o End-user needs (patient wishes, habits, rituals, what mattersto them?)o Financing, resources

eHealth implementation - Design should go hand in hand with implementation  how do you get the innovation to work - Implementation is influenced by many factors - To be successful you need to deal with: o Resources o Ethical concerns o Governance o eSkills o Healthcare has certain challenges itself  eHealth can be disruptive to the norm of practicing healthcare o What works in one context does not have to work in a different contextHow to implement?  A set of planned, intentional activities that aim to ,,,,,,,NASSS framework very fitting to eHealth, can be used in assignment 2Lecture takeaways: - The process of Design, Development, and Implementation of eHealth technologies is continuous and iterative. - Things change over time - what is valuable to a patient today is not tomorrow - eHealth technologies evolve into action and so do Business Models (not static) - Always think eHealth technology = What Value? - Contextual Inquiry, Stakeholders’ involvement, Implementation Plans, and continuous Evaluation are key aspects of eHealth technology uptake

AI enhanced interventions for older people receiving long-termcare servicesParadox: eHealth promises/solutions but still thereare issues with evaluation. Sometimes very usefulbut how to measure impact of solutions is hard  Greenhalfh & Russels: When researchesr measure eHealth interventions  more quantitative/factual, but some more textual analysis may be needed. Ask user at personal level how they feel and if they accept the solution. o More methodology is used and improved o Rigor is needed  Evaluation of problems are Savafi et al  Digital health solutions and to see the impact of high burden conditions o When looked at the study, only 28 % evaluated the effect of eHealth. There are many DHS, but the effect is not much studied. Only 8 studies evaluated clinical effectiveness (patient outcomes) in high burden/risk factor population o Digital health products have the potential to help manage high-burden populations that account for the most morbidity, mortality, and cost in the US health care system.How to evaluate? - Need standardized and validated tools for evaluation - Tools provide a systematic and comprehensive approach to evaluation and makes it easier to compare - Context/reality/alternative approaches? (=new approach)

Paradigms of eHealth evaluation  2 schools of thought - Positivistic: objective measurement of external reality, surveys/experiments/empirical measurements - Interpretivist: socially constructed reality  more upcoming and related to recent literature. o Critical: power relationships and interest  Thinks understanding of context, reality is not objective. It is embedded in reality/social practice. Done with interviews/focus groupsPositivistic evaluation of eHealth:Critical-interpretivist evaluation of eHealthBalance between scientific and alternative approaches to evaluation ofeHealth?  Should be there, numbers are needed but user feedback is very importantKhoja-Durrani-Scott framework

Ethical concerns in eHealthEthics: norms of conduct that distinguish between acceptable andunacceptable behaviorMedical internet ethics: an emerging interdisciplinary field that considersthe implications of medical knowledge utilized via the Internet, andattempts to determine the ethical guidelines under which ethicalparticipants will practice online medicine or therapy, conduct onlineresearch, engage in medical e-commerce, and contribute to medicalwebsitesKey ethical concerns in eHealth: - Privacy, confidentiality, and security of patient data - Accountability - Effectiveness of patient empowerment - Quality of health information - Equality of access (equity)  different parts of the world - Patient-provider relationship - TrustJokinen et al  Analyses analytical issues to eHealth from user perspectiveLecture takeaways:✓ Evaluation is a critical part of eHealth

✓ Paradox of promised benefits of eHealth vs. reality/impact!✓ Various approaches for evaluation (What are we measuring, aim,objective / subjective?)✓ Methodological rigor is needed for evaluation of eHealth✓ Outcomes change over time, evaluation is an ongoing process✓ eHealth has its own ethical issues