Final Term 4 eHealth PDF

**Information Technology and Community Health** **What is eHealth** - eHealth is the use of ICT for health (World Health Organization, 2012). - On May 25, 2005, during the Fifty-Eighth World Health Assembly (WHA), a resolution was adopted by the World Health Organization (WHO) mem...

**Information Technology and Community Health** **What is eHealth** - eHealth is the use of ICT for health (World Health Organization, 2012). - On May 25, 2005, during the Fifty-Eighth World Health Assembly (WHA), a resolution was adopted by the World Health Organization (WHO) member states recognizing eHealth as then cost-effective way of using ICT in health care Services, health surveillance, health literature health education, and research (WHA, 2005) - e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. Given the extensive capabilities of ICT eHealth can be considered in any of, but not limited to, the following, - Communicating with a patient through a *teleconference*, *electronic mail* (e-mail), *short message service* (SMS). - Recording retrieving, and mining data in an *electronic medical record* (EMR) - Providing patient teachings with the aid of electronic tools such as radio, television, computers, smartphones, and tablets. **eHealth**, often confused with telehealth of telemedicine, is the overall, umbrella term According to the WHO, eHealth encompasses three main areas: - The delivery of health information for health professionals and health consumers, through the Internet and telecommunications. - Using the power of information technology (IT) and e-commerce to improve public health services, for example, through the education and training of health workers. - The use of e-commerce and e-business practices in health systems management **The 10 e\'s in \"e-health\"** 1. **Efficiency** - one of the promises of e-health is to increase efficiency in health care, thereby decreasing costs. One possible way of decreasing costs would be by avoiding duplicative or unnecessary diagnostic or therapeutic interventions, through enhanced communication possibilities between health care establishments, and through patient involvement 2. **Enhancing quality of care** - increasing efficiency involves not only reducing costs, but at the same time improving quality. E-health may enhance the quality of health care for example by allowing comparisons between different providers, involving consumers as additional power for quality assurance, and directing patient streams to the best quality providers 3. **Evidence based** - e-health interventions should be evidence-based in a sense that their effectiveness and efficiency should not be assumed but proven by rigorous scientific evaluation. Much work still has to be done in this area. 4. **Empowerment of consumers and patients** - by making the knowledge bases of medicine and personal electronic records accessible to consumers over the Internet, e-health opens new avenues for patient-centered medicine, and enables evidence-based patient choice 5. **Encouragement** of a new relationship between the patient and health professional, towards a true partnership, where decisions are made in a shared manner. 6. **Education** of physicians through online sources (continuing medical education) and consumers (health education, tailored preventive information for consumers) 7. **Enabling information** exchange and communication in a standardized way between health care establishments. 8. **Extending the scope of health care beyond its conventional boundaries**. This is meant in both a geographical sense as well as in a conceptual sense. e-health enables consumers to easily obtain health services online from global providers. These services can range from simple advice to more complex interventions or products such a pharmaceutical. 9. **Ethics** - e-health involves new forms of patient-physician interaction and poses new challenges and threats to ethical issues such as online professional practice, informed consent, privacy and equity issues. 1. **Equity** - to make health care more equitable is one of the promises of e-health, but at the same time there is a considerable threat that e-health may deepen the gap between the \"haves\" and \"have-nots\". People, who do not have the money, skills, and access to computers and networks, cannot use computers effectively. As a result, these patient patient populations (which would actually benefit the most from health information) are those who are the least likely to benefit from advances in information technology, unless political measures ensure equitable access for all. The digital divide currently runs between rural vs. urban populations, rich vs. poor, young vs. old, male vs. female people, and between neglected/rare vs. common diseases. In addition to these 10-essential e\'s, e-health should also be - easy-to-use - entertaining (no-one will use something that is boring!) and - exciting and it should definitely exist! ***Paper- based methods may bring inconvenience especially when it comes to interoperability of health services, information backup and instant data access. A number of bigger problems may also emerge:*** 1. ***Continuity and interoperability of care stops*** in the unlikely event that a record gets misplaced if the patient suffers from a chronic condition, previous findings supporting this diagnosis, drug allergies, pre-existing conditions, or even past accounts of the patient\'s previous visits may no longer be accessed unless the health providers have made several copies of the same record. The patient may also need to recount his/her condition for every transfer of care 2. ***Illegible handwriting poses misinterpretation of data***. A direct observational study of medication administration found opportunities for errors associated with incomplete or illegible prescriptions. 3. ***Patient privacy is compromised.*** Traditional, paper-based records are vulnerable to unauthorized patient viewing since there is no audit trail of the usage of the chart. The disclosure of highly private information arising from such an incident can lead to los of trust in the health facility or even legal risks 4. ***Data are difficult to aggregate.*** Manual data recording and tallying significantly delays implementation of interventions and targeted health programs. Health care monitoring is compromised as information is not readily available and up-to-date on a daily basis. 5. ***Actual time for patient care gets limited.*** Time spent by the community health worker searching for a paper-based record is time lost for actual care. **Well-managed patient information system can have the following Benefits** 1. ***Data are readily mapped, enabling more targeted interventions and feedback.*** Through a system that delivers real- time and accurate patient and community information, health care providers are able to deliver patient-centered care and targeted disease prevention and management programs. The facility and staff are also provided feedback on their performance through computer alerts, enabling them to continually comply with standard guidelines and monitor monthly, quarterly, or yearly health targets 2. ***Data can be easily retrieved and recovered.*** In the event of force majeure, retrieval of patient information is not a problem since data are automatically backed-up periodically in a secure server. 3. ***Redundancy of data is minimized***. Patient data that are frequently required in various health forms such as unique identifying information (e.g. name, birthday, age, gender) need to be recorded only once. These can be linked and organized automatically into related record types through a database, allowing a better record management and ease-of use 4. ***Data for clinical research becomes more available.*** The potential impact of health research in the country is often hindered by the lack of quality data. Whenever data is gathered, it is often not communicated to the rest of the research community Having quality data stored in databases provides faster and more reliable research outputs that may eventually be translated to health care innovations and actual interventions. 5. ***Resources are used efficiently.*** By making patient information more readily available, EMRs reduce costs related to chart pulls as well as supplies needed to maintain paper charts. Studies have also shown that having an EMR as opposed to a paper file can result in reduced transcription costs through point of care documentation and other structured documentation procedures. **Accuracy** - This ensures that documentation reflects the event as it happened. - All values should be correct and valid. - In a computerized system, a computer can be instructed to check specific fields for validity and alert the user to a potential data collection error - In electronic systems, format requirements must be followed (e.g. if date required is mm-dd-yyyy, then it should be presented as 03-24-1989). **Accessibility** - This is a data characteristic which ascertains data availability should the patient or any member of the health care staff needs it. - An example is readily available reports or statistics when needed by decision makers. **Comprehensiveness** - Data inputted should be complete. This is done by making sure that all required fields in the patient\'s record are properly filled up. **Consistency/Reliability** - Having Discrepancies in data recorded makes it consistent. This means that when John Lloyd Dela Cruz is written on the first page of the patient record, it should not be Jon Loyd Dela Cruz in the next. This potential error is reduced through error detection and alerts by the computer. **Currency** - All data must be up-to-date and timely. This is exemplified when the community health nurse records data at the point-of-care or when it happened. **Definition** - Data should be properly labelled and clearly defined. For example 36 is just an ordinary number unless it is labelled as an age of a person. **eHEALTH SITUATION IN THE PHILIPPINES** - **The developing world suffers from inadequate health care and medical services.** - Lack of health care professionals and Infrastructure contributes to this problem, making it more difficult to deliver health care to people in rural and remote communities of the developing world - The ubiquity of mobile technologies and availability of Internet services in the Philippines create a promising ground for eHealth access. - ICT has changed how Filipinos access information and how the government has utilized this to inform its citizenry. - The health sector has also begun utilizing ICT to improve its services. The DOH has introduced a number of health information systems that aim to improve the access of health data, such as the Electronic Field Health Service Information System - Online National Electronic Injury Surveillance System - The Philippine Health Atlas - Unified Health Management Information System **Factors affecting eHealth in the country** - Limited health budget, the budget allocation for health care is relatively small. This is one of the many reasons advancements in eHealth are postponed. ICT projects usually require a huge budget, take a long period to implement, and are occasionally seen as risky endeavors. - The emergence of free and open source software in eHealth, the cost of software procurement or development often takes up a huge portion of the budget. In addition, using ready-made proprietary software can be limiting at times, especially when users want to modify the software to fit their workflow better. - *Decentralized government.* Under RA 7160 or the Local Government Code of 1991, local government units (LGUS) are autonomous, and therefore in control of their own basic health services, including the budget. - Target users are unfamiliar with the technology eHealth is not only about technology. Along with software development and hardware procurement, staff training and maintenance of the system are key factors in determining its effectiveness. Recognition of the cultural aspects of community life is important in starting them off into a new direction such as computerization and automation - One possible pitfall of eHealth implementations is focusing on software development before accomplishing an assessment of the needs of health professionals in the field. - Most health center personnel are not familiar with the use of computers. Implementing an eHealth system requires training of health personnel on basic computer skills, use of software, and maintenance of the equipment. - A term coined by educator and writer Marc Prensky (2001). ***Digital native*** describes a person who grew up and is familiar with digital technologies, and who uses them in daily living. - The entry of digital native nurses into the profession and their nationwide deployment to communities may potentially aid the implementation of various ICT projects in health care - Overall, the Philippines is progressing in the use of eHealth for the benefit of its citizens **USING eHEALTH IN THE COMMUNITY** **Electronic medical records** - EMRs are basically comprehensive patient records that are stored and accessed from a computer or server. Community health centers have the capacity to rapidly adapt EMRs because they utilize a standard process nationwide. - In contrast, EMRs are more difficult to implement in hospitals because each hospital has its own set of protocols coupled with Its Own system of documentation. Even government-owned hospitals do not have a Standard system of health service provision and of maintaining patient records. - Implementing information difficulty systems in the health sector highlights the importance of creating standards - Another reason in EMRs are vital to community health centers is that each patient record is usually used more frequently. Ideally, a person can utilize health center services from womb to tomb. This ideal scenario is made more likely if each patient encounter is properly documented and the patient recording system is set up with accuracy and efficiency in mind. - Vital statistical indicators such as mortality and morbidity rates must come from reliable data, which can be derived from accurate and thorough EMRs. EMR systems also allow computerized processing of indicators, making it easier for nurses to focus on other important aspects of health care. **Telemedicine** - One of the five strategic goals of the DOH\'s National eHealth Strategic Framework for 2010-2016 is to capitalize on ICT. This in order to reach and provide better health services to geographically isolated and disadvantaged areas (GIDAs), to support disseminate MDG attainment, and to information to citizens and providers through telemedicine and mobile health (eHealth). - The WHO defines **telemedicine** as, *\"the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communications technologies for* - The exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities WHO further underscores *four elements* that are specific to telemedicine: 1. Its purpose is to provide clinical support. 2. It is intended to overcome geographical barriers, connecting users who are not in the same physical location. 3. It involves the use of various types of ICT. 4. Its goal is to improve health outcomes. - Telemedicine has the capacity to bridge the gaps in the health referral system. It is understandable that this is not a universal solution and may be applicable only in specific scenarios. The goal of a patient receiving the best care as soon as possible despite an unfavorable location or other adverse circumstances may be reached through telemedicine **ELearning** - Health education, which is essential in health promotion and maintenance, can be facilitated by 1CT. - eLearning is basically the use of electronic tools to aid in teaching. It can be done synchronously, asynchronously, or in a combination of both. This can be in the form of simple instructional videos and information text blasts to social network help groups and interactive simulations. - eLearning can be especially useful in correcting misconceptions about health and health care. It permits access to reliable information about health. For example, control of communicable diseases frequently requires community participation. - With the use of eLearning technology, community can elicit community interest by showing instructional videos on measures to control a health nurses' particular disease. **ROLES OF COMMUNITY HEALTH NURSES IN eHEALTH** - Community health nurses' roles are significantly diversified by eHealth. With the advent of eHealth, nurses are made available to several clients at a single time, making health care delivery more efficient. - Advances in IT may also help the nurse in optimizing efforts towards maintaining an open line of communication with clients, paving the way for establishing and maintaining rapport. - IT literally at the fingertips of the nurse provides greater opportunity to learn more about clients and their conditions; eHealth, however, cannot be a replacement for actual patient care. It is best viewed as a powerful tool for nurses-bridging gaps and improving access especially in a resource-constrained country like the Philippines. **Major roles of an eHealth nurse in the Philippine community setting** **Data and records manager** - Community health nurses monitor the trends of diseases through the EMR, allowing for targeted interventions for health promotion, disease prevention, curative services, or rehabilitation. Nurses also maintain the quality of data inputs in the EMRs, making sure that information is accurate, complete, consistent, correct, and current. Nurses also participate in regular data audits. **Change agent** - Nurses act as change agents by working closely implementing eHealth with them and not for them. Change agents do not force technology on the community, but inform and guide the community in selecting and applying appropriate ICT tools. - Change agents also collaborate with health leaders, policy makers, stakeholders, and other community health professionals to determine their knowledge and awareness on eHealth and appropriate ICT tools. Nurses then build on the baseline eHealth knowledge and help develop appropriate eHealth tools to the community. **Educator** - Nurses provide individuals and families through ICT tools health education to (e-g., teleconference, SMS, e-mail, and virtual/ simulated environment). - Nurses may also use scheduled text messages to patients among the catchment population to send important reminders, etc. health information, - They may also participate in making eLearning videos on specific diseases (eg., diabetes mellitus, tuberculosis), which the patients can watch during their waiting time at health centers. Such videos may also be installed in the clients personal phones (if supported) and watched at a time convenient to them. **Telepresenter** - In the event that a patient needs to be referred to a remote medical specialist through telemedicine, nurses may function as a tele presenter. This means that the nurse may need to present the patient\'s case to a remote medical specialist, noting salient for case assessment, evaluation, and treatment. This usually occurs via a teleconference. **Client advocate** - As client advocates, community health nurses must safeguard patient records, ensuring that security, confidentiality, and privacy of all patient information are being upheld. This becomes more challenging especially because with technology, transfer of information can happen instantly. - The client must also be well informed about the benefits and challenges of EMRs, telemedicine, and other eHealth tools. Nurses must ensure that personal and health information handling through eHealth (i.e., collection, storage, and transmission) is well explained. - Clients must sign an informed Consent, if necessary. Nurses must also guarantee that all eHealth interventions are performed in a safe and ethical manner making sure that the personnel in the ehealth are competent and have received ehealth training and certification **Researcher** - Using eHealth tools (e.g., EMRs), patient records can easily be retrieved and analysed retrospectively by community eHealth nurses. They are responsible for identifying possible points for research and developing a framework, based on data aggregated by the system. - An eHealth nurse researcher also pursues continuing nursing informatics education, with the goal of developing a research framework which will be beneficial to the community. ***Philippine Health Information Exchange serves the following purposes:*** - Ease the unification and integration of health data and processes across different health facilities employing disparate electronic medical record systems; - Promote interoperability by providing means for communication and coordination of electronic health data among the various health domains (i.e. disparate clinic information systems, and applications) without loss of semantics; - Increase accountability for the proper management of health information; - Harmonize and optimize eHealth processes and workflows; - Serve as reference in the development of integrated information systems - Promote the implementation and use of interoperability standards. ***PHIE aims to achieve integrated healthcare services and delivery thru:*** - Enabling secured data sharing between authorized healthcare providers and consequently, supporting protected access to clients' health data record across providers in many geographic areas of the country; - Providing a single unified view of clients' health data record across health facilities whether a hospital or clinic through an interface that is accessible anywhere and anytime; thereby, enhancing client care collaboration; - Facilitating aggregation of health data into a longitudinal electronic medical record - Generating accurate and real-time health statistical reports for monitoring and evaluation, with subsequent development of appropriate interventions, policies, and protocols. ***The PHIE is composed of six (6) interacting components, namely:*** a. **Client Registry** manages the unique identification of citizens receiving healthcare services. b. **Provider Registry** - manages the unique identification of healthcare providers. c. **Health Facility Registry** manages the unique identification of places where health services are administered. d. **Standards Terminology Service** manages the unique identification of clinical activities, standard health data sets, terminologies and formats. e. **Shared Health Record** a repository of clients records with information in the exchange. f. **Interoperability Layer** receives communication from various application systems being used by the health facilities, and orchestrates message processing.