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e-Health : An overview

Mrs. Anagha Joshi

Mrs. Anagha Joshi

e-Health is a wide and fast-growing field with many implications on how healthcare will be delivered in the future. Now, medical knowledge is an eagerly sought public commodity on the Internet. It seeks to explore ways to use emerging technologies to improve the health and well being of all people, including the underserved. e-Health is the use of emerging technologies, especially the Internet, to improve or enable health and healthcare.

The Internet is a tool; e-Health is the health-related industry made possible by this tool. Four key ways to categorize the many products and services in the e-health industry are: Content, Commerce, Connectivity and Care. This industry also needs to accept and overcome some specific challenges like Access, Research, Security, Privacy/Confidentiality etc.The goal of the code is to help, create a trustworthy environment for all users. Because of the ever increasing consumer demand for information and expectations to get that information is perhaps the single largest driver of the e- health industry. India is being consider as the potential user of this system because of its huge population and increasing literacy level.

Mission

It seeks to explore ways to use emerging technologies to improve the health and well being of all people, including the underserved. It develops initiatives to:

Enhance the capacity of people to access and utilize eHealth resources,

Improve the state of knowledge and public understanding of eHealth-related issues, and

Improve the quality and effectiveness of eHealth resources.

Why?

e-Health is the use of emerging technologies, especially the Internet, to improve or enable health and healthcare. E-Health resources can help:

Improve health status by supporting healthy lifestyles, improving health decisions, and enhancing health care quality;

Reduce health care costs by improving efficiencies in the healthcare system and prevention;

Empower people to take greater control of their health by supporting better-informed health decisions and self-care;

Enhance clinical care and public health services by facilitating health professional practice and communication; and

Reduce health disparities by applying new approaches to improve the health of underserved populations.

Ensuring access to and quality of E-Health resources will be central to realizing and maintaining health in the future. This paper provides an introduction to e-health, outlines its four main categories, comments on challenges involved in moving an organization towards a higher level of involvement in e-health, and gives practical advice on gaining a positive return-on-investment (ROI) with e-health opportunities.

Terminology

e-health: The use of electronic technologies for exchanges of communication, interaction and decision-support regarding health. This includes activities between providers, payers, regulators, communities, individual consumers and suppliers.

Internet: A global public network that facilitates communication and knowledge sharing on an electronic platform using the http protocol.

Intranet: A private network facilitating communication and knowledgesharing within an organization.

Extranet: A shared network connecting an organization to its business partners, vendors and suppliers, enabling users to communicate and to exchange information securely.[2]

e-Health Content: An electronic provision of health information.

e-Health Commerce: Products and services researched and paid for online.

e-Health Connectivity: Refers to Internet-based products and services that link the various participants in the health care marketplace.

e-Health Care: Using Internet capabilities to extend the clinical capabilities and outreach of health care providers.

B2C: Exchange between business and consumers (also referred to as B-to-C).

B2B: Exchange between business and business (also referred to as B-to-B).

e-Health Security: The technical issues of the security of electronic personal health-related information (or data) against unwanted access.

e-Health Confidentiality: Refers to who is authorized to access personal health-related information.

e-Health Ownership: Refers to who owns personal health-related electronic information and under what authority that information can be released or distributed.

e-Health Driving Forces:-

e-Health Driving Forces Chart

Employers

Employers continue to be a significant force in the health marketplace. Scrutiny over premiums drives competing health plan prices closer together and forces differentiation by service. Health care administrative overhead costs are assuming one of the largest shares of product cost, driving employers to seek new and innovative approaches to administrative efficiency and improved quality comparisons. Employers are engaged more and more in the cost and quality review in health care.

Employees are pressuring employers to offer more options for their health care, and to have a means by which to compare alternatives. This is driving a need for reliable and standardized quality comparison indicators.The Internet can provide a medium from which to satisfy this need for cost and quality information and differentiate progressive from less-progressive health care organizations.

Engaged Consumers

Many of today’s health consumers are Internet-savvy and are demanding that more of their service needs be available via the Internet. According to the American Hospital Associations Health Forum, consumers are willing to pay more for it too. For example, nearly three-fourths of e-health consumers want disease and treatment information, physician and hospital report cards and online interaction with providers. Thirty-four percent said they would pay more to manage their benefits online and twentyfive percent said they would switch plans to be able to do it.

One reason for the increasing level of consumer involvement in health care decision-making is that consumers now assume a greater share of the total economic burden for health care costs. It was predicted that the US average per capita disposable income will increase at annual growth rate of only 1.5% by 2005 where as total consumer health care cost(out of pocket +insurance premiums) will increase to 7.3%,almosy 5 times the rate of growth of the disposable incomes. This increase may be due, in part, to the increase in the popularity of defined contribution programs among employers.

e-health Consumers Want On-line Information from Traditional Health Care Players Yet there is Minimal Usage or Awareness

e-health Consumers Want On-line Information

Empowered Consumers

If spending more of their own money has caused customers to pay more attention to health care, then the Internet has given them a vehicle with which to express their newfound interest. Consumers are finding that the Internet provides access to data they need in an environment that is anonymous and easy to use. Online health information-seekers are in fact growing twice as fast as the entire online population. Cyber Dialogue estimates that by 2005, over 88.5 million adults will use the Internet to find health information.  The evolutions timing will likely be a function of both consumer demand and the ability of health care organizations to respond. Self-reliance and empowerment embody the emerging e-health consumer. The Institute for the Future predicts the percentage of U.S. adults who are college-educated, computer literate and have increased levels of disposable income will go from approximately 25% in 1978 to over 50% in 2005. As our survey of members of the Network for Healthcare Management shows, the level of e-health business penetration varies greatly

Health System Reaction

There were 20,000 to 25,000 health sites on the Internet in September 2000,[10] and 36.7 million E-health consumers searched the Internet for health information during the second quarter of 2000.

Managed Care Organizations (MCOs) offer Information on Links to other Health sites, Member service news, Formulary, Medical/Admin Policies, Benefits, and Clinical Guidelines etc.

Costs vary throughout the e-health marketplace. Initially, average Web site start-up costs for basic content were over $20,000, with at least that amount spent again since going live, according to the Managed Care Information Centers recent poll of MCOs.

It is clear today that content is not enough and costs can grow exponentially beyond these initial

content site costs. Our experience with net work members shows normal operating costs for a medium- sized health system with innovative content, commerce and beginning care offerings can exceed over $1 million a year.

Health care institutions are clearly facing smaller profit margins than in the past decade. So it is time to introduce new health care services which are yet unseen in traditional bricks and mortar world of health care.This is the right time to grab the opportunity for the development and growth of this business.

 Four key ways to categorize the many products and services in the e-health industry are:

-Content,

-Commerce,

-Connectivity and

-Care.

Each is outlined more fully in the sections that follow.

Content:

e-health content is an electronic exchange of health information.

Health information content is the primary offering of most health organizations Web sites. Consumers use e-health for   convenience (relative to other sources of health information), currency (versus non-online sources), availability (compared to asking your doctor, for example) and anonymity.

Use

An example would be a consumer receiving an e-mail a week on updated information on diet and nutition. Contextual linking refers to providing         related information on the Web page screen

along with the requested information. A patient looking    at one disease issue may find, as they float from page to page, links to related topics or assessment programs that they may not have thought about before.

Also the web sites offer administrative linkages to appointment systems, lab results, and claims management.

Commerce:

e-health commerce refers to products and services researched and paid for online.

On the business-to-consumer (B2C) side, estimates for online health commerce and advertising by 2004 will amount to over $11 billion per year ñ a small fraction of the estimated total e-health market valuation of $300 billion.

A survey of 1,800 Internet users, found that people seeking health information on the Web are more likely to seek products and medical care for their health issues. Health care business-to-business (B2B) will rise to over $348 billion a year by 2004. It is estimated that less than 5% of supplier business is currently conducted electronically The Internet will enable even more consolidation of purchasing power. Whether linking to the purchasing habits of customers or suppliers, the Internet will significantly change current product exchange relationships.

Use

B2C offerings are likely to be medications, medical equipment/supplies and non-prescription health products.The initial e-commerce wave was consumers purchasing vitamins, supplements, and other personal health products. Prescription purchasing has been slower to start due to insurance, legal and reimbursement issues.[11] For early success, the key at this time in the market appears to be commerce offerings that are reliable (and easy) user interfaces and link to appropriate reimbursement and traditional retail locations.

B2B purchasing is currently comprised of primarily the supply/procurement of medical supplies, lab supplies, specialty medical products, life sciences supplies and bulk purchase of pharmaceutical supplies

Connectivity:

e-health connectivity refers to Internet-based products and services that link the various participants in the health care marketplace.

It took television 26 years to achieve mass penetration; the Internet has reached mass penetration in just seven years.[4] Consumers are ready for virtual linking to their health care needs. A report on e-health connectivity recently published by Cap Gemini Ernst and Young

identifies four connectivity opportunity areas:

      1)Patient and consumer services -integration of all consumer health-related needs.

      2)Clinician-focused services ñ integration of clinical, business, and research/education  needs of clinicians.

      3)Business and trading partnerships ñ connected web of supplier and payor relationships that support provider and consumer communities and internal operations seamlessly.

      4)Employer/Employee support ñ seamless access to internal information, processes and  knowledge management.

Uses

The majority of health Web sites offering connectivity use it for streamlining, administrative functions (such as claims processing and managing referrals) and for links to other health sites, provider directories, maps and directions, and customer service e-mail. The more progressive sites are offering other functions, such as online enrollment, ID card changes and new card generation, claims status checks, referral information, clinical guidelines and so forth.

Care:

 e-health care is using Internet capabilities to extend the clinical capabilities and outreach of health care providers.

The Internet holds tremendous potential for effectively providing care at the point of service and optimizing quality of care for individuals. Unfortunately, developments in e-health have had high levels of acceptability up to the point where personal information is exchanged for the purposes of direct personalized care. Despite predictions of a dramatic leap in the near term to online cords and virtual care, significant barriers exist.

Because e-health direct patient care implies contextual, patient-specific and condition-specific care, the patient 8 Seek secure and structured communication between providers and patients.

Trust is a fundamental concern in ehealth. Indeed, it is fundamental to health care. To receive the care they need, patients must share private information and be willing to take medications, use medical devices, or often accept interventions that intrude on their bodies. They rely on health care providers to keep their personal information confidential, to provide accurate and appropriate information about their conditions and possible treatments, and to recommend the therapy they believe to be in the patient's interest.

But trust can be particularly difficult to sustain in the anonymous, virtual environment of the Internet and World Wide Web. Anyone, anywhere, who has access to a computer, a link to the Internet, and modest technical skill is able to set up a web page offering health information, products, or services, regardless of his or her qualifications. And anyone, anywhere is able to present him- or herself as a patient-whether to a health care professional or to an online patient community-whatever his or her actual health status

Virtual health management applications of the future, however, show increasing promise to provide enough privacy protection and efficiency for the consumer and provider to encourage mass participation. Fueling this are: a growing sense of anonymity among users coupled with ever-improving privacy protection measures; existing disease management companies moving their wares online; and the movement online of popular drug compliance programs.

The e-Health Code of Ethics

The goal of the code is to help create a trustworthy environment for all users, whether they are patients, health care professionals, website sponsors, people who develop health applications and content for the Web or individuals who turn to the Internet to help them stay well.

Fundamental values

Respect for persons

Candor & Honesty

Quality

Informed Consent

Privacy & Data Security

Professionalism in Online Health Care

Responsible Partnering

{mospagebreak title=e-health for the future}

e-Health For the Future

E-Health is likely to change delivery of medical and social care beyond all recognition. The technology is developing at a staggering pace and there will be developments we have not yet even dreamt of. Over the next few years, as eHealth is deployed more widely, one of the main challenges will be to manage the change that this will cause. There will be new ways of working which will cut across traditional boundaries. The boundaries between primary, secondary and social care will become blurred and eventually disappear. Medical and nursing staff will collaborate in new ways, with areas of responsibility being redefined.

There will be need to train and retrain staff on an ongoing basis. Some staff will need to relocate as, for example, some hospital departments become smaller and more care is delivered in the community. The days of paper based medical records and X-rays being on film are numbered. Staff in Medical Records departments are more likely to be running quality control programmes on electronic records than hunting for missing notes. A major change will be the increase in community based care, driven in part by the need to support an increasingly ageing population. The aged are large users of medical care. Most wish to remain at home rather than be in an institutional setting and e-Health will assist in this. E-Health can enable a patient's home to become a virtual hospital ward. Vital signs can be transmitted to monitoring centers, which can detect possible problems. A nurse, based in the monitoring centre could be available 24 hours a day to provide reassurance and advice. A GP or specialist could be contacted if there are signs causing concern. The need for hospital or nursing home care can therefore be minimized.

Electronic records will be developed in a way that makes them accessible, to those authorised to see them, at any time, from any location. Our medical history could also be stored in our multi-purpose "credit card". Integration of interactive digital television, computers and the Internet is likely to change how we access medical care. We will expect quality medical information to be available round the clock, from the comfort of our own home. How will the NHS adapt to this demand? Will patients with long-term health problems feed information from portable monitors into a medical channel at home, rather than visit a hospital clinic? Will facilities exist to allow us to use the home system to call up a relative who is in hospital and undertake routine virtual visits, to see someone who may be too far away to permit a face to face visit?

Developments in portable telephones will mean that mobile video telephony becomes routine. Such technology has obvious applications for delivery of health and social care. Work is ongoing into incorporating health-monitoring devices into clothing. Link these to your videophone and no matter where you are, you could gain access to high quality medical advice. There will be considerable challenges posed by developments outlined above and by many others. The globalization of communications will require standards to be developed to permit international e-Health services. Issues such as data protection, legal status and licensing will require international agreements. For the individual and the state development of new services will pose challenges, but will also offer exciting opportunities to improve health care dramatically. At first we will do things differently, but the major benefits will come when we exploit these new opportunities fully and do different things differently.

Ø      e-Health for professionals

Current e-Health activities can be classified according to the technology used, the type of activity or the target group. One of the most important aspects of classification is the distinction between real time and store and forward. In real time e-Health, the classic example of which is video consultation, the interaction between the participants is "live" and they can interact immediately. The advantage of this approach is that it enables optimum transfer of information between the participants. The disadvantages are that it is logistically difficult to manage large-scale services and they tend to be relatively expensive. Store and forward e-Health is less expensive and easier to manage as there is no "live" interaction. One participant gathers information (text, data, images, etc) in electronic form and sends it to the other participant, who views it at a subsequent convenient time and reports back. The classic example here is dermatology second opinions. Choice as to which of the above approaches is preferable varies with the type of service required; neither is universally preferable.

Below is listed a selection of current e-Health activities, listed by their primary location. The list is not intended to be comprehensive and details of other services will be found in numerous locations across this site. UK e-Health Association members can access details of the various applications that other members are running by visiting the Members' forum on this site. New deployments of telemedicine are occurring with increasing rapidity. Telemedicine will be part of the movement towards a model of care based around the individual, rather than around institutions, a topic discussed in Telemedicine for the Future.

Ø      e-Health for the public

Traditionally to access medical care or advice, you have had to travel to the doctor or hospital. The more complex or rare the problem, the further it has been necessary to go.

E-Health, by making use of computers and telephone technologies, now makes it possible for an increasing range of medical services to be available locally. An example of a current telemedicine service is NHS Direct, has been extended to provide advice services to the whole country.

In some parts of the country traditional hospital based outpatient clinics are being replaced with nurse-run clinics in GP practices. The nurses talk to the patient, collect all the information required on a computer and send this "electronic patient record" over the phone lines to a specialist. The specialist could be located anywhere. The specialist views the record (which could include photographs, X-rays, ECGs or other details as well as text) and uses his computer to send a report back to the patient's GP.

Minor injury units are now being linked to trauma centre. If you attend such a unit, the nurse can send X-rays over the phone line, for a radiologist to view and report back. She can also videoconference with a Consultant in the trauma centre in order to discuss how to manage an injury.These sorts of approaches enable care and advice to be made available much more locally and often more quickly than the traditional approaches.The range of e-Health services is increasing rapidly and will become a core feature of the NHS. Access to expertise regardless of where you live should help to ensure fair provision of services for all. Access to good quality health information over the Internet, digital TV and via multimedia kiosks will give us all an opportunity to maintain better health.

 {mospagebreak title=Research Methdology}

Research Methdology:

The respondents covered are from middle and upper middle class which are conversant with internet. This is stratified random sampling. The sample size was 300 families in the metro city of Pune, India. They were interviewed by a structured questionnaire.

Challenges

 Cyber Dialogue listed their conclusions on the current decelerators of e-health growth as:

1.Publicized privacy problems with health content and health insurance web sites

2.Growing privacy concerns among consumers regarding submitting or transmitting health information online

3.Delays in companies implementing their B2B strategies

4.Little or no movement by insurers to embrace the Internet due to concerns or reliance on legacy information systems

5. The lack of doctor/providers to embrace the web as a tool for business and communication with other professionals and patients

Specific challenges include:

Ø      Access

Ø      Research.

Ø      Security.

Ø      Privacy/Confidentiality

Ø      Ownership.

Ø      Quality/Standards/Ethics.

Ø      Community Health

Data Analysis & Interpretation:

 1) Do you access internet?

Image

 

Interpretation: From the above graph it is seen that from the decided respondents all are accessing Internet.

2) If Yes- How often?

Image

Interpretation: From the above graph it is seen that majority of the class is accessing the internet regularly

3) Do you access any health care sites?

Image

Interpretation: From the above graph it is seen that only 33% respondents access health care sites

4) If Yes- for what purpose?

Majority of the respondents are saying that they access the health care sites for getting information of health care products, cosmetics and anything new etc.

5) Are you aware of e-Health services?

Image

Interpretation: From the above graph it is seen that they don’t have any idea about e-health as such in comparison of  health care products.

6) What do you do when you or your family members get sick?

Image

Interpretation: From the above graph it is seen that the typical Indian mentality always go for self medication and the secondly consult doctor.

7) Whether you take second opinion about the first diagnosis?

Image

Interpretation: From the above graph it is seen that 60% of the respondents go for second opinion.e-health can capture this market.

7a) If Yes – How do you go about it?

Image

Interpretation: There are many respondents who don’t go for second opinion and out of the remaining,mejorly respondents go for  the doctors consultation.

8) For Which type of product category, you will take help of e-Health service? (if available)

Image

Interpretation: From the above graph it is seen that respondents will opt for OTC products as well as cosmetics equally, followed by prescribed and neutraceuticals.

9) Are you ready to trade online for Medicines, related products and services?

Image

Interpretation: From the above graph it is seen that majority of the respondents are ready for economic online trading.Around 50 respondents are uncertain about their decision. 

 {mospagebreak title=Conclusion}

Conclusion

Because of the ever increasing consumer demand for information and expectations to get that information is perhaps the single largest driver of the e- health industry. In today’s financially challenging and competitive world nearly all organizations are at early stages of adopting e-health initiatives. The organizations that are likely to be successful are those that align their e-health initiatives with clear expectation of results and with offerings that move them closer to virtual health management.

 E-health as if in India:

In India among the huge population of 100 cr comparatively very less population is literate and also from that a small fraction comprise of computer literates. So e-health perhaps get good opportunity in urban areas where computer literacy level is quite good but all well equipped hospitals and easily available medical facilities brought it to a standstill where as in rural areas where all these facilities and hospitals are not easily available         would have given it a boost  but unfortunately the literacy level is dragging it back. As if India is crossing all the mile stones very fast and successfully the e-health mile stone will be turned very soon.

As this data was collected from a group of higher middle, highly educated class, well versed with the Internet, this data can be considered as representative of population from metros only and not a representative of Indian population as a whole. Though people surf through Healthcare products site, awareness regarding e-Health is negligible. Economy is the only constraint for trading online. The success of e-Health providers will depend on cost effectiveness of the products and services rendered.

{mospagebreak title=References}

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{mospagebreak title=About Authors}

Mrs. Anagha Joshi

Mrs. Anagha Joshi
M.Pharm
Working as Associate Professor with Indira Group of Institute,Pune
Research area of interest is Novel Drug Delivery System.

Mr.Prashant Kalshetti

Mr.Prashant Kalshetti
B.Pharm, MBA(Marketing)
Working As lecturer in Indira Institute of Management,Pune
Research Area of interest is Health Management,Pharmaceutical Administration.

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