Health In The Electronic Era

Because the electronic era is re-shaping medicine, I would like to discuss some of its implications on general health care. The introduction of HIPAA (Health Insurance Portability and Accountability Act) regulations and implementation has become the medical "Y2K" focusing event of the century and has caused the entire health care system to study the ramifications of electronic health information. Gunther Eysenbach, the editor of the Journal of Medical Internet Research has defined e-Health as follows:

I will also summarize his "ten e’s in health care":

1. Efficiency – one of the promises of e-health is to increase efficiency in health care, thereby decreasing costs. For example, the formation of medical error database, electronic health claims submission and 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 by being able to compare costs and services of health providers.
3. Evidence based – e-Health interventions should be evidence-based. Scientific evidence of intervention effectiveness would replace regular health assumptions. There are many public companies, collaborating with academic centers to provide the medical community with evidence based medicine models.
4. Empowerment of consumers and patients – Health care can be patient and evidence based as access to health care knowledge has become available. The AMA, though, recently did a review of health information web sites and concluded that not all medical information is reliable, and that you would need to visit multiple sites to get a correct view of a particular medical condition.
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 and health care providers 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. HIPAA implementation will definitely standardize health communication formats and health coding conventions.
8. Extending the scope of health care beyond its conventional boundaries. For example, you may want to participate in a clinical trial in Europe or information from across the world can apply to your particular health situation.
9. Ethics – 3-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. In a recent survey the reason physicians are NOT using e-mail is because of liability and security reasons. The Department of Health & Human Services has recently issued a HIPAA security mandate that all e-health web sites must conform to.
10. 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 those who have technology access and those who do not. It is estimated that the health sector that would benefit the most from e-health technology will not be able to access the system, and a political lobby is being formed to address this issue.

Along these same lines, Thomas R. Eng, has written a book called "The eHealth Landscape: A Terrain Map of Emerging Information and Communication Technologies in Health and Health Care". In this book, Eng outlines both the benefits and pitfalls of e-health. He mentions the millions of Americans without health insurance vs. the 68% of Americans who access the Internet for health information. The topics he covers include:

• Current status of the e-health sector
• Perspective of major e-health stakeholders (for example who might profit from this industry and who would influence health policy)
• Overview of major e-health issues
  - Quality
  - Privacy, confidentiality and security
  - Access and the digital divide
  - Content and application development
  - Research & Evaluation
  - Data standard development
  - Integration of e-health segments
• A cautionary view of e-Health
• Internet related trends and their implications for e-health tools
• Key questions for e-health (What will be the ultimate impact of emerging information and communication technologies on the future of health and health care?)

Also to note, a distinguished group of leading U.S. clinicians, medical academicians and other healthcare professionals announced, on July 19, 2001 – the creation of the Institute for Medical Knowledge Implementation (IMKI), a not-for-profit organization dedicated to the development and maintenance of medical knowledge application content that can be used in clinical information systems to promote improved healthcare outcomes.

To accomplish its mission, the Institute will operate a "public library" of non-proprietary, evidence-based medical knowledge code that is available to and can be implemented by all healthcare information technology (HIT) system vendors and individual users. Tools for authoring and submitting medical knowledge application content will be provided in 2002 via the Institute’s recently launched Web site, www.imki.org.

Every day there is continual medical information ported to the web, and we should find ways to make this information available to those who may benefit from it the most.