On August 30, 2010, Susannah Fox posted E-patients, Cyberchondriacs, and Why We Should Stop Calling Names starting a discussion about names. I think the discussion could be summarised in two main trends.

On the one hand, e-patients name is still useful as a brand to spread the message of individuals utilising the Internet for health purposes. Therefore, using the Internet for seeking health information on injury, disease, nutrition, improving health, etc could be consider as a “proxy” to understand the diffusion of e-patients phenomenon or normalization and routinization of technological resourcefulness, mentioned by Carl May. Susannah Fox has been analysing data from USA since 2000. It looks like that the use of the Internet for health in this country has reached a “saturation” point among Internet users, however non-Internet users and minorities, mentioned by Gilles Frydman, are still far away from this saturation point. As a part of this digital divide in Health, it is different to engage young or elderly populations. For the first group, talk about e-patient does not make any sense because, in plain English, they are digital natives while for elderly population is totally different. However, digital natives will be the patients of the near future.

To tackle the situation in Europe I have collected some data from Eurostat checking Information society statistics based on the surveys on ICT usage in enterprises and households. They have gathered the following question “I have used Internet, in the last 3 months, for seeking health information on injury, disease, nutrition, improving health, etc.)”. I have developed charts of European countries and of EU 15, EU 25 and EU 27 for ‘% of individuals’ and ‘% of individuals who used Internet in the last 3 months’. All charts revealed a positive trend but Europe is still behind USA, even the penetration of broadband in Europe is bigger than in USA.

Click on the image below to enlarge the chart to full viewing size

On the other hand, we have to realise that this proxy does not tackle the complexity of this phenomenon and its relationships with other variables, including digital and non-digital aspects of individuals daily live. Therefore, e-patient name could be considered as an inhibitor of this complexity and it does not help us to go deeper in our analysis.  I guess we may have to find a balance between get bored spreading the message and get excited about deeper analysis.

Although I have not posted about Pharmacists and the use of the Internet and I have not found many research on this topic,  it’s clear that these health professionals are playing an important role in healthcare. Therefore, they also have a role in relationship with the Internet, specially Community Pharmacists, who are probably the most accessible health professional and are daily dealing with all kind of patients. Health promotion, Health prevention, Health Literacy, patients’ education,… are just some of the fields where Community Pharmacists can encourage patients to become more engaged in their own health care or their relatives health care.

Following our analysis of the integration of Information and Communication Technologies into medical practice and into nursing practice, we have analysed Community Pharmacists. The specific objectives were to develop and characterise a typology of CPs based on their ICT utilization and to identify factors that can enhance or inhibit the use of these technologies.

Cluster one consists of CPs whose information needs place a greater emphasis on international and national information; on activities related to professional education and information from the Pharmacists Association as well as workplace and pharmaceutical industry. This group also emphasizes ICT use for activities such as information search, communication and the dissemination of information as well as for corporate activities. This group is thus referred to as representing ‘integrated Community Pharmacist’. The label is used descriptively in order to capture the sense that for this group ICT are a mundane and valued resource. Cluster two is characterised by notably different features to the previous one. The second profile represents those CPs placing less emphasis on ICT so are consequently labelled as ‘non-integrated Community Pharmacist‘.

Statistical analysis of the relationship between these profiles  revealed that ‘integrated Community Pharmacist‘ are more likely to start using Internet at an earlier stage, to consider it very useful, to use this tool on a daily basis, to have a blog and to consider Internet health information very relevant. No significance association related to age, gender or pharmacy ownership was found.

Further analysis of the relationship between the two profiles and the pharmacist-patient relationship resulted in ‘integrated Community Pharmacist‘ being more likely than ‘non-integrated Community Pharmacist‘ to recommend that patients go online to find health information and to have more patients that discuss such information during a consultation. ‘Integrated Community Pharmacist‘ are also more likely to believe that patients going online for health information improve their autonomy and their quality of life as well as improving both the health professional/patient relationship and  the pharmacist/patient relationship. Finally, ‘integrated Community Pharmacist‘ are more likely to be found on the Internet searching or providing advice on professional forums. Additionally, drivers for ICT use such as improving communication with other health care professionals and improvement in work productivity are likely to have a higher impact on ‘integrated Community Pharmacist‘ while barriers such as lack of training or lack of time are less likely to challenge them.

It was observed that factors related with ‘intensive use of Internet’ (every day), ‘emphasis on Internet for communication and dissemination’ as well as information needs from the Pharmacists Professional Association play a positive and significant role in the probability of being an ‘integrated Community Pharmacist‘. Recommending patients going on-line for health information and discussing or sharing patients’ Internet health information findings also have a positive and significant role.

Acknowledgements

The research reported is part of a broad study supported by Departament de Salut de la Generalitat de Catalunya (Catalonia Health Department) and directed by Prof. Manuel Castells. Survey launched is a result of collaboration between the Internet Interdisciplinary Institute at Open University of Catalonia and the Pharmacist Association of Barcelona (Col.legi Oficial de Farmacèutics de Barcelona).

Lately, I have been checking systematic literature reviews about Chronic Disease Management, Remote Monitoring and Treatment and Information and Communication Technologies:

• Whitten, P. S., Mair, F. S., Haycox, A., May, C. R., Williams, T. L., & Hellmich, S. (2002). Systematic review of cost effectiveness studies of telemedicine interventions. Bmj, 324(7351), 1434–1437.
• Louis, A. A., Turner, T., Gretton, M., Baksh, A., & Cleland, J. G. F. (2003). A systematic review of telemonitoring for the management of heart failure. Eur J Heart Fail, 5(5), 583–590.
• Jaana, M., & Pare, G. (2007). Home telemonitoring of patients with diabetes: a systematic assessment of observed effects. J Eval Clin Pract, 13(2), 242–253.
• Pare, G., Jaana, M., & Sicotte, C. (2007). Systematic review of home telemonitoring for chronic diseases: the evidence base. J Am Med Inform Assoc, 14(3), 269–277.
• Jaana, M., Pare, G., & Sicotte, C. (2009). Home telemonitoring for respiratory conditions: a systematic review. Am J Manag Care, 15(5), 313–320.

I do not want to reproduce all the abstract here,  but some common trends could be identified:

• Lack of cost-effectiveness analysis;
• Lack of Randomized Controlled Trials;
• Difficulties in extrapolating or comparing the results;
• Patients satisfaction and acceptance of the technology.

To sum up, following Pare et al. (2007) “Home telemonitoring of chronic diseases seems to be a promising patient management approach that produces accurate and reliable data, empowers patients, influences their attitudes and behaviors, and potentially improves their medical conditions. Future studies need to build evidence related to its clinical effects, cost effectiveness, impacts on services utilization, and acceptance by health care providers”.

Is not about TECHNOLOGY, is it?

I’m delighted to announce that the article entitled “The integration of Information and Communication Technology into medical practice” has been accepted and is already in press at the  International Journal of Medical Informatics. As soon as possible I will upload a pre-print version.

PREPRINT

Please cite this article as:

Lupiáñez-Villanueva, F., Hardey, M., Torrent, J., & Ficapal, P. (2010). The integration of Information and Communication Technology into medical practice. Int J Med Inform, 79(7), 478–491.

PUBMED link

ABSTRACT

OBJECTIVES:

To identify doctors’ utilization of ICT; to develop and characterise a typology of doctors’ utilization of ICT and to identify factors that can enhance or inhibit the use of these technologies within medical practice.

METHODS:

An online survey of the 16,531 members of the Physicians Association of Barcelona who had a registered email account in 2006 was carried out. Factor analysis, cluster analysis and binomial logit model were undertaken.

RESULTS:

Multivariate statistics analysis of the 2199 responses obtained revealed two profiles of adoption of ICT. The first profile (38.61% of respondents) represents those doctors who place high emphasis on ICT within their practice. This group is thus referred to as ‘integrated doctors’. The second profile (61.39% of respondents) represents those doctors who make less use of ICT so are consequently labelled ‘non-integrated doctors’. From the statistical modelling, it was observed that an emphasis on international information; emphasis on ICT for research and medical practice; emphasis on information systems to consult and prescribe; undertaking teaching/research activities; a belief that the use of the Internet improved communication with patients and practice in both public and private health organizations play a positive and significant role in the probability of being an ‘integrated doctor’.

CONCLUSIONS:

The integration of ICT within medical practice cannot be adequately understood and appreciated without examining how doctors are making use of ICT within their own practice, organizational contexts and the opportunities and constraints afforded by institutional, professional and patient expectations and demands.

Please cite this article as:

Lupiáñez-Villanueva, F., Hardey, M., Torrent, J., & Ficapal, P. (2010). The integration of Information and Communication Technology into medical practice. Int J Med Inform, 79(7), 478–491.

PUBMED link

Lately, I have been checking and reading some scientific papers about health communication from:

• Journal of Health Communication: International Perspectives
• Health Communication
• Patients Education and Counselling

The aim is to write a paper based on the presentation done with Michael Hardey:

The purpose of this paper is  to identify how health professionals view public use of the Internet and whether new forms of communication are emerging with the following objectives:

• To identify the utilisation, experience, expertise, barriers and expectations that doctors, nurses and community pharmacists have with the Internet and the email.
• To identify the experience and expectations that doctors, nurses and community pharmacists have with patients using the Internet.
• To identify factors that can enhance the integration of the recommendation of health information available on the Internet and the email within the health professional / patients relationship.

Any reference, suggestion, recommendation… about the presentation will be appreciated.

I have collected all the presentations in the same post to summarise the information. Thank you very much indeed to all the participants for these inspiring and wonderful days. I would like also to express my gratitude to Internet Interdisciplinary Institute (IN3) for its support.

Workshop: Innovative health technologies: health systems in transition
Supported by: Internet Interdisciplinary Institute (IN3)
Organized by: Francisco Lupiáñez-Villanueva (Internet Interdisciplinary
Institute –UOC) and Michael Hardey (Hull/York Medical School – Science and
Technology Studies Unit, Department of Sociology, University of York)
Data: 26th and 27th November
Place: Meeting room -1A , UOC IN3 building. Av. Canal Olímpic, s/n. Edifici B3,
08860 Castelldefels (Barcelona)

26th November

• Andrew Webster - Innovation in health: a social science perspective
• Michael Morrison - ‘Measuring Innovation - a brief introduction to
  the REMEDiE project’
• Laura Machin - Cord blood banking: initial observations
• Mariann Hardey - Private medical care and the Web
• Eulàlia Hernádez - Providing resources for caregivers trough the
  Internet.
• Flis Henwood - ‘Health-e discourse? Engaging the community in ehealth
  developments for obesity self-management’
• Sue Ziebland - Knowledge is Power? The role of health information

27th November

• Imma Grau - Studying Virtual Communities for patients with chronic
  illnesses, in Forumclinic
• Daniel López - Reframing telecare: an ethical discussion concerning
  ageing-in-place, independence and care.
• Darren Reed - Performativity of Data
• Michael Hardey - Consuming professions: user-review websites and health services.
• Francisco Lupiáñez-Villanueva and Michael Hardey - Health professionals, the Internet and Internet informed patients.

“Innovative health technologies: health systems in transition Workshop”

Supported by: Internet Interdisciplinary Institute (IN3)

Organized by: Francisco Lupiáñez-Villanueva (Internet Interdisciplinary Institute –UOC) and Michael Hardey (Hull/York Medical School – Science and Technology Studies Unit, Department of Sociology, University of York)

Data: 27th November

Place: UOC IN3 building. Av. Canal Olímpic, s/n. Edifici B3, 08860 Castelldefels (Barcelona)

Michael Hardey - Consuming professions: user-review websites and health services

The relationship between doctor and patient was variously regarded as ‘special’, ‘outside’ or otherwise at a distance from other consumer experiences. Since then, the status of doctors has changed and information about health and illness has moved from the confines of the consulting room to the World Wide Web. This presentation considers the recent development of Web 2.0 resources that are constructed around user-generated content about identified health practitioners and services. Web sites where users can both read and write comments about health practitioners and services reflect the broader consumer content industry commonly associated with sites like Amazon and TripAdvisor.

Michael Hardey

Reader in Sociology at the Hull/York Medical School and the Department of Social Sciences, University of Hull. He is also an Associate Director Researcher of the Science and Technology Studies Unit, University of York . His main research interests are in mediated information and relationships. This falls into three broad areas: e-health and in particular the role of the Internet in shaping health beliefs and behaviours; e-body and identity (particularly the representation of the self through new media); and the generation and mediation of information through Web 2.0 resources.

“Innovative health technologies: health systems in transition Workshop”

Supported by: Internet Interdisciplinary Institute (IN3)

Organized by: Francisco Lupiáñez-Villanueva (Internet Interdisciplinary Institute –UOC) and Michael Hardey (Hull/York Medical School – Science and Technology Studies Unit, Department of Sociology, University of York)

Data: 27th November

Place: UOC IN3 building. Av. Canal Olímpic, s/n. Edifici B3, 08860 Castelldefels (Barcelona)

Imma Grau - Studying Virtual Communities for patients with chronic illnesses, in Forumclinic

Conventional clinical care can be complemented by digital information and communication technologies, while offering an opportunity to enhance patient autonomy. It has been suggested that people with a high level of autonomy make a more intensive use of Internet and that this use, in turn increases the level of autonomy. Internet would appear to be a powerful tool for complementing the health care of chronic patients.

The Web 2.0 virtual environments promote collaboration and quick exchange of information among users. Some of such groups of Internet users have become working virtual communities, as defined by Barry Welman: networks of interpersonal links that provide sociability, support, information, a sense of belonging, and social identity. The same need applies to many health information seekers.

Forumclinic is a DVD and web-based interactive programme for patients, aimed to improve patient autonomy regarding personal health matters. Authors are professionals from Hospital Clinic, a university hospital and leading research institution, and from associated health centres. The “Fundación BBVA”, a non-profit organization of a bank, finances the project.

On the web, information for each illness section is classified into four categories: 1) Text that summarises basic data on each disease; 2) News, updated weekly from recent research, related to every illness that is of potential interest to the chronic patient, produced by health professionals with a journalistic approach; 3) Videos and 3D animations that explain biological mechanisms or techniques for treatment or rehabilitation in order to facilitate the understanding of the text; and 4) the professionally-moderated discussion forums.

Forums facilitate dynamic group interaction between professionals and patients through direct communication, introduction of topics raised by the patients, or through the ‘suggest a topic’ box.

In this presentation I’ll explain how we did the analysis on the generated Virtual Communities using three tools:

The first is based on the results provided by Google Analytics, after separation of data by disease. For the second, we ask users to register, include their socio demographic data. This has allowed us, through analysis of server logs to obtain general behaviour patterns. Finally, the third method is a qualitative method: participant observation. The information of the present analysis corresponds to the year 2008.

Imma Grau

Degree in Telecommunications Engineering, post graduate in Technology and Organization Management and Innovation followed by a Media and Communication Studies Degree, all at Ramon Llull University. Advanced Studies Diploma from “ Information and Knowledge Society” in the IN3 PhD programme (UOC).
Currently working as Audiovisual Area manager of the Clinic Hospital, Barcelona, and Director of forumclinic Interactive Programme providing therapeutic education to people with long-term illnesses, developed using information and communication technologies, with the financial support of Foundation BBVA, the Science and Education Department, the Autonomous Government of Catalonia, and some patient associations collaboration. 

Her research is focussed on studying the diffusion and uses of information and communication technology health services, and Internet as a medium for spreading scientific knowledge. She was involved in the Technological Modernisation, Organisational Change and Service Delivery in the Catalan Public Health System group, directed by Manuel Castells within the framework of the Internet Intedisciplinary Institute (IN3-UOC).

“Innovative health technologies: health systems in transition Workshop”

Supported by: Internet Interdisciplinary Institute (IN3)

Organized by: Francisco Lupiáñez-Villanueva (Internet Interdisciplinary Institute –UOC) and Michael Hardey (Hull/York Medical School – Science and Technology Studies Unit, Department of Sociology, University of York)

Data: 27th November

Place: UOC IN3 building. Av. Canal Olímpic, s/n. Edifici B3, 08860 Castelldefels (Barcelona)

Daniel López presentation: Reframing telecare: an ethical discussion concerning ageing-in-place, independence and care.

Telecare has been presented by policy-makers and developers as a simple and cheap technology that enable ageing-in-place with autonomy. The aim of this presentation is to critically discuss what ageing-in-place with autonomy mean for elderly people using telecare. According to some results from ethnography conducted 4 years ago in a catalan telecare service, there are different ways of being autonomous enacted and, given that, also different conceptions of the body and of living at home. By presenting these complexities we want to put forward several ethical questions concerning the current telecare developments. First of all, what new arrangements, practices, collectives and relationships of care arise with the implementation of telecare and smart home systems in care for older people? How do these arrangements shape existing care practices? What definitions of care, and good care, are implied and embodied in the new care arrangements? How do these built-in definitions and normativities differ from and change existing practice? What implications do they have for the meanings of place, distance and home in care? These questions, among other, are being discussed in a FP7 project currently carried out by different research teams in Barcelona, Lancaster, Amsterdam and Oslo and coordinated by Maggie Mort. So in order to conclude, I would like to present these questions and make some remarks based on some insights taken from the current fieldwork and from the former research projects.

Daniel López

Assistant Professor at the Universitat Oberta de Catalunya. Currently working on the implementation of new technologies in care settings like Home Telecare from an STS perspective. The main areas of interest are: a) the emergence of new spatialities and temporalities of care; b) the emergence of new practices of caring and security due to the increasing importance of technologies of accountability; and c) the enactment of hybrid forms of autonomy and independence. Currently involved in an FP7 project called “Ethical Frameworks for Telecare Technologies for older people at home (EFORTT) concerned with the implications of the introduction of remote care technologies worn, installed or embedded in the homes of older citizens/frail older people (see http://www.lancs.ac.uk/efortt/index.html) and also a project funded by the Ministerio called CONDEPCIU concerned with the techno-scientific controversies around the new Spanish care policies addressed to elderly/frail people.