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).

We are planning to launch again our survey to Physicians, Nurses and Pharmacists with the collaboration of their Professional Associations of Barcelona. Therefore, we are redesigning the questionnaires and checking our multivariate analysis. Following the published paper entitled “The integration of Information and Communication Technology into medical practice”, we have send to a peer-review journal another paper focused on Nurses. Below you can find the main figures:

Table 5 revealed that cluster one (4.58%) is composed of those nurses who make greater use of ICT and the Internet for access to clinical and scientific information. The nurses within this cluster are also more likely to use ICT as a resource for publishing and international contact on national and international information. This first profile represents those nurses who place high emphasis on ICT in that it forms an integral part of their practice. This group is thus referred to as representing ‘Integrated nurses’. In other words, ICT and the Internet has become an important tool to be used in the delivery of care for the ‘integrated nurse’.

Cluster two (95.42%) is characterised by a distinctive set of features. The second profile represents those nurses who place less emphasis on ICT so that it is used to support their daily work only when required. This group are consequently labelled ‘Non-integrated nurses’.

Statistical analysis of the relationship between the two profiles (see Table 6 of the presentation) revealed that ‘Integrated nurses’ are more likely than ‘Non-integrated nurses’ to carry out research activities, to consider the Internet is ‘very useful’ to their nursing practice and to recommend that their patients use online health information. ‘Non-integrated nurses’ are more likely than ‘integrated nurses’ to be only engaged in delivering nursing care and to believe that patients use of online information will have little impact on their treatment their or understanding of their condition.

Finally, it was found that all the variables included have a significance explanatory power regarding the integration of ICT within nursing practice (see Table 7). It was observed that an ‘emphasis on international information’, performance ‘research activities’ and ‘the perception that health information available on the Internet’ was relevant to nursing played a positive and significance role in the probability of being an ‘Integrated nurse’.

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 a collaboration between the Internet Interdisciplinary Institute at Open University of Catalonia and the Nurses Association of Barcelona (Col·legi Oficial de Infermeres 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.

On March 15th to 18th the Ministerial High Level Conference on eHealth and the World Health IT Conference and Exhibition were being held in the same week in a joint initiative called “e-Health Week 2010”. First of all, I would like to congratulate the organizers, specially TICSALUT Foundation and ehealthweek2010, for the very well organized conference and their social media coverage.

The conference was divided into five themes:

• eHealth for Sustainable Healthcare Delivery
• eHealth Addressing Global Challenges through Local Actions
• eHealth works: Here is the Evidence
• eHealth Market: Past and Prospects
• eHealth User Platform

Furthermore,  Paralel sessions and Plenary Sessions were coveraged by @ehealthweek2010 using Twitter #hastag as follow:

Paralel Sessions

• eHealth Governance
• How can IT Help Fight Pandemics
• Is Sustainability of Healthcare Possible without eHealth?
• When Telemedicine does Deliver!
• Embedding eHealth into New Professional Curricula
• Ageing - A Global Challenge
• Empowering the Patient through Information Delivery
• Beyond Technical Interoperability
• eHealth for the Economy
• ICT for a Global Infraestructure for Health Research
• eHealth and Healthcare Org The Chiken and the Egg
• Standards for a Global Scene
• eHealth Procurement
• eHealth for Mental Health

Plenary Sessions

• The ehealth Agenda in the UE
• The right information, at correct place and at the right time
• 2.0 Health care in practice
• EU-US cooperation in eHealth: facing common challenges
• EHealth for urgent public health challenges
• How contributes eHealth in health and well being
• The impact of eHealth in organizations and health personnel
• The dangerous decade. Challenges for system builders national health information
• European market of e-health: dream or reality?

I also had the opportunity to tweet some of the sessions. On one hand, it was a wonderful opportunity for networking and for watching in action how policy-makers, practicioners (specially Hospital managers and IT managers) and the ICT Health industry work together. On the other hand, there was a lack of analytical/empirical presentations so it was remarked by most of the participants that more research is needed. Furthermore, there are many eHealth, mHealth, Health 2.0,…. Health has been always related to technology so probably it is time to delete all the letters and just talk about HEALTH. Nowadays, HEALTH could not be understood without Information and Communication Technologies and these technologies could not be understood without economic, organization, social and cultural changes.

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)

Francisco Lupiáñez-Villanueva and Michael Hardey - Health professionals, the Internet and Internet informed patients

The practice of medicine and health care has been increasingly influence by and made use of the Internet as a source of information, communication and social interaction. This paper examines how doctors, nurses and community pharmacists use the Internet and how this shapes their interaction with patients. It is based on data from surveys of doctors, nurses and pharmacists working within the Catalan National Health Care System (CNHS) that were carried out during 2006. The consequent data provides an extensive and detailed quantitative database that is amenable to multivariate statistical analysis. This analysis is described and from it the manner in which the different health professions engage with Information and Communication Technologies (ICTs) and the Internet is identified.  It is suggested that the Internet should now be understood as part of mundane work and that professionals have recognised that it can be an important source of information and support for patients. There appears to be a cumulative effect whereby the more engaged with ICTs practitioners become the more likely they recognise and respond to patients who want to discuss and use resources and information from the Internet.