Consumer Health Informatics - Part 1

Introduction

This component, Health Management Information Systems, is a “theory” component, specific to health care and public health applications. The topic for the eighth unit of this component is Consumer Health Informatics

This lecture provides a definition of consumer health informatics, identifies how the Internet has impacted consumer health informatics, explains how current and emerging technologies may affect consumer health informatics, and introduces the role of genomics in consumer health informatics.

Part 2 offers definitions of personal health records or PHRs, describes the role of PHRs and their implications within health care, and discusses the challenges of consumerism in health information systems.

Objectives

Lecture one has two objectives. By the end of this lecture the student should be able to explain how current and emerging technologies – including the Internet – have impacted and may continue to affect consumer health informatics, and describe the role of genomics in consumer health informatics.

Health Communication

The report, Healthy People 2010, published in 2000 described health communication as encompassing the study and use of communication strategies to inform and influence individual and community decisions that enhance health. This report goes on to define health communication as the art and technique of informing, influencing, and motivating individual, institutional, and public audiences about important health issues. When taking informatics into consideration, consumer health informatics is interactive health communication where the focus is on consumers. Furthermore, as cited in Healthy People 2010, interactive health communication is the interaction of an individual with an electronic device or communication technology to access or transmit health information or to receive guidance on a health-related issue.

Since the publication of the report, interactive health communication continues to evolve and impact consumer health informatics.

Consumer Health Informatics

AMIA’s "working" definition for Consumer Health Informatics is "a subspecialty of medical informatics which studies from a patient/consumer perspective the use of electronic information and communication to improve medical outcomes and the health care decision-making process.“

The American Medical Informatics Association or AMIA is a non-profit organization dedicated to the development and application of medical informatics in the support of patient care, teaching, research, and health administration. It is seen as the prominent informatics organization in the US. According to their website, “AMIA is the professional home for biomedical and health informatics. For over thirty years the members of AMIA and its honorific college, the American College of Medical Informatics (ACMI), have sponsored meetings, education, policy and research programs. The federal government frequently calls upon AMIA as a source of informed, unbiased opinions on policy issues relating to the national health information infrastructure, uses and protection of personal health information, and public health considerations, among others.” AMIA’s definition therefore is essential to understand.

When the applications of informatics technologies focus on patients or healthy individuals as the primary users, this is considered to be consumer health informatics.

Interactive Health Communication

As cited in Healthy People 2010, interactive health communication is the "interaction of an individual with an electronic device or communication technology to access or transmit health information or to receive guidance on a health-related issue." Some common technology and devices used in this process that have and will continue to impact consumer health informatics include the Internet, Web services, wireless communication, and social media.

For example, many health care organizations use the Internet as a channel for information delivery. The Internet has become a way to gain access to health information, contact health care professionals, and receive health care services at a distance.

Before investigating how consumer health informatics has been impacted by electronic devices or communication technology, let’s first define the terms. The first three definitions are from wikipedia.com.

“The Internet is a global system of interconnected computer networks that use the standard Internet Protocol Suite (TCP/IP) to serve billions of users worldwide. It is a network of networks that consists of millions of private, public, academic, business, and government networks of local to global scope that are linked by a broad array of electronic and optical networking technologies. The Internet carries a vast array of information resources and services, most notably the inter-linked hypertext documents of the World Wide Web (WWW) and the infrastructure to support electronic mail.” (Wikipedia: Internet)

“Web services are typically application programming interfaces (API) or web APIs that are accessed via Hypertext Transfer Protocol (HTTP) and executed on a remote system hosting the requested services.” (Wikipedia: Service States)

“Wireless communication refers to the transfer of information signals without using wires. It encompasses various types of fixed, mobile, and portable two-way radios, cellular telephones, personal digital assistants (PDAs), and wireless networking.” (Wikipedia: Wireless)

Kaplan and Haenlein define social media as “a group of Internet-based applications that build on the ideological and technological foundations of Web 2.0, which allows the creation and exchange of user-generated content.” (source)

Impact on Consumer Health Informatics

Each of the previous interactive health communication methods could be considered an e-Health tool. According to Expanding the Reach and Impact of Consumer, “e-Health” is a broad term for the heterogeneous and evolving digital resources and practices that support health and health care. This same report stated, “Consumer e-health is part of the broad cultural shift toward Internet and technology use, such as portable music devices, cell phones, instant messaging, and interactive voice-response systems, as a normal part of everyday life.”

While the concept of an interaction of an individual with an electronic device or communication technology may have a variety of descriptors, the impact on consumer health informatics remains the same. First, it has created a new role for the consumer where the consumer is a key player in managing his/her own health, in partnership with healthcare providers. Second, it has set up expectations that health information is available when it is needed. With the growth and development of the Internet combined with the increase in the use of the Internet to search for health related information, consumers are drawn to use convenient and anonymous technologies for health purposes.

Impact of the Internet

According to the report, Expanding the Reach and Impact of Consumer e-Health Tools, “Significantly, there are indicators that Internet access is growing in every segment of the population and that many of these segments are ready to think about new uses of the Internet and other digital technologies for health.”

Just how has the Internet affected consumer health informatics? Some examples are:

  1. There is increased use of the Internet to find out information about healthcare providers and treatment options. Opportunities to select information based on their personal interests and preferences.

  2. The sponsoring organization provides consumers with tools to develop and maintain their own PHRs.

  3. E-mail exchange is possible between consumers and health care providers.

  4. Increased marketing sophistication results in accessibility of health care products for purchase.

Impact of Emerging Technologies

The report, Healthy People 2010, made several points regarding how advances in consumer health informatics are changing the delivery of health information and services. In particular, the report stated the following: “The convergence of media and emergence of the Internet create a nearly ubiquitous networked communication infrastructure. This infrastructure facilitates access to an increasing array of health information and health-related support services and extends the reach of health communication efforts. Delivery channels such as the Internet expand the choices available for health professionals to reach patients and consumers and for patients and consumers to interact with health professionals and with each other (for example, in online support groups). ”

Emerging technologies that are influencing consumer health informatics include those that come under the umbrella term “social media.”

Social Media

Wikipedia states “Social media are media for social interaction, using highly accessible and scalable publishing techniques. Social media use web-based technologies to transform and broadcast media monologues into social media dialogues.”

While not originally created with healthcare in mind, today these media are seen as valuable health care tools. They are used in the health care environment for a variety of purposes including, for example, the use of a social network such as PatientsLikeMe where individuals go to commiserate with others who have a specific disorder. Some media are used by healthcare providers to provide information to their patients. For example, Mayo Clinic uses both blogs and podcasts to discuss diseases, conditions and treatments.

Health care organizations may use social media to assist patients in making informed choices and to build or maintain reputation in the marketplace. Photo videos such as those found on YouTube are popular. Mayo Clinic has a “Mayo Clinic Channel” where multiple YouTube videos are available for viewing.

The legitimacy of social media has increased as well. Respected healthcare organizations such as Mayo Clinic and governmental agencies such as the Centers for Disease Control and Prevention have established social media centers. For example, CDC’s social media site describes itself as “your online source for credible health information.”

Potential e-Health Value Propositions

This table is an excerpt from “Table 4, Potential e-Health Value Propositions for Major Stakeholders,” found in the report, Expanding the Reach and Impact of Consumer e-Health Tools. Included on this slide are three stakeholders in the e-health market and some of the interests motivating them.

  • The first stakeholder is the consumer. The benefits sought from consumer e-Health include private, 24/7 access to resources, expanded choice and autonomy, new forms of social support, possibility of better health, more efficient record management, lower cost healthcare services, and avoidance of duplication of services.

  • Second are the clinicians. The benefits sought from consumer e-Health include greater efficiency, better communication, and more adherent and satisfied patients.

  • The final stakeholder is the health care organization. The benefits sought from consumer e-Health include more patient self-care and health management, lower administrative costs, and improved quality and patient outcomes.

Challenges Presented

Having described the various impacts of the Internet and its derived technologies on consumer health informatics, what challenges do these technologies and media present? They include privacy and security concerns, liability risk, lack of law or legislation governing the boundaries, lack of payment for engagement, and resistance by healthcare providers.

While the Health Insurance Portability and Accountability Act or HIPAA contains privacy and security requirements, it does not contain guidelines regarding the transmission of personal health information over the Internet. However, Subtitle D of the Health Information Technology for Economic and Clinical Health Act (HITECH Act), enacted as part of the American Recovery and Reinvestment Act of 2009, addressed the privacy and security concerns associated with the electronic transmission of health information. Even so, privacy and security issues remain a challenge for healthcare providers wishing to use the emerging technologies.

Other challenges include the risk of liability, especially with relation to what constitutes medical advice which goes hand-in-hand with the lack of law or legislation governing designated boundaries for these emerging electronic device or communication technology tools.

Healthcare providers are also reluctant to use interactive health communication in their practices, due to the lack of payment for their time and effort. For example, according to a Health Resources and Service Administration report, the absence of consistent, comprehensive reimbursement policies is often cited as one of the most serious obstacles to total integration of the use of telecommunication technologies to deliver medical information and services to locations at a distance from the care giver or educator into healthcare practice. Finally, health care providers may be reluctant to get on-board with some of these technologies due to wariness regarding their usefulness. There is also concern over the potential replacement of some person-to-person interactions, and a danger of losing essential benefits of the doctor/patient relationship, which include: appreciation of a patient’s needs and personal preferences.

To conclude this unit, the role of genomics in consumer health informatics will be explored.

Role of Genomics

According to the CDC Web site (), “By studying the relationship between genes, environment, and behaviors, researchers and practitioners can learn why some people get sick, while others do not. Family health history information can also help to identify people who may have a higher risk for certain diseases. Better understanding of genetic and family history information can help researchers and practitioners identify, develop, and evaluate screening and other interventions that can improve health and prevent disease. Individuals can contribute to their health by keeping records of their family health information and sharing this information with their doctor and with other family members.” The family history being a piece of the personal health record plays a role in consumer health informatics.

Another role of genomics in consumer health informatics is the connection to personalized medicine. This image of a prescription form with the DNA double helix illustrates how having genomic information connected to patient data enables clinicians to find the information they need to better diagnose and treat people. Physicians have the ability to “personalize” medical care by identifying the predisposition of a person to have a disease, and developing therapies adapted to genetic features of patients.

Summary

A broad cultural shift toward using technology and the Internet as a normal part of everyday life is emerging. Government policy is placing great emphasis on both health information technology and personal health management for consumers. The integration of communication media means electronic access to health information with Web-enabled telephones, handheld devices, and other emerging technologies. Interactive health communication enables consumers to gather information, make health care decisions, communicate with health care providers, manage chronic disease, and engage in other health-related activities.

In summary, this lecture provided a definition of consumer health informatics, identified how the Internet has impacted consumer health informatics, explained how current and emerging technologies may affect consumer health informatics, and introduced the role of genomics in consumer health informatics. Some challenges of the Internet and its derived technologies on consumer health informatics were also presented. These included concerns with privacy and security, risk of liability, lack of law or legislation governing the boundaries, lack of payment for engagement, and resistance by healthcare providers.

Let’s now move on to Consumer Health Informatics - Part 2 to learn definitions of personal health records or PHRs, the role of PHRs and their implications within health care, and the challenges of consumerism in health information systems.

Next: Consumer Health Informatics - Part 2

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