Sessions 11-13, abstracts
Wangberg, Silje C.
E-HEALTH CONSUMERS: PRACTICE AND PERSPECTIVES
Andreassen, H. (1), Wynn, R.(1&2), Sørensen, T.(1), Wangberg, S.(1), Hjortdahl, P.(1&3)
1 - Norwegian Centre for Telemedicine, Tromsø, Norway
2 - Department of Clinical Psychiatry, University of Tromsø, Norway
3 - Department of family medicine, University of Oslo, Oslo, Norway
The use of Internet health services is growing. So is patients' demand for e-health services, like e-mail access to their doctor, and access to read their own patient record online. Changes in the patient-doctor relationship, with the emergence of a more empowered patient role, have been suggested both as explanation and consequence to this development. However, few studies have focused on how important e-Health is considered to be for the users. Is it challenging the primary physician's position as the most important source of health information? How important is it for the patients that their primary physicians can provide e-health services, like e-mail, a web-site, and the possibility to send prescriptions via e-mail? The paper addresses these issues. It is based on data from a representative sample of the Norwegian population (N=1007), gathered in 2005. We will also look into who the typical Internet health surfer in Norway is, and how health related use of the Internet affect health behavior. The data reported in this paper is part of the project, "WHO/ European survey on eHealth consumer trends" (ehealth Trends), funded by the European Commission. Seven countries participate in the project; lead partner is the Norwegian Centre for Telemedicine (NST).
Christiansen, Ellen K
REFLECTIONS ON PROFESSIONAL SECRECY, DATA SECURITY AND PATIENTS' RESPONSIBILITY AND EMPOWERMENT
Christiansen, Ellen K
Norwegian Centre for telemedicine, Tromsoe, Norway
Many patients are unwilling to have their personal information distributed other than for purposes of clinical care. ------------------------------------
Confidentiality of patient information is today mainly taken care of through health care personnel's obligation to maintain professional secrecy and legal requirements for data security. If patient information goes astray, whatever the reason is, it might represent a breach of the health personnel's duty to conduct their work in accordance with requirements of professional responsibility and diligent care.
A patient is competent to exempt health personnel from the duty of confidentiality, but not to interfere with legal requirements for processing of their personal data.
The relationship between doctors and patients has been changing over time. One might say that patients tend to have changed from humble and insecure to participating and confident, while the doctor's role has somewhat altered the other way around.
Empowerment of patients has, among other factors, lead to a larger extent of patient participation, information and self-determination with regards to medical treatment. It is worth considering if this change of roles should influence processing of patient information, as well. To what extent should or could the patients take responsibility for the protection, processing and storing of their medical information themselves, alone or in co-operation with the public health care service?
The purpose of this presentation is to discuss if the changing of roles in the health care sector should influence the legislation in force, and if so, how and in what areas.
The issue for this presentation is relevant to "legal issues (and ethics) related to personal information and privacy".
EVALUATION OF E-HEALTH SYSTEMS IN PRIMARY HEALTH CARE CONTEXT: A PROPOSAL
Iluyemi A., Croucher R.
QMUL, London, United Kingdom
The use of Information and Communication Technologies (ICTs) in health care, research and services has been termed as E-health by the World Health Organization (WHO). Moreover WHO has explicitly stated in its various documents that E-health main focus is on primary health care (PHC) in the context of Alma Ata Declaration of PHC.
With the rapid development and pilot implementation of e-health projects in many countries of the world, it is highly imperative that E-health projects must address the issues of system or technical functions, human perspectives and organizational context in tune with the principles of Alma Ata Declaration of PHC before a wide scale implementation.
This is to ensure the sustainability of these projects and to inform policy for practice in the adoption of e-health in primary health care system especially in developing countries. This paper is in line with healthcare politics and strategies for the future theme of this conference.
In this paper a socio-technical model of evaluation based on the Donabedian SPO theoretical framework for health care quality and performance assessment that has been used in evaluating primary health care projects will be presented.
The aim of this paper is to present an evaluation model for e-health projects in primary health care settings and to propose for the adoption of this model as a framework for the implementation of e-health in primary health care.
WEARABLE BIOMEDICAL SENSORS IN A TELE-HOME-CARE CONTEXT, A FORESIGHT SCENARIO
Fensli R.(1), Gunnarson E.(2), Gundersen T.(3)
1 - Agder University College, Faculty of Technology and Science, Grimstad, Norway
2 - Ullevaal University Hospital, Department of Anaesthesia, Oslo, Norway
3 - Sørlandet Sykehus HF, Medical department, Arendal, Norway
In this paper a foresight scenario is developed describing how wearable biomedical sensors can be used in a tele-home-care situation in order to give a conspicuous clinical usefulness of the technology. New possibilities for improved interactions between different health-care levels can easily be obtained, where the regular General Practitioner (GP) will play an important role together with the local communities' health care service. The scenario will have a focus on the patient's use of new tele-medical solutions both for monitoring purposes and for actively performing dynamic electronic communication with health care personnel.
Development of wireless biomedical sensors has been focused in several international research projects (1), and much effort has been made on technical issues where different proprietary solutions are dominating the arena. In order to obtain efficient solutions, the services developed should be based on some standardization principles, and need to be implemented within the framework of a National Health Network.
Description of work to be presented
Trends in developing new wearable biomedical sensors will be highlighted, where small multi-parameter sensors can be sticked to the patient's skin for continuous monitoring of different kind of vital sign parameters, with automatic anomaly detection and wireless transmission of recorded events to a clinical diagnostic system at the hospital (2). The home nurse services together with the GP as the responsible doctor will play an important role, but trends shows a challenge in patient's involvement where they are taking a more active part of the treatment by increased knowledge and in close electronic interaction with the health care services.
Signals of the monitoring parameters will be automatically transmitted, but the patient will require an electronic feedback from the health care service. This information will give him evaluations of the actual situation detected and how the he should behave with medication etc. Such solutions need to be incorporated within the framework for a patient's "Individual care plan" and collaboration among professionals. A future "core" electronic health record (C-EHR) is described (3, 4), and the patient should be given access to this system where he can store his medical diary and can define access to the medical care personnel involved in the treatment. Secure solutions can be based upon a model of Spatial Role Based Access Control (5), where factors as the recorded events, the observed patient's medical condition, time and location are important parameters in order to give the care givers and rescuing personnel automatic access to the C-EHR in situation where this is needed for efficient patient care. This will require a clarification of roles and legal access to the C-EHR, where automatic escalation and changes will be dependant upon the patient's actual medical situation observed, in order to obtain a secure but flexible solution to the information needed.
1. Rubel P, Fayn J, L S-C, Atoui H, Ohlsson MT, D, Adami S, et al. New paradigms in telemedicine: ambient intelligence, wearable, pervasive and personalized. Stud Health Technol Inform 2004;108:123-32.
2. Fensli R, Gunnarson E, Gundersen T. "A Wearable ECG-recording System for Continuous Arrhythmia Monitoring in a Wireless Tele-Home-Care Situation." In: The 18th IEEE International Symposium on Computer-Based Medical Systems; 2005 June 23-24, 2005; Dublin, Ireland; 2005. p. 407-12.
3. Valerie Austin et al., "Core Data Sets for the Physician Practice Electronic Health Record", Techreport: American Health Information Management Association (AHIMA), 2003. Available online at: http://library.ahima.org/xpedio/groups/public/documents/ahima/pub_bok1_021607.html
4. Torbjørn Nystadnes, "Legemiddelopplysninger i Samtykkebasert kjernejournal", Techreport: Kompetansesenter for IT i helse- og sosialsektoren (KITH), 2005.
5. Frode Hansen and Vladimir Oleshchuk, "Security Model for Wireless Environments based on Spatial RoleBased Access Control", In : SKLOIS Conference on Information Security and Cryptology (CISC2005), Beijing, China, December 15-17, 2005.
Relevance to the conference topics
This work addresses primarily the future of healthcare and well-being where new possibilities are highlighted, but also innovations within telemedicine and e-health are addressed.
THE TELEMEDICINE ORGANIZATION: HOW TO MAKE IT WORK
The Work Research Institute, Oslo, Norway
Organizational issues are important when new technology is implemented. In the telemedicine community organizational issues have been given much attention. In Norway two larger empirical materials have been collected. More than 30 publications have appeared, of which many are found in international journals.
On the basis of two developed questionnaires qualitative interviews were performed of people involved in teleradiology and telemedicine remote consultations.
The studies are very rich in findings. Many organizational consequences and many types of organizational consequences have been identified. Examples of relevant organizational issues are: telemedical work and co-operation, the important role of centralization and decentralization for regional organization of telemedicine, organizational consequences in cooperating organizations, changes in the job situation, learning and the relevance of learning organizations.
Solutions exist to the organizational problems, but organizations must learn how to adapt organization. For the future of telemedicine organizational factors will be decisive. In future managers cannot rely on champions to obtain a larger volume of telemedicine, but must involve themselves substantially in organizational work. The research has contributed to a considerably changed image of organization and telemedicine.
SUPPORTING MOBILE COMMUNICATION IN HOSPITALS
Hasvold, P.(1&2), Henriksen, E.(1), Scholl, J.(1), Ellingsen, G.(2)
1 - Norwegian Centre for Telemedicine, Tromsø, Norway
2 - University of Tromsø, Tromsø, Norway
Most hospitals rely on a mobile communication infrastructure based on paging systems. Pagers offer a cheap and reliable way of contacting staff, but suffer from limitations due to their simplicity. The most obvious is that they require staff to locate a telephone before initiating a conversation. They also frequently cause unnecessary interruptions, which can be particularly time consuming for health care workers.
Alternatively, studies have shown potential benefits for mobile phones (Spurck et. al, 1995) and text messaging (Eisenstadt et. al, 1998) when deployed in hospitals. However, despite their tremendous popularity in other areas of society these technologies see little or no use in hospitals where the traditional paging system is notoriously difficult to replace.
A likely explanation is social and organization consequences of their use that are not generally considered. Accordingly, a better understanding of how current paging systems work in hospitals seems prudent. Based on a Computer-Supported-Cooperative-Work (CSCW) approach, we analyse the role of a current paging system in the Department of Oncology at the University hospital North Norway. A methodology based on a case study is applied that draws on participant observation and interviews of medical personnel.
Finally, we offer some implications for design for the adoption of mobile technologies in general, and for improved medical paging systems (instant messaging) in particular.
Spurck PA, Mohr ML, Seroka AM and Stoner M; The impact of a wireless telecommunication system on time efficiency. J Nurs Adm. 1995 Jun;25(6):21-6.
Eisenstadt, S.A., Wagner, M.M., Hogan, W.R., Pankaskie, M.C., Tsui, F.C., Wilbright, W. Mobile workers in healthcare and their information needs: are 2-way pagers the answer? (1998): Proceedings AMIA Symposium 1998, AMIA Press, pp. 135-139.
EMPOWERING PATIENTS BY INTRODUCING MOBILE DATA TERMINALS IN HOME CARE SERVICES AT NORTH CALOTE
Norwegian Centre for Telemedicine, Tromsoe, Norway
Patient empowerment was one of the main objectives of the e-Home Health Care at North Calote project (2003-2006), which was organized as coordinated trials in 5 municipalities of N. Finland, N. Norway and N. Sweden. The project aimed at increased quality and precision of client information handeling in home care by introducing mobile ICT equipment to the professional health workers. The data equipment allowed uploading as well as downloading of individual client information together with the patients. A change in professionals' client information handling was expected as a consequence of new tool application, along with a modification of staff/staff as well as staff/patient communication patterns.
We have investigated the impact of introducing mobile data terminalson the professionals' information handeling - asking how modifications of communication routines are likely to influence the professional/patient relation. How is the introduction of ICT in home care services likely to alter the patientss' influence on service production at North Calote according to the involved parties? A structured questionnaire to clients, their families and professionals and the organizing and in depth interviewing of focus groups as an integral part of each trial constitute the basis of the inquiry. In this paper, we outline a model for reasoning about patient empowerment, and we discuss how present professional practices fit the "ideal type" of patient empowering home care services. We suggest a vision of the future where clients are provided access to the electronic system - offering the professionals their feedback on service delivery.
Keywords: Empowerment, user participation, home care, e-health
USER EXPERIENCE DESIGN GUIDELINES FOR TELECARE SERVICES
Bruno von Niman, Torbjørn Sund*, Alejandro Rodríguez-Ascaso, Steve Brown and Paul Garner
ETSI Specialist Task Force 299 and 264 560, Route des Lucioles, Sophia Antipolis, France
Western populations are ageing, with a corresponding increase in the pressure on the health system. Telecare can contribute to relieve this pressure, by enabling dependent people to live outside of institutions proportionately longer. Telecare also has very beneficial effects for the citizens, giving them freedom to move, more self-reliance, lessened anxiety, and the possibility to obtain personal attention on demand .
Technical progress has made possible very sophisticated ICT-based telecare products and services. However, the technical proficiency of the intended end user may not have followed. In addition, the user may have physical, sensory or cognitive impairments that render normal interaction difficult or impossible. For telecare systems to be widely accepted, it is therefore especially important that all aspects of the human experience are taken into account.
Many elements must be considered in the evaluation of the user experience of a telecare system: User confidence in the equipment and the service, device setup, initial configuration, calibration and maintenance, ease of use, organizational and cultural issues, how to get in contact with a human carer, physical characteristics of the equipment, and accessibility and mobility issues, to mention some [2, 3]. This paper will report from work in progress performed by a Specialist Task Force set up by the European Telecommunications Standards Institute (ETSI), to develop user experience and user interface guidelines applicable to a wide range of telecare systems. It progresses from a previous work published as an ETSI Technical Report. It is expected that, when finished, these guidelines will promote the usage of telecare.
Key words: e-Inclusion, eHealth, Telecare, User experience.
 ETSI TR 102 415: Human Factors (HF); Telecare services; Issues and recommendations for user aspects
 European Commission, Directorate General Information Society: "Report from the Inclusive Communications (INCOM) subgroup, Working Document (January 2004)".
 CEN/CENELEC Guide 6: "Guidelines for standards developers to address the needs of older persons and persons with disabilities".
TELECARE - PRACTICAL EXPERIENCES WITH VIDEO COMMUNICATION IN HOMECARE
Pfeller, T 1
, Huber, E 2
, van Venrooij, B 3
1 - SCOTTY Group Austria, Grambach, Austria
2 - Volkshilfe, Graz, Austria
3 - Sensire, Doetinchem, the Netherlands
Video Communication can be seen as a supplement to the home visits of nurses and carers. The basis of home care will always be personal contact and presence. Video communication as additive can increase the efficiency of home care whilst increasing the quality at the same time.
This presentation will summarize the experiences gained in two independent projects, detailing the process of implementing such video systems, discussing the reasons for success and failure, and provide an outlook on future applications.
Elderly clients accept new technology more easily when it is user-friendly and they are not forced to learn complicated processes of handling the different parts of the video system. The more benefits it offers to the users the greater the acceptance of video communication is. Clients report that they feel more secure in the knowledge that they have permanent direct access to a nurse through a video connection.
Video technology, once adapted to the elderly patient's needs, does not necessarily represent a hurdle. Its acceptance does very much depend on how carefully the user is guided by his/her care provider and on his/her environment (family, friends) motivating him/her to make use of the system.
Combining video communication with data acquisition will be a further step towards Telecare. Implementing medical devices such as blood pressure monitors, blood glucose monitors, Bluetooth electrocardiogram (ECG) belts, etc. will improve the lives of patients with chronic diseases.