E – HEALTH APPLICATIONS
*telehealth has both clinical and nonclinical uses*
Non-clinical applications: professional education, healthcare administrative duties,
research, and the aggregation of health data excluding patient-specific medical treatments
and decisions
Clinical applications: medical decisions involving patient care, diagnostics, and treatment
- Applications can be specialized such as with telepathology, telepsychology, or remote
patient monitoring services for ICUs in acute care facilities,
o Forging new relationships between patients and all types of practitioners;
moving care out of the physician-centric perspective into the twenty-first
century model of healthcare seeing more consumer empowerment
Impact of the Web
- Two online activities common to people living with chronic diseases include blogging
and online health discussions *show pics*
o Having a chronic disease significantly increases the likelihood that the user will
use the Web to read and share information
Consumer Engagement
The National eHealth Collaborative (2012) developed the Patient Engagement Framework to assist
healthcare organizations in developing a strategic plan to incorporate eHealth tools and resources
as part of an overall engagement strategy
Managing Health Conditions and Accessing Resources
- Electronic resources are being used to learn about and manage health conditions
“when controlling for age, income, education, ethnicity, and over- all health status,
internet users living with one or more conditions are more likely than other online adults
to:
o Gather information online about medical problems, treatments, and drugs
o Consult online reviews about drugs and other treatments
o Read or watch something online about someone else’s personal health experience
Transforming the Practice of Healthcare
Wearable and Portable Monitoring Systems
• VitalJacket -utilizes microelectronics n a wearable T-shirt that continuously
monitors electrocardiogram waves and heart rate
shirt can be used for patients or for healthy subjects involved in fitness
activities or sports
• BodyMedia - wearable monitoring system focusing on weight loss, health, and
fitness
armband has sensors that collect heat flux, galvanic skin response, skin
temperature, as well as an accelerometer. Utilizing a USB cable, one can
sync the data with Activity Management software where it is stored and can
be tracked by the user
• Health Buddy System - remote monitoring platform that provides a daily
interface between care coordinators and patients with chronic illnesses
o connect glucose meters, weight scales, blood pressure cuffs, and other
medical devices so additional patient data are sent to the healthcare
professionals;
o Health Buddy has been used with a variety of patients including
coronary artery bypass graft, chronic heart failure, diabetes, and
asthma; Care providers access data that can provide an early alert of
warning signs that the patient is deteriorating; it addresses gaps in care
before the patient becomes critical
Telenursing and Decision Support Tools
Telenursing is broadening the role of nurses and advancing their value in the chain of
healthcare delivery to consumers in remote regions or to homebound patients
o Home health nursing via visual communication is a technique that provides
accessible care and reduces both travel time and expense
Using videophones, the nurse and patient can establish a more personal
relationship. Images can be transmitted interactively from the patient’s
home directly to attending physicians, improving follow-up and treatment
for things such as leg wounds. This technology can be used to plan care
interventions and to train patients and their caregivers. Utilizing field notes,
photos, and video- recorded dialogs, all care provider can easily follow any
changes in leg wounds.
o Teletriage - component of telenursing wherein decision support tools have been
developed as a guide for the teletriage nurse assessing a patient
o Utilizing these decision support tools, along with nursing judgment and critical
thinking skills, helps minimize risk when providing telephone assistance
o For example: the Medicare Quality Improvement Community (MedQIC) Web
site
has a free online teletriage resource toolkit to support consistent and
appropriate teletriage assessments for many conditions including
adverse drug reaction; breathing difficulty; depression; feeding tube
problems; nausea, vomiting, and fluid loss; wound drainage; and pain
management
Possibility of Virtual Worlds
o Web-based 3D virtual worlds could act as a potential tool to engage a variety of audiences
in healthy behavior and lifestyle choices regardless of location
These tools are also being used as a new educational method for the healthcare
professions that will help facilitate learning through interactive, collaborative
learning environments
o The 3D worlds are created online using a virtual persona, or avatar, which interacts with
other avatars in the online world
o The Centers for Disease Control and Prevention (CDC) has established a Second Life island
where users can see streaming videos and access links to information
The island has a virtual lab and conference center
Health Portals and Web 2.0
Support groups are using the Web as a new platform to organize, share experiences, seek
online counseling, and simply connect with others
o Web sites such as Facebook, Twitter, and MySpace are now being utilized by
healthcare providers as a place to engage with colleagues on clinical and non-clinical
issues.
Hospital portals are being developed where patients can make appointments, renew
prescriptions, and review test results and their medical records online
o Example: My Healthevet
which offers veterans, active duty service members, their dependents, and
caregivers access anytime to VA healthcare information and services that
include tracking tools and journals to help the user track their health
activities
o WebMD
is a consumer portal that is a leader in providing online health information. It
provides the ability to browse condition-specific and wellness-related topics.
Individuals have the ability to participate in moderated exchanges where they can
get expert feedback on a variety of topics such as osteoporosis, skin problems, and
gynecology problems.
o PatientsLikeMe
is a popular social networking site. This site contains communities that have been
developed to allow patients to become proactive. The community forums include
patients, doctors, and organizations. Users learn about treatments and symptoms,
and can participate in the forum or have one-on-one discussions, and was developed
for individuals with life-changing diseases such as Amyotrophic Lateral Sclerosis
(ALS), Parkinson disease, and epilepsy
mHealth Applications
Wireless communication technologies are forcing a transformation in how and where
healthcare is delivered
o The abilities to collaborate, share high-resolution images, and even have live
broadcasting of surgeries are all enabled by new technologies.
Applications areas for mHealth include consumer education, emergency response systems,
professional and patient communications (e.g., text messaging, e-mail, social networking),
health promotion and community mobilization, and public and population health
mHealth growth has been around the world with significant demand from “bottom-of-the-pyramid”
consumers located in rural areas. Pilot projects are ongoing in countries such as Indonesia, Brazil,
Sudan, and Uganda. In Africa, health personnel use mobile phones to provide emergency medical
care; their phones use solar charges. A toll-free mobile service is being launched in remote areas of
Tanzania, Kenya, and Uganda. In developing economies, mHealth will be a major part of eHealth.
mHealth will need to be integrated into the training of healthcare workers, so professionals have the
knowledge and skills required to use the technology safely and effectively
