CHAPTER 22

INFORMATICS AND
THE HEALTHCARE
INDUSTRY
Presented By : Allyssa Leila Orbe
 OBJECTIVES

1. Define concepts of eHealth, telehealth, and mHealth.

2. Explore applications of eHealth for healthcare, education,
and research.
3. Examine evidence on the impact of eHealth in health
promotion and health maintenance.
4. Analyze the transformational nature of eHealth within the
healthcare industry.
5. Discuss a telehealth case study.
 HISTORICAL CONTEXT OF
EHEALTH
The rudimentary roots of telemedicine extend back to ancient times
where simple forms of distance communication, such as the use of
light reflections and smoke signals, were used to relay messages
about external threats, famines, and disease
Long-distance communication evolved from these modest
beginnings to systems such as the telegraph, radio, and onward to
advanced digital communication and communication systems.
Telehealth applications have evolved from simple communications
to sophisticated, pervasive, and widespread systems in the home that
make use of wireless, wearable, robotic, and multi-sensorial
technologies.
 HISTORICAL CONTEXT OF
EHEALTH
In the past, trends in telehealth applications were grouped according
to the various media: voice, data, and video.
Tools of telemedicine offer effective and efficient solutions for remote
monitoring of the chronically ill, as well as an avenue to allow for
diagnosis and treatment of individuals who have no access to
healthcare because of geographic limitations.
 THE CONCEPT OF EHEALTH
eHealth is an emerging field of medical informatics, referring to the
organization and delivery of health services and information using
the Web and related technologies.
In a broader sense, the term characterizes a number of things
eHealth represents optimism, allowing patients and professionals to
do what was previously impossible
eHealth technologies provide opportunities for customized and
meaningful communication, enabling patients to receive individually
tailored information that can be viewed and responded to at their
convenience.
Patients can also post their comments and advice to virtual
communities
 THE CONCEPT OF EHEALTH

eHealth opens doors for new types of relationships

e-Health is the single-most important revolution in healthcare since
the advent of modern medicine, vaccines, or even public health
measures like sanitation and clean water”
 THE CONCEPT OF TELEHEALTH

The American Telemedicine Association (ATA) uses the terms

telemedicine and telehealth interchangeably.
Telemedicine is the use of information exchanged from one site to
another via electronic communications to improve patients’ health
status.
Telehealth is often used to encompass a broader definition of remote
healthcare that does not always involve clinical services
Telehealth can be considered another component of the eHealth
concept
 THE CONCEPT OF TELEHEALTH
Teleconferencing and digital networking systems are now merging,
giving rise to “group consultation” opportunities
There is agreement that telemedicine is “the delivery of personal and
non-personal health services and education as well as a means for
safeguarding the living environment via information and
communication technology
 THE CONCEPT OF MHEALTH
Another component of eHealth is mobile-health (mHealth), which
can be considered a delivery mechanism for eHealth
mHealth typically refers to the use of a wireless communication
device that supports public health and clinical practices (Eytan,
2010; TBHome, 2010)
Waegemann (2010) views mHealth as the new generation of
telemedicine that is laying the foundation for a new generation of
healthcare
He describes eHealth as having a focus on using electronic medical
records and other technologies, while mHealth focuses on
behavioral and structural changes
As mHealth continues to progress, nursing care will need to evolve
 EHEALTH APPLICATIONS
Telehealth has both clinical and non-clinical uses.
Non-clinical applications include professional education; healthcare
administrative duties; research; and the aggregation of health data,
excluding patient-specific medical treatments and decisions.
Clinical uses include medical decisions involving patient care,
diagnostics, and treatments.
These two categories are somewhat blurred as patients and providers
exchange e-mail
Telehealth applications can be specialized, such as with telepathology,
telepsychology, or remote patient monitoring services for ICUs in
acute care facilities
Telehealth is moving care out the physician-centric perspective into
the 21st century model of healthcare that will see more consumer
empowerment
 IMPACT OF THE WEB
Today, 85% of American adults (ages 18 and older) are using the
Web
A 2010 Pew Internet and American Life Project study indicates 89%
of adults with no chronic diseases go online, while only 72% of adults
living with chronic disease are likely to access to the Web (Fox &
Duggan, 2013)
Chronic disease is typically associated with being older, African
American, less educated, and living in a lower-income household
Two online activities that are common among people living with
chronic diseases are blogging and online health discussions
Having a chronic disease significantly increases the likelihood that
the user will use the Web to read and share information
“Nuggets” of information are discovered via these online discussion
groups; individuals in the groups connect and they “just keep going”
 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
The framework includes five phases
 MANAGING HEALTH CONDITIONS
AND ACCESSING RESOURCES
Electronic resources are being used increasingly to learn about and
manage health conditions
Internet users living with one or more conditions are more likely
than other online adults to:
Gather information online about medical problems, treatments, and
drugs.
Consult online reviews about drugs and other treatments.
Read or watch something online about someone else’s personal
health experience” (Fox & Duggan, 2013).
Those with chronic conditions are more likely to fact check
information found on the internet with their clinicians
TRANSFORMING THE
PRACTICE OF
HEALTHCARE
 WEARABLE AND PORTABLE
MONITORING SYSTEMS
The VitalJacket utilizes microelectronics in a wearable T-shirt that
continuously monitors electrocardiogram waves and heart rate
A system available today from BodyMedia is a wearable monitoring
system that focuses on weight loss, health, and fitness. The armband has
sensors that collect heat flux, galvanic skin response, skin temperature, as
well as an accelerometer.
Health Buddy System is a remote monitoring platformer that provides a
daily interface between care coordinators and patients with chronic
illnesses; this system has a proven track record over the past decade. The
appliance can also connect glucose meters, weight scales, blood pressure
cuffs, and other medical devices so additional patient data are sent to the
healthcare professionals
 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
Home health nursing via visual communication is a technique that
provides accessible care and reduces both travel time and expense
Teletriage is a component of telenursing. Decision support tools have
been developed as a guide for the teletriage nurse assessing a patient.
These tools provide the nurse with structure around the teletriage
processes. Utilizing these decision support tools, along with nursing
judgment and critical thinking skills, helps minimize risk when providing
telephone assistance
 POSSIBILITY OF VIRTUAL
WORLDS
Web-based 3D virtual worlds are
currently being investigated 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
The 3D worlds are created online using
a virtual persona, or avatar, which
interacts with other avatars in the online
world
 HEALTH PORTALS AND WEB 2.0
Web 2.0 social networking sites such as Facebook, Twitter, YouTube,
and MySpace are proliferating
Hospital portals are being developed where patients can make
appointments, renew prescriptions, and review test results and their
medical records online
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
PatientsLikeMe is a popular social networking site. This site contains
communities that have been developed to allow patients to become
proactive. Users can learn about treatments and symptoms, and can
participate in the forum or have one-on-one discussions.
 MHEALTH APPLICATIONS

Wireless communication
technologies are forcing a
The rapid and pervasive transformation in how and
worldwide adoption of where healthcare is
mobile cellphones is going to delivered. The abilities to
drive tremendous growth in collaborate, share high-
handheld healthcare over resolution images, and even
the next decade have live broadcasting of
surgeries are all enabled by
new technologies
 IMPACT OF EHEALTH APPLICATIONS
11 Transforming the Way We Learn
Web-based educational programs are changing the way consumers and
healthcare providers learn
The role of the nurse as a patient and consumer educator in the digital age is
1 evolving as well

2 Transforming Healthcare Delivery

Electronic Data Exchange. Advances in eHealth and the growing use of
electronic health records have contributed to the realities of health data
exchange
Payment Reform Through Meaningful Use. The HITECH Act also introduced
the concept of “meaningful use.” The idea was that not only should providers
use electronic records within their practices, they should make use of the
 IMPACT OF EHEALTH APPLICATIONS
13 Transforming Emergency Preparedness and Response
During a disaster situation, the use of telehealth technology would allow
clinicians to provide healthcare services remotely
Advanced wireless electronic technologies are the quickest vehicles to
1 communicate needs during emergency situations

2
 EHEALTH CHALLENGES AND ISSUES
Innovations in eHealth do not come without challenges and issues that healthcare
professions must address. As the transformation of healthcare moves toward patient-
13
centric models, the healthcare professionals must resolve some key challenges and
issues. These issues concern on legal, ethical, and public policy arenas

1 Licensure
1 The lack of infrastructure for interstate licensure was a key impediment to the
growth of telehealth

2 Ethical Issues
The predominant ethical issues concerning telehealth are privacy,
confidentiality, and security
It is imperative that providers and healthcare systems establish policies
concerning privacy, confidentiality, and security as they create systems to
facilitate patient-centered care through the provision of eHealth.
EMERGING ISSUES AND CHALLENGES
For all the possibilities it presents, eHealth does come with challenges,
including privacy concerns, equity across populations, and the need to
define a new type of relationship between the patient and healthcare
provider
Disparities in healthcare and access to care still persist and a true
solution eludes us
Reimbursement for telehealth interventions and a positive cost–benefit
ratio are necessary before providers can consider adopting
technological innovation into their practice environments
REGULATION OF MHEALTH APPLICATIONS
A recent development regarding mHealth is ruled by the U.S. Food and
Drug Administration (FDA, 2013) to regulate a small segment of these
applications. The FDA is interested in regulating mobile medical
applications that meet the definition of a medical device, are intended
to be used as an accessory to a regulated medical device, or transform a
mobile platform into a regulated medical device

PUBLIC POLICY
The American Telemedicine Association (2014) outlined guidelines to
“advance the science, to assure uniform quality of service to patients,
and to promote reasonable and informed patient and provider
expectations.” These guidelines include administrative, clinical, and
technical recom-endations designed to provide a safe, quality,
telehealth experience.
 CONCLUSION
Without a doubt, eHealth applications will
proliferate in the future. Healthcare
professionals need to seize the opportunities
made possible by advanced technologies
wnd create powerful and human-centered
applications to facilitate consumers’ full
participation in health and wellness. To
evolve this process, healthcare professional
need to be actively involved in resolving
challenges, shaping public policy, and
evaluating health outcomes.
THANK YOU!
Presented By : Allyssa Leila E. Orbe