Presentation on theme: "ARA Online Audiologic Rehabilitation Perry C. Hanavan. MA, FAAA Augustana College Sioux Falls, SD ARA Summer Institute 2001 Vancouver, BC June 7-10, 2001."— Presentation transcript:
ARA Online Audiologic Rehabilitation Perry C. Hanavan. MA, FAAA Augustana College Sioux Falls, SD ARA Summer Institute 2001 Vancouver, BC June 7-10, 2001
ARA Africa Every morning in Africa, a gazelle wakes up. It knows that it must run faster than the fastest lion, Or it will be killed. Every morning in Africa, a lion wakes up, It knows that it must outrun the slowest gazelle, Or it will starve to death. It doesn’t matter whether you’re a lion or a gazelle, When the Sun comes up in the morning, you’d better be running.
ARA World E-Commerce and Internet Market Report Top five countries in each new-economy indicator category: Financial transactions - Amount of credit cards issued per person, per year and credit card spending -- Iceland, Luxembourg, U.K., US and Canada. Literacy and education rates - Ability to meet the educational needs of a competitive economy -- Finland, Australia, Canada, Iceland and the US. Market potential - Measures standard of living and retail sales -- US, Finland, Iceland, Canada and Taiwan. Globalization - Willingness to accept foreign economic influence and embrace the global capital market -- Netherlands, Hong Kong, Finland, Ireland and Sweden. Technological sophistication -- Number of computers and Internet connections — US, Finland, Iceland, Canada and Taiwan.
ARA What is the Internet "The Internet isn't about wires and tubes. In effect, it's about change. A whole host of things in our world are just waiting to be changed, longing for better solutions, and the Internet is the stimulus, and perhaps the means, to unleashing these pent-up desires, trends, and forces to their next natural state.” Weintaub, JN. (1997) Capital thoughts. Internet World, March
ARA They’re Here! “As audiologists we need to adjust our model…The internet is the tool not the solution that will pave the way for the new model.” (Glen Meier) Northern, JL. (2001) Hearing services on the internet: They’re here! Audiology Today. 13(2):7.
ARA Old Technology It’s not how hard you work… It’s how much work you get done.
ARA Why Consider Online AR? Online AR information is apart of the global resources that constitute the Internet Online AR information is easily accessed –Search engines (Google, AltaVista, HotBot) –Directory services (Yahoo) (SearchWave) –Professionals, organizations, business, government, laypersons have created resources Consumers, professionals, and others want access to online AR information Improve audiologist-patient relationships
ARA High Tech High Touch Service Healthcare consumers experiences before, during or after visits to their physicians: forgetting to ask all their questions during doctor visit (60%), having to see doctor in person to ask questions that could be answered by telephone or e-mail (41%), getting through to someone who could answer questions (35%), providing the same information over and over again each visit to doctor’s office (35%), not having enough time with doctor (29%). http://www.harrisinteractive.com/about/healthnews/HI_HealthCareNews-V1- Issue1.pdf
ARA High Tech High Touch Online population would like to receive e-mail reminders for preventive care (81%), Follow-up e-mails after visits to doctors (83%) For their doctors to be able to access and monitor their lab tests online (84%). http://www.harrisinteractive.com/about/healthnews/HI_HealthCareNews- V1-Issue1.pdf
ARA Time Spent by Professionals Average Amount of Time Professionals Spend Explaining Details of Hearing Test Results ---------------------------------------------------------------------------------- TopicOtoAud ---------------------------------------------------------------------------------- Shortest time in minutes (mean)5.865.94 Range.25-300-30 Average (minutes)11.9512.41 Range2-602-75 Longest time in minutes (mean)25.7226.94 Range3-1204-120 Martin, FN, Bar, MM, and Bernstein, M. (1992). Professional attitudes regarding counseling of hearing-impaired adults. American Journal of Otolaryngology. 13(3): 979-287.
ARA Time Spent by Professionals Average Amount of Time Professionals Spend Explaining Implications of the Hearing Impairment ---------------------------------------------------------------------------------- TopicOtoAud ---------------------------------------------------------------------------------- Shortest time in minutes (mean)6.916.81 Range0-7.40-30 Average (minutes)13.5713.89 Range1-3002-75 Longest time in minutes (mean)31.3232.55 Range2-6004-240 Martin, FN, Bar, MM, and Bernstein, M. (1992). Professional attitudes regarding counseling of hearing-impaired adults. American Journal of Otolaryngology. 13(3): 979-287.
ARA Internet Applications of AR E-mail Electronic Support Groups –Discussion groups –Listservs –Forums –Chats World Wide Web
ARA E-mail and AR Person to person communication TeleAR –Video clip attachments –Digital photo attachments –Document (forms) attachment
ARA Electronic Support Groups Professional to consumer Consumer to consumer
ARA WWW Text Graphics Videos Simulations Virtual reality Forms Interactive programs
ARA Online AR Patient diaries Educational information FAQs Electronic support groups Forms Scheduling information Maps (directions) Resources
ARA Profusion of Web Content Information is only as useful when relevant to problem, valid, and easy to access Slawson formula: Usefulness=relevance x validity/work to access Slawson, DC, Shaughnessy, AF, and Bennet, JH. (1994). Becoming a medical information master: feeling good about not knowing everything. Journal of Family Practice. 38:505-13
ARA Telemedicine applications Video-otoscopy captures the image The use of live video teleconferencing to evaluate and treat patients in-house preliminary results show no difference in outcomes Burgess LP, Holtel MR, Syms MJ, Birkmire-Peters DP, Peters LJ, Mashima PA. (1999) Overview of telemedicine applications for otolaryngology. Laryngoscope. 109(9):1433-7
ARA Electronic Mail 70 inquiries from published web site –39 patient inquiries –20 family inquiries –11 unknown relationship 1.3 (avg) inquires per week 2 (avg) messages to follow-up (range 1-10) 2 (avg) number of replies (range 1-9) Widman, LE and Tong, DA. (1997) Request for medical advice from patients and families to health care providers who publish on the world wide web. Archives of Internal Medicine. 157:209-212. 96% – identified qualified consultant in area of cardiology 74% - identified the author’s expertise of arrhythmias 70% sought a second opinion 21% sought advice whether to consult a physician
ARA Electronic Mail 44 - diagnosis and management of cardiac arrhythmias 8 - recording procedures 5 - diagnosis and management of coronary artery disease 10 - other areas of clinical cardiology 2 - general internal medicine 1 - neurology Widman, LE and Tong, DA. (1997) Request for medical advice from patients and families to health care providers who publish on the world wide web. Archives of Internal Medicine. 157.209-212. 15 - help in establishing a diagnosis 14 - select or understand therapy for established diagnosis 1 - understand prognosis 6 - obtain information about a disease or medication
ARA Electronic Mail Conclusions: –Individuals can identify qualified consultants outside local health care system and communicate directly with provider Widman, LE and Tong, DA. (1997) Request for medical advice from patients and families to health care providers who publish on the world wide web. Archives of Internal Medicine. 157:209-212.
ARA Why Email and AR? Public is well-educated, curious, and used to seeking health care from printed media HMO’s have financial disincentives to provide needed treatments, lack referrals to specialists, etc. Traditional insurance plans may not pay for or pay only a portion of services, therefore, patients are verifying necessity of proposed evaluations Lack of resources in rural or remote areas, globally
ARA Electronic Mail Ethical issues – duty to respond, increasing growth of Internet users Compensatory issues – overhead, academic credit, professional societies Legal issues – no legal responsibility to respond, disclaimer, saved as medical record, state and foreign country laws Confidentiality issues – non-encrypted records, printed and saved as medical record, not released to others without consent Information Quality issues – expert source, educate layperson about information quality on the Internet D’Alessandro, DM, D’Alessandro, MP, Colbert SI. (2000) A proposed solution for addressing the challenge of patient cries for help through an analysis of unsolicited electronic mail. Pediatrics. 105(6): http://www.pediatrics.org/cgi/reprint/105/6/e74.pdf http://www.pediatrics.org/cgi/reprint/105/6/e74.pdf
ARA Electronic Support Groups Six-level system in information-age health care, patient-consumers may seek what they need in the following order: individual self-care, family and friends, informal self-help networks, the professional as coach, the professional as partner, professional as authority. Ferguson T. (1997) Health online and the empowered medical consumer. Jt Comm J Qual Improv 23(5):251-7
ARA Electronic Support Groups Benefits: getting information, sharing experiences, receiving general support, venting feelings, gaining accessibility, using writing. Disadvantages: "noise," negative emotions, large volume of mail, lack of physical contact and proximity. Han, HR and Belcher, AE. (2001) Computer-mediated support group use among parents of children with cancer--an exploratory study. Computers in Nursing 19(1):27-33.
ARA Electronic Support Groups Impact of Internet use on coping ability of HIV patients found three themes: Internet promotes empowerment, augments social support, facilitates helping others Reeves, PM. (2000) Coping in cyberspace: the impact of Internet use on the ability of HIV-positive individuals to deal with their illness. J Health Commun. 5 Suppl:47-59
ARA ESG – CF Teens Teenagers with chronic disease will actively participate in ESG ESG helped meet psychosocial needs Management of ESG was extremely easy ESG utilized inexpensive technology Patients who are difficult to assemble in one physical location may benefit from participating in an electronic support group (ESG). Johnson KB, Ravert RD, Everton AE. (2001). Hopkins teen central: Assessment of an internet-based support system for children with cystic fibrosis. Pediatrics. 107(2): E24 http://www.pediatrics.org/cgi/reprint/107/2/e24.pdf http://www.pediatrics.org/cgi/reprint/107/2/e24.pdf
ARA Electronic vs Traditional SG Traditional Support Group Barriers: –Practical -- travel, transportation, schedules –Medical -- health factors, weakness –Stylistic -- incongruent attitudes Electronic Support Group Barriers: –Computer with Internet connection –Computer skills –Visual acuity and finger dexterity –Lack of non-verbal communication Weinberg, N Schmale, J, Uken, J, Wessel, K. (1995) Computer- mediated support groups: Social work with groups. Social Work with Groups. 17(4):43-45.
ARA Electronic Support Groups http://groups.yahoo.com http://groups.google.com/ (fomerly www.deja.com)http://groups.google.com/ http://www.topica.com/
ARA CI Electronic Support Groups email@example.com http://groups.yahoo.com/group/ci http://groups.yahoo.com/group/cifamily http://groups.yahoo.com/group/CI-Prelinguals http://groups.yahoo.com/group/citeens-preteens http://groups.yahoo.com/group/ProblemCI firstname.lastname@example.org http://www.delphi.com/parentsclarion/start/ http://www.topica.com/lists/cochlearimplants/
ARA Specialty Electronic Support Groups http://groups.yahoo.com/group/AuditoryNeuropathy http://www.topica.com/lists/menicircle/
ARA HOH Electronic Support Groups http://groups.yahoo.com/group/HOH-LD-News/ http://groups.yahoo.com/group/LDAchat/join http://groups.yahoo.com/group/Hearing_Aids http://groups.yahoo.com/group/Listen-Up http://groups.yahoo.com/group/USA-L_News http://groups.yahoo.com/group/hear http://groups.yahoo.com/group/bhNEWS http://www.hearinglossweb.com/ alt.support.hearing-loss (groups.google.com)alt.support.hearing-loss email@example.com subscribe firstname.lastname@example.org The Hard of Hearing / Deafened Live Forum (AOL)
ARA Web Content assessed quality of information a lay person could obtain from Internet sources regarding the treatment of childhood diarrhea low percentage of concurrence with the AAP guidelines medical institutions, schools, and hospitals need to devise ways to carefully monitor and establish quality control of what is being distributed from their home pages patients must be warned about the voluminous misinformation available on medical subjects on the Net McClung, HJ, Murray, RD, and Heitlinger, LA. (1998). The internet as a source of current patient information. Pediatrics. 101(6): http://www.pediatrics.org/cgi/reprint/101/6/e2.pdf http://www.pediatrics.org/cgi/reprint/101/6/e2.pdf
ARA Therapy and WWW WWW resources, structured behavior components, weekly contact, individualized therapist feedback delivered via e-mail (best) WWW resources alone (produced results) Conclusions: Internet appears to be a viable method for delivery of structured program Tate, DF, Wing, RR and Winett, RA. (2001) Using internet technology to deliver a behavioral weight loss program. JAMA. 285(9):1172-1177.
ARA WWW and ESG New mode of communication that will play vital role for nurses Site helps users learn about their disease and become active in their own management Site provides nurses with a means to teach patients in a supportive environment Site serves as patient advocate Potential to contribute to the development of a new nursing knowledge base in the form of nursing informatics Bliss, J, Allibone, C, Bontempo, B, Flynn, T and Valvono. NE. Creating a Web site for on-line social support melanocyte. Computers in Nursing. 16(4):203-207.
ARA WWW for Med Information 924 gastroenterology patients surveyed 50% reported access to Web 51% of those with access had searched the web for medical information 60% of surveyed intended to use web for searching medical information 4% (35) had ever been referred to the Web by their physician O’Connor, JB and Johanson, JF. (2000). Use of the web for medical information by gastroenterology clinic population. JAMA.284:1962-1964.
ARA Web and Consumer Voice Compared professional, commercial and consumer generated Web sites 53 different treatment types were mentioned Antidepressant medication and psychotherapy were noted by almost all sites Consumer sites mentioned psychological therapies less frequently Consumer sites provide a voice to inform psychiatrists and GPs about preferred treatments and side effects Christensen, H, Griffiths, KM and Medway J. (2000). Sites for depression on the web: a comparison of consumer, professional and commercial sites. Aust N Z J Public Health. 24(4):396-400.
ARA JIT, Web, and Healthcare Provided educational information via the Web to reduce postoperative pain following surgery Patients who had access to the pain management information on the Web site reported significantly less postoperative on arrival to their home after surgery Concluded that using the Internet to provide just in time patient education can significantly effect the clinical outcome of care Goldsmith, DM and Safran, C. (1999). Using the web to reduce postoperative pain following ambulatory surgery. Proc AMIA Symp:780- 784.
ARA Web Based AR John Tracy Clinic (online correspondence)John Tracy Clinic hear-it.org – (youth, medical, adult, political versions- IFHOH)hear-it.org HearingAidHelp.com (Hearing Planet)HearingAidHelp.com www.hearing411.com (Siemens)www.hearing411.com
ARA Guidelines for AMA Web Sites Principles for content Principles for advertising and sponsorship Principles for privacy and confidentiality Principles for e-commerce Winker, MA, et al. (2000) Guidelines for medical and health information sites on the internet: principles governing AMA web sites. JAMA. 283(12):1600-1606).
ARA Conclusion Online healthcare is having a growing cultural impact Effecting the image of the practitioner-patient relationship Consumers are bringing new strategies into their acquisition of health information and care Professions are attempting to establish norms for “proper use” of the Internet for consumers Healthcare communities should establish approaches that empower consumers to use Internet as part of healthcare (AR) strategy Statuses of professionals may be bolstered as they develop ways to empower and support consumers use of the Internet Oravec, JA. (2001). On the “proper use” of the internet: self-help medical information and on-line health care. J Health Soc Policy. 14(1):37-60.