Internet and Medicine: 10 years after From the network's perspective Marc Nyssen Medical Informatics dept. Vrije Universiteit Brussel Belgium

Internet and Medicine: 10 years after From the network's perspective Technology Institutes Medical profession Schools/universities Where do we come from? - trends Patients Conclusions

Internet and Medicine: 10 years after From the network's perspective What is the network 's perspective? health sector consist of computers connected to me hospital computers activate medical staff to produce data general practitioners are prompted to produce messages with patient data Pharmacists spend their spare time discussing with representatives I produce a lot of administrative messages to keep Ministries and medical insurance institutions busy distance education, Ehealth research and E-med-commerce

Technology 10 years ago: first web browsers (mosaic,...) Internet bad reputation Ad-hoc dial-up network services most widely spread and used service Little or no encryption

Technology Now: large connectivity fraction Internet Permanent connectivity not far away Wireless: wap, bluetooth, IEEE a/b, gprsUMTS most widely spread and used service Little or no encryption

Technology 10 years ago: first web browsers (mosaic,...) No tables No frames No javascript No Java...

Technology From static to dynamic web pages Database driven web servers Java Public key encryption XML ssh/sftp replacing telnet/ftp sender authentification required! (smtp)

Institutes Authoritative centers Karolinska Institute NIH DG Information Society Unit C4: eHealth Medline (pubmed, medlineplus) Several others

Institutes Karolinska Institute Institut Pasteur

Institutes DG Information Society Unit C4: eHealth

Institutes Medlineplus

Institutes Pubmed

Portal sites Medical portals After the Internet bubble... just a few examples Medscape Medwebplus Medical Martix Promedmail

Portal sites Medscape

Portal sites Medwebplus

Portal sites Medical matrix

Portal sites Promedmail (Jack Goodall)

Portal sites EHTO

Societies

Conferences

Publications Journals IEEE TITB (2003-) Electronic Healthcare (2001-)

Publications Journals

Publications On-line

Publications pubmed searches on “Internet AND medicine”

Ethics HON (Healtcare On the Net) Internet Healtcare Coalition

Ethics HON code of ethics Authority, complementarity, confidentiality, attribution, justifiability, transparancy of authorship, transparancy of sponsorship, honesty inadvertising Ehealth Code of Ethics Candor, honesty, quality, informed consent, privacy, professionalism, responsible partnering, accountability

Medical profession General Practitionner Hospitals Specialists Para-medics From “cards” to servers Large nationwide projects

Medical profession General Practitionner Electronic health record Medication databases Communication of lab results Communication with GP's (group practice/guard) Communication with hospitals Communication with specialists

Medical profession Hospitals patient “administration” communication with health insurance bodies technology oriented departments local network(s) communication with referring GP's communication with patients??? teamwork: who can access what?

Medical profession Specialists Very different needs Common: “patient administration” Financial administration + reporting Mini-clinics and group practices

Medical profession Para-medics, health workers “at large” Tele-follow-up of patients Access to at least part of medical record Nursing record Physical therapist's record

Medical profession From “cards” to servers? Social security card (national, European) Diabetes card Minimal health record -> summary health record Big brother : example in Spain Centralized vs. distributed health records

Medical profession Nationwide projects (amongst many others) Denmark: electronic prescription Belgium: “kruispuntbank sociale zekerheid” Electronic passport Telematics commission – labeling of her UK: masterplan for NHS

Medical profession Nationwide projects (amongst many others) Hygeia Crete

Medical profession Nationwide projects (amongst many others) Keneya Blown (vestibule de la santė) Mali

Schools/universities E-learning Computer literacy E-health programs Master after master “management of health data” Need for an European master program in eHealth?

Standards bodies Internet Society (IETF) WWW Consortium CEN HL7 IEEE

Where do we come from? Where do we go to? Trends... Basic connectivity New protocols? New models? Client-server Peer-to-peer Distributed systems Huge parallelism (grid?)

Patients/public Finally widely available to the public at large Remote diagnosis New medication announcements Distance pharmacy Distance education/certification Accurate medical information and councelling

Patients/public Useful health tricks

Patients/public Distance pharmacy

Patients/public New medication:

Patients/public Distance education/certification: effortless diploma

Patients/public Finally widely available to the public at large missing: “super portal” combining all of these!

Patients/public Informative sites: patients are most concerned!

Conclusions Medical Internet applications become established Most required technologies are available Diversity of medical systems Quality labels and interoperability Privacy Few completely new ideas Complex application “standards” Missing level between research and deployment Political drive exists but for the right motives?

References Resource Book of IST Projects relating to Health (September 2002 Edition), Directorate B, Unit B1, European Commission, Information Society Directorate General E-Health in Belgium and in the Netherlands, Proceedings of MIC2002, Roger France, Hasman, De Clercq, De Moor eds., IOS Press, ISBN Information and Communication Technologies and Poverty Reduction in Sub Saharan Africa, Richard Gerster, Sonja Zimmermann, Gerster Consulting, October 2003 Yearbook of Medical Informatics 2003, IMIA & Schattauer GmbH, ISBN X Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions, Eysenbach G, Powell J, Englesakis M, Rizo C, Stern A. BMJ May 15;328 Ethical challenges of medicine and health on the Internet: a review, Dyer KA., J Med Internet Res Apr-Jun;3(2)